Brain, Vol. 124, No. 3, 638-639,
March 2001
© 2001 Oxford University Press
Book reviews |
ALZHEIMER'S DISEASE AND RELATED DISORDERS ANNUAL.
By Serge Gauthier and Jeffrey L. Cummings. 2000. London: Martin Dunitz. Price £39.95. Pp. 272. ISBN 1-85317-909-4.
Department of Clinical Neurological Sciences, The University of Western Ontario, Ontario, Canada
Progress in the area of Alzheimer's disease and related disorders has achieved such a pace that it justifies a yearbook. While one may expect a discussion of the main publications of the preceding year, this volume actually consists of reviews of `topics of the year' in the realms of pathology, dementia, diagnosis, natural history and treatment. The subject matter includes genetics of Alzheimer's disease and frontotemporal dementia; dementia with Lewy bodies; parkinsonism with dementia; subcortical vascular dementia; minimal cognitive impairment; functional and neuropsychiatric manifestation of dementia and cholinesterase inhibitors; and hormonal and anti-inflammatory therapy of Alzheimer's disease.
Peter St George Hyslop emphasizes that, as we begin to unravel the genetic components of dementia, complexities arise. It is by now clear that in the majority of Alzheimer cases, familial aggregation of Alzheimer's disease reflects a complex mode of transmission such as one or more common independent, but incompletely penetrant, single autosomal gene defects; a multi-genetic trait; or a mode of transmission wherein genetic and environmental factors interact. In ~10% of cases, Alzheimer's disease is transmitted as an autosomal-dominant trait with age-dependence but high penetrance, which has allowed the discovery of the four genes so far associated with inherited susceptibility to Alzheimer's disease. Hyslop predicts that additional Alzheimer's disease susceptibility genes will be discovered and warns against genetic screening for Alzheimer's disease, except in special circumstances.
The genetics of frontotemporal dementias are no more clear than those of Alzheimer's disease. Mann and colleagues' statement that `genetic advancement also holds the prospect of future treatment' is indisputable, but the identification of a gene and the development of therapy based upon that knowledge may be further away than we may wish. Identification of genes for muscular dystrophy has not yet yielded any treatment, and muscle is a much simpler tissue than brain.
The chapters on dementia with Lewy body disease and parkinsonism with dementia illustrate the fact that patients are beginning to escape the diagnostic cells that we have made for them. Ian McKeith points out that Alzheimer-type and vascular pathological changes often co-exist in Lewy body disease and calls for collaboration between dementia and movement disorder specialists. Irene Litvan makes it clear that a number of tauopathies such as progressive supranuclear palsy, corticobasal degeneration, Pick's disease and Alzheimer's disease can present with parkinsonism and dementia.
Erkinjuntti and Pantoni argue that subcortical dementia arising from lacunar and white matter lesions is the prototypical vascular dementia. They think that this allows a more homogeneous and representative group to be identified. They also propose clinical and brain imaging criteria for subcortical vascular dementia. The main shortcoming of their criteria is that they are postulated rather than proven. This reflects a general problem in the field of `vascular dementia': investigators try to be more precise than our knowledge allows. We may have to begin much more empirically and recognize that it matters not only what, but how and where lesions occur, and in whose brain. `Vascular dementia' (an obsolete term) probably occurs most commonly in brains with Alzheimer's disease or other pathological changes.
Minimal cognitive impairment, discussed by Florence Pasquier, is beginning to get the attention that it deserves, not only because it is twice as common as frank dementia, but also because treatment and prevention may be most effective at an early stage.
Hartmut Lehfred and Hellmut Erzigkeit offer a timely chapter on functional aspects of dementia and Yuri Bronstein and Jeffrey Cummings discuss the often troublesome, neuropsychiatric manifestations of dementia. Gauthier reviews the cholinesterase inhibitors and concludes that symptomatic therapy has been established by randomized clinical trials for periods of 6–12 months but, beyond this time, a slowing of decline is a more realistic goal. Victor Henderson and Bruce Miller conclude that, although various steroid hormones hold theoretical promise for Alzheimer's disease, the data do not justify their use. The book concludes with a thoughtful and well-balanced contribution by Paul Aisen on anti-inflammatory therapy for Alzheimer's disease, probably the single most promising category of treatment.
The book fairly reflects the state of the art in Alzheimer's disease and related disorders. By and large the chapters are well written by individuals with credibility in their respective fields. As such, the book can be recommended to all those dealing with dementia. A concern arises with future annuals; will there be enough new data in one year to justify covering the same topics, or will the next yearbook cover new topics? Whichever the answer may be, we look forward to the next volume.
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