Diagnosis and Management of Dementia

Diagnosis and Management of Dementia: A Manual for Memory Disorders Teams. Wilcock GK, Bucks RS, Rockwood K, editors. Oxford: Oxford University Press; 1999.402 pp. with index (paper). ISBN 0-19-262822-4. Can$86.95.

Dementia — and Alzheimer’s disease in particular — has become a major public health problem, and the expected prevalence of this class of illness is expected to double by the middle of the next century. Health delivery systems have been generally slow to keep up with the need for services to affected individuals. One trend that has appeared in the past 20 to 30 years has been multidisciplinary memory disorder clinics. This model of diagnosis and provision of treatment seems to work very well in a number of centres, but these specialty units are still not widely available, particularly outside of tertiary care centres. Setting up and running such a clinic is a topic of this new book. Many recent publications address either the pathophysiology or the medical treatment of dementia; however, a more practically oriented book such as this one has not previously appeared.

The book is divided into 3 major sections. The first is on establishing and organizing a clinic, the second is on the diagnostic process and the final section is on management. The book has a multidisciplinary and multinational authorship, and the authors have experience in working with patients in multidisciplinary clinics.

The first section on establishing and organizing a clinic covers all aspects — from administrative and logistical concepts, to information management, medical, psychiatric, neuropsychological, speech, occupational and community assessments. In addition there is a brief chapter on the research potential of such clinics. They are all covered well, although some rather briefly.

There is a small section on the diagnostic process for dementia. This stresses the differential diagnosis and indicates how one differentiates between age-related memory and cognitive decline and pathological conditions.

The final section of the book is concerned with treatment, and this covers topics that have not previously been covered well in publications. This includes support for caregivers and nonpharmacological approaches to treatments, such as behavioural modification and management of associated problems. There is a chapter on medical management, which reviews the current state-of -the-art in therapy and gives a glimpse of some of the therapies that may appear in the future. There is also a final chapter on the role and perspective of the primary care physician.

There is an appendix, which I found to be one of the more useful parts of the book. It is a paper that surveyed the memory disorder teams represented by the contributors to this book. This survey covers clinics in North America, the United Kingdom, Europe and Australasia. Anyone already running such a memory clinic or anticipating setting up one would find the information conveyed in this section quite useful as a benchmark. The survey asked such information as how many clinics are held per week, how long the first visit or appointment takes and how long the waiting lists are.

I think this book is potentially very useful for those already running clinics, those anticipating setting up clinics and those involved in rationalizing health care services for older individuals with cognitive impairment.