Book Review
Geriatric Psychiatry 
Dementia. Mario Maj, Norman Sartorius, editors. Chichester (UK): John Wiley & Sons, Ltd; 2000. 392 p. US$95.00.
Reviewer
rating*: Good
Review by: Andrew Wiens, MD
Ottawa, Ontario
This book is part of a series edited by Dr Maj and Dr Sartorius and sponsored by the World Psychiatric Association. It is well laid out and contains few production errors (none that are noticeable). As are many medical texts, it is quite expensive, and for this reason, I would find it difficult to justify its price for most individuals. Its back cover invites readers to “be guided by the evidence,” stating that the book contains “urgently needed” reviews of current research and clinical practice and that it will be invaluable for a whole range of health professionals, as well as for managers and policy-makers. The editors suggest that the less lofty and more realistic goal is to “bridge the gap between research evidence and clinical practice.”
The main editors are not considered experts in dementia. The contributors to this volume, on the other hand, are well known to those in the dementia field. The book contains 6 main reviews that cover 6 areas: 1) definition and epidemiology of dementia, 2) clinical diagnosis of dementia, 3) neuropsychological and instrumental diagnosis of dementia, 4) pharmacologic treatment of dementia, 5) psychosocial interventions for dementia, and 6) costs of dementia.
Only the Chapter 1 review, however, attempted to cover dementia. The remaining reviews should, for the most part, have the term “dementia” replaced by “Alzheimer’s disease,” especially the review in Chapter 2. Nonetheless, this latter review on the clinical diagnosis of dementia (Alzheimer’s disease), by Dr Reisberg, and the epidemiology review, by Dr Henderson and Dr Jorm, were the most comprehensive and useful. The review of pharmacology, although relatively complete, shows its age. It is more a testimony to ongoing advances in the field than to any deficit in the review itself. The section on dementia costs showed wide differences in cost of care for patients with dementia in developed countries; these costs would likely be unbearable in underdeveloped countries. Beyond health economists or for interest’s sake, I’m unsure about how useful the review is; for clinicians, it provides less assistance than do other chapters in the text.
The reviews alone would not have contributed much to the literature of dementia, because similar reviews were already available when this book was published. The cost to assemble these for a personal reference file would be considerably less than the cost of this book. The most striking fact gleaned from this volume is the tremendous growth in the number of patients with dementia foreseen in the third world, coupled with the inability to fund the type of dementia treatment as studied in mostly developed countries.
What raises this volume from the ordinary, mainly for those who allot a substantial portion of their career to dementia care, are the 7 to 14 commentaries after the main review in each chapter, ranging from 2 to several pages each. They provide a depth of knowledge for different types of dementia and from various perspectives. They give the book a similar feeling to that obtained at conferences, during the discussion period following the delivery of a paper or during provocative hallway discussions with experts. These discussions find different and compelling ways to look at data, sometimes in ways contrary to what is commonly presented. They also provide a peer-reviewed feel to the process of reading the text.
A good example of this is the commentary entitled, “Dementia: The Challenge for the Next Decade,” by Anthony Mann (p 59–62). In one segment of his contribution, he comments on findings that the apolipoprotein, E4, is associated with a higher risk of Alzheimer’s disease. Another apolipoprotein, E2, is often classified as being “protective,” though it is associated in some studies with a higher incidence of cardiovascular events. Anthony Mann proposes an alternative:
If E4-based dementia were associated with a longer course compared to others, then the associations could have a different explanation.
For example, perhaps those with E2-based dementia are “killed” before they can develop the full-fledged syndrome.
Whether or not this is true, perspectives such as this one allow us to develop more critical eye, greater wisdom, and curiosity when reading, listening to, and evaluating information presented to us in any field of study. I may challenge residents with these alternative views when they seem too certain about a particular something, with the intention not to berate them but to illustrate that we don’t always know. For this reason, we need to be prepared to deal with uncertainty and to look at new ways to resolve problems. Some of these views may turn out to be wrong, but the process of understanding helps us learn more.
The opportunity to look at different perspectives makes parts of this book compelling; however, it does suggest a more limited audience than the publishers would hope for—one that comprises experienced clinicians who desire a more in-depth knowledge of the illness and who want to be stimulated by alternatives. Personally, it helps me to have a mind open to alternative possibilities and helps me to better understand how the perspectives of this devastating illness differ with respect to families and caregivers (even though this was not specifically addressed in any of the commentaries). Unfortunately, general readers may have insufficient background knowledge, and these commentaries will be less illuminating to them.
In summary, this is a book to stimulate those in the field, but it is not likely to be used as a reference. With the rapidly advancing knowledge in dementia, it is unlikely that its use will often move beyond this initial contact. It is doubtful that people who deal with dementia beyond the specialist group will find the book useful.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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