The nature and nurture of dementia

Abstract

Dementia is a growing problem, estimated to affect 24·3 million individuals worldwide, with 4·6 million new cases every year. Furthermore, many elderly individuals have other memory deficits and problems in cognitive functioning, and the cost of caring for these patients is high. There is a need for a systematic approach towards the effects of dementia and the practical problems of managing this disorder. In Dementia in Clinical Practice, Giannakopoulos and Hof have compiled a practical and updated review of the main topics of dementia. This multi-authored textbook is subdivided into four sections—Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia. There is also discussion of mild cognitive impairment. In the section on Alzheimer's disease, the first chapter addresses clinical investigations in primary care, summarising clinical characteristics and progression of deficits, diagnostic criteria with neuropsychological assessment, laboratory studies and neuroimaging, and differential diagnosis. The next chapter presents the relevance and limitations in clinical practice of the concept of mild cognitive impairment. This chapter, although brief, deals with the main concerns of memory or cognitive age-related problems. Pathological substrates of cognitive decline in Alzheimer's disease are next discussed, followed by a review of functional imaging, electrophysiological markers, and future perspectives on imaging exploration in dementia and mild cognitive impairment. Hopes and expectations of pharmacological interventions in primary care are appropriately dealt with in the final chapter of this section, with valuable and updated summary tables and practical recommendations boxes provided. Primary-care physicians and students could find this chapter very useful because of the practical presentation, with drug indications, main side-effects, and future directions provided in tables. The other sections follow a similar structure for the other disorders covered in this book. The role of the primary-care physician in screening for vascular dementia and cognitive impairment is discussed in the first chapter of vascular dementia, with a good review of risk factors provided. The concept on vascular cognitive impairment, the neuropathological background in relation to the MRI findings of vascular and mixed dementia, and the treatment approaches in vascular dementia are next addressed. Clinical diagnosis, clinical validity of neuroimaging, therapeutic approaches, and an interesting discussion on the associations and importance of brain lesions in Parkinson's disease and Lewy body dementia are all provided in this section. In the last four chapters of the book, clinical diagnosis, neuropathology, neuroimaging, and therapeutic interventions for frontotemporal dementia are dealt with. The importance of frontotemporal degeneration as a cause of dementia is emphasised, as is the role of neuroimaging and the molecular therapies that are beginning to emerge. Undoubtedly, Dementia in Clinical Practice will be interesting to the medical specialties that deal with dementia, as well as researchers and students interested in this area, because it provides good background information on both the clinical and basic science aspects. The alternation of chapters on the practical and clinical aspects and neuroimaging findings with chapters on basic science also makes the book a pleasure to read. For a future edition, inclusion of the socioeconomic effect of dementia, with a cost-effectiveness analysis of the main drugs and non-pharmacological approaches for dementia care, would further improve this high-quality book.