As the number and proportion of elderly individuals in the populations of the world’s developed countries continue to rise, the number and proportion of people with some form of dementia increase as well, threatening to bankrupt health care systems. Most of the attention in the popular and scholarly press, understandably, is devoted to the latest discoveries in the neurobiology of the demented brain and on the results of drug trials that promise a “cure” for these diseases.
In the absence of a cure, however, there is much to know about the less glamorous aspects of the day-to-day care of dementia patients and their families. The strength of this book is that it contains up-to-date summaries about neuropsychological evaluation, support for caregivers, legal and ethical issues, mobilization of community resources, structuring environments, and nursing care as well as diagnosis, neuroimaging, molecular biology, and drug treatment of cognitive and behavioral problems. The chapter on psychological and behavioral management should be particularly valuable for young physicians because it teaches that not every problem behavior requires a drug intervention; many can be managed more effectively with simple techniques like distraction or minor changes in the residential environment.
Some comment on the neuropsychological evaluation of patients who do not speak English would have been welcome. The Hispanic population in the United States is already large and rapidly increasing, and in some areas there are large numbers of people from Asia. Evaluating the elderly from these groups is especially challenging because they often have little or no formal education and may not be literate in their native language. Still, some progress has been made in developing suitable test materials in Spanish, and a list of references would have been useful.
At least five recent studies have demonstrated that how people spend their leisure time affects the probability that they will develop Alzheimer’s disease later in life. Exactly which activities exert a “protective” effect is unclear, but the long-term implications could be quite profound, especially if it could also be shown that maintaining mentally stimulating activities after the onset of dementia slowed its progression.
In summary, this book will be a valuable reference for physicians and psychologists who treat the elderly. It will be particularly useful as a text for interns, residents, and fellows in psychiatry, neurology, geriatric medicine, and neuropsychology.
