Abstract
What can be said when there is a 4-year delay between a conference and the publication of its proceedings? Perhaps if the intended readership is not too discerning, then the lapse in timeliness may go unnoticed.
Alternatively, the field of research may be moving at a rather slow pace. Clearly, neither applies in this instance where eminent psychiatrists, neurologists, and neuroscientists have pooled resources to make impressive advances in our understanding of the ‘primary’ dementias, particularly Alzheimer's disease. What may save this book, however, is the quality of some of the reviews and the proud heritage of its predecessors: this is the 74th publication of the Association for Research in Nervous and Mental Disease.
The subjects cover the traditional areas of dementia research, beginning with epidemiology and genetics, and ending with imaging, diagnostics and therapy. Interestingly, there are chapters on genetic counselling, ethics and health economics. The main types of ‘primary’ dementia covered are Alzheimer's disease, transmissible spongiform encephalopathy (prion disease), vascular dementia, head trauma and dementia pugilistica (the latter few bringing into focus the inadequacy of the term ‘primary’).
Most of the contributors are well-known experts in their respective fields. Alzheimer's disease genetics (Schellenberg) and amyloid pathways (Selkoe, Gandy) suffer from the 4-year interval, as these subjects have been at the forefront of research efforts. Prion diseases are given a prusinerian perspective (DeArmond). The difficult areas of vascular dementia deserve more detailed coverage, as there are many loose concepts and poorly understood principles awaiting elaboration. The controversial areas relating head trauma to subsequent neurodegeneration (Parkinsonism and Alzheimer's disease) also would have benefited from a more critical appraisal.
Within the past 3 years, several new cholinergic therapies have emerged into the market place, and unfortunately these have not been able to be included. There is a very useful review of psychotropic agents in the management of dementia (Raskind). The chapters on genetic counselling (Folstein) and ethics (Murray) are good starting points: the former is now of pressing practical significance with the emergence of both causative genes and associative genetic risk factors for Alzheimer's disease, prion disease, and some of the frontotemporal dementias.
Finally, the economics of dementia (Binstock) are given an overview, albeit from the US perspective of failed Health Care Reform.
Overall, the book suffers badly from the 4-year gap. As a testament to the advances in dementia research from 1985 to 1994, it serves a worthwhile purpose. There are an ever increasing number of multi-author books which deal with this rapidly evolving field with a greater sense of immediacy.
It is difficult to see how this one could compete.