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Progress in Alzheimer's Disease and Similar Conditions
Catherine L. Woodman, M.D.
Am J Psychiatry 1998;155:1129-1129.
View Author and Article Information
Iowa City, Iowa

edited by Leonard L. Heston, M.D. Washington, D.C., American Psychiatric Press, 1997, 289 pp., $47.50.

Book Forum

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This book aims broadly to update health care professionals on brain disease in general and Alzheimer's disease in particular. The goal is ambitious—staying up-to-date in the rapidly changing fields of molecular genetics and brain imaging is challenging even for those whose research is affected by these findings. The editor has met his goals in this notably worthy volume.

The book has chapters that thoroughly cover aspects of Alzheimer's disease interspersed with chapters that address neurological mechanisms of disease. In his introduction, Dr. Heston outlines the concept of providing models of disease process that can then be applied more broadly. The bulk of the chapters focus specifically on Alzheimer's disease, the best-known of the more common brain diseases. These chapters cover the disease from the molecular level to patients and those around them. The current data related to epidemiology, pathophysiology, psychopharmacology, and pathology of Alzheimer's disease are thoroughly covered. The language is crisp, clear, and understandable, and the chapters are extensively referenced.

Alzheimer's disease is presented as a model for diseases with heterogeneous causality, having both genetic and environmental contributions to illness expression. Major molecular strategies have been used to study Alzheimer's disease, including linkage and candidate gene strategies. These studies have defined DNA mutations directly associated with Alzheimer's disease as well as located regions of DNA that have additional mutations. The chapters that describe these mutations offer important insights for the study of other brain diseases. Heterogenicity is likely to be the rule rather than the exception for psychopathology. The chapters dealing with these subjects are well written, easy to follow, and yet reasonably thorough. The book strikes a nice balance between conciseness and detail that is difficult to achieve and rarely seen.

Two chapters in the volume (chapters 5 and 7) describe unique mechanisms of disease illustrating the advances in molecular genetics that have occurred over the past decade. Dr. Prusiner's chapter on prion biology begins by describing the state of the art in prion-associated disease and then walks the reader step-by-step through the experimental evidence that has been amassed to explain disease causality and transmission. Dr. Orr and Dr. Zoghbi's chapter describes unstable triple-repeat bases in DNA and the consequent neurological diseases that are known to be caused by repeated triplets of CAG. They then propose a model of pathogenesis for diseases where there is evidence for genetic anticipation.

In addition to the well-written chapters examining the cellular and molecular aspects of Alzheimer's disease are three chapters with a macro-orientation. One is a firsthand account of coping with a spouse with familial Alzheimer's disease. This chapter is moving yet not heavy-handed and alerts the clinician to aspects of this chronic disease and its impact on families that are best told by those who are affected. The chapter on caregiver stress and strategies to combat it and the chapter about a community-based training program to identify isolated at-risk elderly individuals who live in the community but lack support services to obtain needed resources or placement describe concrete ways to intervene for patients who are currently ill with Alzheimer's disease.

Finally, chapter 11, written by the editor, concisely summarizes the state of the art for brain diseases and then proposes principles to provide guidance for future efforts and research. This chapter synthesizes the widely varied aspects of the book in a concise and thought-provoking manner. Progress in Alzheimer's Disease and Similar Conditions is highly recommended.




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