Abstract
The first two editions of this text were written by Jeffrey Cummings together with D. Frank Benson and were extremely influential. I well remember the excitement with which Cummings' first visit to Australia in 1995 was anticipated by those who had read either edition of this work. Although excellent texts on both the psychiatry of later life and organic psychiatry had been published earlier, the 1983 first edition of Dementia: a clinical approach was the first quality text to deal solely with this increasingly important disorder which was starting to be a major focus of medical practice in developed countries around the world. Its clear, coherent, practical, humane, historically informed approach won many converts and contributed to the rapid improvement in knowledge about, and care of, people with dementia which has occurred over the last three decades.
Unfortunately Benson died in 1996, but Cummings has been fortunate in persuading another professor of neurology, his Los Angeles colleague Mario Mendez, to collaborate on the third edition, which has been completely recast since 1992. What you get for your money is 14 colour plates and 16 chapters which address the significance, definition and epidemiology of dementia, mental status assessment, diagnosis, 10 different types or groups of dementias (from Alzheimer's disease to miscellaneous dementia syndromes), pharmacotherapy, non-pharmacologic management and some conclusions and speculations about future directions in research and treatment. Most chapters are copiously referenced, but the book always retains a strong clinical focus and one never feels as though one is wading through a tediously written review of all the literature ever published on a particular topic. The authors are not shy about giving their opinions and advice on how to deal with particular problems presented by patients and I found this refreshing and helpful even when (occasionally) I disagreed with a particular recommendation (e.g. the routine prescription of high dose vitamin E to people with Alzheimer's disease). The early chapters are particularly good. Most psychiatrists would benefit from perusing the list of 10 myths about the diagnosis of dementia published on pp.5,6 and trainees in psychiatry ought to read and digest the chapter on assessment very thoroughly indeed. The approach of dealing with the different types of dementia more or less separately in the core chapters is probably the only way one can tackle the organization of a book of this type, but the authors do not lose sight of the huge overlap in causative pathologies often found in individuals with the dementia syndrome.
Although I very much enjoyed reading Dementia: a clinical approach, there are some aspects which could be improved in a future fourth edition. The chapter on pharmacotherapy has a tendency to give fairly dogmatic advice which, while reflecting the current consensus of USA clinical practice, is less inclined to adduce specific evidence for its advocacy of certain treatment strategies than it might be. The chapter on non-pharmacologic therapies is a bit disappointing with less than 35 references and a very restricted discussion of the specifics of how the very common behavioural and psychological symptoms of dementia actually should be managed. Last, I think that carer issues are important enough to demand a separate chapter all on their own.
Despite my relatively mild disappointment with a few aspects of this volume, it remains a key text for the clinician who wishes to understand and treat people with dementia. Trainees in psychiatry ought to read this book, psychiatrists who specialize in the care of older patients will need to buy a copy and every memory clinic and aged care assessment team in Australia and New Zealand should have ready access to Dementia: a clinical approach.