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Book Forum: Geriatric Psychiatry   |    
Early-Onset Dementia: A Multidisciplinary Approach
CONSTANTINE G. LYKETSOS, M.D., M.H.S.
Am J Psychiatry 2003;160:195-195. doi:10.1176/appi.ajp.160.1.195
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Edited by John R. Hodges. New York, Oxford University Press, 2001, 478 pp., $115.00.

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This edited book attempts to fill a void by providing a complete volume targeted primarily at clinicians on the dementias with early life onset. The volume is the brainchild of Dr. Hodges, who runs a clinic for patients with these conditions and who discovered the absence of any literature specifically for dementias of early onset. The term "early onset" was appropriately chosen over the term "presenile" to avoid having to define an age cutoff. The editor believes that there are several differences between dementias with early or late onset in differential diagnosis, medical care, and social issues. One aim of the book is to highlight and discuss these differences.

Early-Onset Dementia contains 20 chapters written by highly esteemed and accomplished experts in a wide range of clinical, basic, and other areas. There are detailed chapters from several applicable disciplines on epidemiology, clinical assessment, neuropsychological assessment, neuropsychiatric assessment, brain imaging, molecular pathology, neuropathology, and neurochemical pathology. In addition there are chapters dedicated to the major disorders that cause dementia, including Alzheimer’s, Huntington’s, and Pick’s diseases; dementia with Lewy bodies; vascular dementia; the prion dementias; and inflammatory/infective brain diseases causing dementia. There are also a few special chapters on dementia in young adults and on practical or pharmacological management.

Overall the volume is well written, clearly organized, and appropriately referenced. There is rich use of pictorial information, including images, figures, and graphs, all of which substantially enhance the presentation of the material. One exception is the chapter by Berrios and Markova, "Psychiatric Disorders Mimicking Dementia," which is rather theoretical and confusing and seems to be more a nosological treatise than the anticipated practical clinical narrative. The chapters "Epidemiology of Pre-Senile Dementia," by Harvey, and "Dementia in Young Adults," by Panegyres, are particularly good. In fact, these two chapters are most relevant to the topic of early-onset dementia and the most interesting from this point of view as well. Of note, however, a statement made by Panegyres is from my point of view problematic if not incorrect. Panegyres asserts that the care of patients with dementia requires a multidisciplinary team, including the usual range of clinical professionals, which should be led by a neurologist. In fact, dementia specialists in psychiatry, geriatric medicine, and neurology are equally qualified to lead specialized dementia teams, as experience across the world has shown. To limit such leadership to neurologists would not only go against what has evolved in practice but would also place leadership in the hands of physicians with the least experience or tradition in leading multidisciplinary teams.

This book is rather specialized and would be of greatest interest to psychiatric subspecialists in geriatric psychiatry, neuropsychiatry, or consultation-liaison psychiatry (psychosomatic medicine). General psychiatrists who practice in nursing homes, in assisted living facilities, or in close collaboration with neurologists would also benefit from the book. It might be of value to colleagues in training in these fields as well.

One issue must be pointed out in closing. Although this is a good book for the most part, there is little here not to be found in one of the many available standard textbooks on dementia or one of the numerous review papers published annually. The main advantages of this book are that it is the most recent in the area and that it has broad textbook-like coverage of the material in ways that make it useful to clinicians seeing patients with early-onset dementia. However, the book has failed in its apparent effort to be specific to early-onset dementia. Almost all the chapters pay homage to the early-onset aspect of the topic in passing but are indeed rather standard chapters on topics relevant to dementia in general.

The concept of early-onset dementia is itself problematic, and the book fails to make a strong case for it. As reading this volume clearly shows, there is at present very little that is different between early-onset and late-onset dementia. In fact, those of us who run dementia clinics often deal with younger patients with dementia. In my view, clinical care is not much different once issues of differential diagnosis (i.e., what is the cause?) and social issues (e.g., is the patient still working? does the patient have young children?) are accounted for. The background information relevant to clinical care is also largely the same. In fact, even with Alzheimer’s disease, the cause of dementia in about two-thirds of older people but only about 25% of younger people, the phenotypes of the young and the old differ little. The case for special books and special clinics for younger people with dementia has yet to be made persuasively. Early-Onset Dementia may well be ahead of its time in this regard.

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