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Book Reviews   |    
Agitation in Patients With Dementia: A Practical Guide to Diagnosis and Management
Reviewed by Allan A. Anderson, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.9.1074
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edited by Donald P. Hay, M.D., David T. Klein, Psy.D., Linda K. Hay, R.N., Ph.D., George T. Grossberg, M.D., and John S. Kennedy, M.D., F.R.C.P.C.; Washington, D.C., American Psychiatric Publishing, Inc., 2003, 272 pages, $47 softcover

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This is a book that will serve as a useful reference for the general psychiatrist who treats patients with dementia and who desires a text that summarizes this topic of identifying and managing agitation syndromes among patients with dementia. Psychiatrists who attend to nursing homes and other long-term facilities or who have an active inpatient consultation service will find this book helpful.

Agitation in Patients With Dementia: A Practical Guide to Diagnosis and Management has an impressive list of contributors. The list includes many national and international leaders in the field of geriatric psychiatry. Early chapters define the problem of agitation, review the epidemiology and neurochemistry of agitation in dementia, and review the use of assessment scales. These chapters are followed by a number of chapters that focus on specific treatment modalities.

Many geriatric psychiatrists reading this text would be familiar with most of the findings presented, because they do mirror current practice in this area. Most chapters are up to date in their review of the current treatments available. At the time of publication about the only pharmacotherapy not available for use in dementia was memantine. The book includes two well-written chapters on psychotherapy and behavioral treatments for agitation in dementia. A separate chapter delineates the use of electroconvulsive therapy among agitated patients with dementia.

A majority of this text includes chapters that specifically identify the various treatment modalities for agitation in dementia. These include chapters on the use of antidepressants, antipsychotics, and mood stabilizers. One chapter is devoted to the topic of lesser-used pharmacotherapies. However, the book includes very little information on the use of acetylcholinesterase inhibitors, which, although marketed for cognitive improvement, have demonstrated benefit in behavioral symptoms. There are a few interesting chapters on alternative therapies, including one on the use of bright-light therapy and another on hormonal treatments. The final chapter briefly reviews legal and ethical issues. All the chapters are organized and well written in an easy to read format.

A major enhancement would have been the inclusion of a summary chapter delineating a selection process for choosing among the various treatments. Although writing such a chapter would prove a bit daunting, the benefit would include a better synthesis of available treatment options brought into focus in a practical format. This could have included some form of an algorithm that would be an aid in identification and appropriate treatment of agitation.

Overall, Agitation in Patients With Dementia provides a fine summary of the problem and its various treatment options. One final comment concerns the book's dedication. The contributors dedicated the book to Linda Hay, Ph.D., the late wife of Dr. Donald Hay, one of the book's editors. According to the dedication, the work summarized in this text was work that Linda pioneered for years. It therefore is a very fitting dedication to her.

Dr. Anderson is medical director and director of geriatric psychiatry at Shore Behavioral Health Services in Cambridge, Maryland.

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