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Book Forum: Clinical Practice   |    
Dementia, 2nd ed.
Am J Psychiatry 2003;160:1532-a-1533. doi:10.1176/appi.ajp.160.8.1532-a
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Detroit, Mich.

Edited by John O’Brien, D.M., M.R.C.Psych., David Ames, B.A., M.D., F.R.C.Psych., F.R.A.N.C.P., and Alistair Burns, M.D., F.R.C.P., F.R.C.Psych. New York, Oxford University Press, and London, Arnold (Hodder Headline Group), 2000, 940 pp., $198.50.

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If you are old enough to remember when Alzheimer’s disease was a relatively rare disorder and can recall memorizing the difference between senile dementia and arteriosclerotic dementia for board examinations, your age puts you at risk for the subject of this excellent book. On the other hand, you are also old enough to recall simpler nosological ages, when all that was known about dementia could fit in a chapter. This book is clearly the current magnum opus on the disorder likely to reach epidemic proportions in the 21st century in the West unless more effective treatments or preventions are found.

The 1990s saw the publication of a number of books on dementia, including the first edition of this book. Given the information explosion at the end of the 20th century, most of these will need to go into second editions as this one has. Published concurrently in London and New York, it is largely written by experts from the United Kingdom, Australia, and New Zealand, although there are contributions from the rest of the world (including some from the United States), making it an international endeavor. The use of "whilst" instead of "while" in numerous places, the use of "carers" for what in the United States are called "caregivers," and the use of "old age psychiatry" in professorial titles instead of "geropsychiatry" or "geriatric psychiatry" signal its British English origins. It seems as if Americans have become fonder of Greek word origins and the United Kingdom goes with plain English.

The book is divided into seven parts: Dementia: General Aspects, Alzheimer’s Disease, Vascular Dementia, Dementia With Lewy Bodies, Focal Dementias, Dementia With Neuropsychiatric Disorders, and Other Dementias. The chapters are all succinct yet thorough and very well referenced. The section on the general aspects of dementia makes up more than one-third of the book, covering diagnosis and assessment as well as investigations that include all the imaging techniques. Neuropsychiatric aspects of dementia are covered in chapter 6, a useful summary for the psychiatrist. This section also covers the management of dementia thoroughly, including an emphasis on the importance of environment in managing those with dementia (chapter 17). Chapters of particular interest to psychiatrists in this section are those on services for dementia in several parts of the world, including the United States.

The section on Alzheimer’s disease is the next longest in the book and is again very thorough. The entire biopsychosocial spectrum is well covered. Chapter 32, "The Epidemiology of Alzheimer’s Disease," is of particular interest, comparing data between developed and developing countries.

The following sections are briefer. Section 6, Dementia With Neuropsychiatric Disorders, will be of particular interest to general psychiatrists. Depression, alcoholism, and schizophrenia are covered in separate chapters. Discussion of the concept of pseudodementia in the chapter on depression is particularly useful.

This is a very comprehensive textbook of enormous value to all who deal with dementias. I have no reservations about the book whatsoever. However, the reader will find a plethora of information that is, at least for now, of heuristic merit without much in the way of active intervention. There is an epilogue by Elaine Murphy, M.D., Ph.D., F.R.C.Psych., which could have served as an excellent book review on its own. Having read this entire book in 1 week, she concludes that although there has been an explosion of knowledge and some reason for optimism, major advances still seem "just over the next mountain range." Chapter 4, "Assessment and Differential Diagnosis of Dementia," which essentially presents the workup a psychiatrist would do, does not differ substantially from what I learned in residency 40 years ago. What has changed is the therapeutic nihilism that used to be abroad. This book provides the reasons for optimism that eventually we will better understand the neurophysiology and pathophysiology of dementia.




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