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Book Reviews

Posted in Book Reviews on 12th Mar 2013

Physical Comorbidities of Dementia

book-Dementia

Editors:  Kurrle S, Brodaty H, Hogarth R

Published by: Cambridge University Press, 2012

Price: £27.99

ISBN: 9781107648265

Reviewed by:  AJ Larner, Cognitive Function Clinic, WCNN, Liverpool, UK.

Canonical definitions of dementia, like that enshrined in the Diagnostic and statistical manual of mental disorders (DSM-IV-TR, 2000), acknowledge that the dementia syndrome may be associated inter alia with such features as functional decline, falls, sleep disturbance, and epileptic seizures, as well as the cognitive decline. These physical comorbidities of dementia have perhaps attracted less research attention than the cognitive aspects, because they are not sine qua non in diagnosis. However, they are of disproportionate practical significance since they, rather than cognitive decline per se, may determine the need for nursing home placement and, for both patients are carers, may constitute the most distressing aspects of living with dementia.

The book takes the form of a systematic literature review of selected physical comorbidities of dementia, covering the period 1990-2011 and retrieving over 2500 references.  The authors summarise their findings in chapters devoted to falls, delirium, epilepsy, weight loss and nutritional disorders, incontinence, sleep disturbance, visual dysfunction, oral disease, and frailty.  Each chapter describes, where known, epidemiology,  aetiology, assessment and management, and culminates in recommendations, two brief case studies, and key points.

Although much of the material may be familiar to clinicians who see patients with dementia, the review is welcome, and there is always something new to learn (I was entirely ignorant of the links between oral disease and dementia). The use of the generic descriptor ‘dementia’ rather than specific dementia subtypes probably reflects the historic (and current) lack of sophistication of studies in the literature.  Where differences are known (e.g. sleep disorders in DLB, continence issues in FTD) these are covered.  The recommendations in each chapter make this a practical resource for patient management, rather than simply an arid literature review, although in some spheres (e.g. epilepsy) the evidence base for intervention is limited or non-existent. It may be hoped that some of the areas of uncertainty will be addressed by the time of the next edition.


Imaging in Parkinson’s Disease

book-Imaging-in-Parkinsons

Editor:  David Eidelberg

Published by: Oxford University Press

Price: £70

ISBN: 978 0 19 53948 4

Reviewed by:  Sundus Alusi, Consultant Neurologist, Liverpool, UK.

This book is a comprehensive and balanced review of the advanced imaging techniques in Parkinson’s disease. It addresses important aspects in this field, including the science behind the imaging tools, their potential usefulness for diagnosis as well as advantages and shortcomings of emerging imaging techniques in everyday clinical practice.

The book is intended for neurologists in the field of movement disorders, neuro-radiologists and basic neuroscience researches. It is clear, and takes the reader step-by-step.

The first couple of chapters address the role of dopaminergic imaging, PET and SPECT, in clarifying the pathophysiology of Parkinson’s disease, particularly presynaptic nigrostriatal dysfunction. The third chapter, however, looks at the study of glucose metabolism and brain blood flow in the improving our understanding of the neuronal circuitry of Parkinson’s Disease pathophysiology.  The fourth chapter explores the imaging of structural abnormalities, whilst the fifth outlines the limitations of transcranial sonography in Parkinsonian disorders.

Imaging to investigate specific problems in Parkinson’s disease is covered in a series of dedicated chapters: tremor, motor deficits, cognitive dysfunction are studied in Chapters 7,8, 9 and 10.

In terms of more fundamental neuroscience, theories of aetiology receive attention, in particular inflammation and activation of microglia in Chapter 11. The biomarkers of disease progression, the effects of treatment, medical and surgical, and complications of therapy are elegantly described in chapters 12, 13, 15 and 14 respectively.  Last but not least, potential applications in research and clinical trials, are discussed in the final chapters.

The book as a whole or its component parts, depending on the reader’s interest, may be recommended for general reading. It contains invaluable citation lists and high quality illustrations, to make it a good source of reference. Its description of numerous hypotheses may well stimulate, or inspire, the research readership. Its price, £70, is as handsome as its illustrations.