A Review of Alzheimer's Disease: A Physician's Guide to Practical Management; Edited by Ralph W. Richter and Brigitte Zoeller Richter; Totowa, NJ: Humana Press; 2004. 479 pages, hardcover, $99.50 (see http://www.humanapress.com, part of the Current Clinical Neurology Series).

This book, edited by a physician and a pharmacist, pulls together the latest information on Alzheimer's disease (AD) for the benefit of physicians, nurses, ancillary health care personnel, and even interested laypersons. The book focuses on the importance of early diagnosis and treatment of AD, as well as how to help families, friends, patients and caregivers negotiate the long and difficult caregiving process. Throughout many of the book chapters, there is information that helps to support physicians as they work with caregivers and families coping with AD. Despite the fact that AD imposes a huge burden on patients and families and despite everything we know about AD, it is still routinely underdiagnosed, misdiagnosed, and undertreated.

This timely and important book includes sections (each with multiple chapters written by experts from around the world) on the Scientific Background of Alzheimer's Disease; Epidemiology; Clinical Assessment; the Transitional Stage; Treatment Options; Late-Stage Therapy; Future Developments; Treatment Outcome Management; Neuropsychiatric Management; and Family and Caregiver Issues. Also included are frequently asked questions (FAQs), as well as a complete and thorough appendix of resources, support groups, and helpful institutions and organizations. The book includes lavish and detailed charts, tables, and diagrams to amplify and illustrate the complex sections of the text.

It is believed that currently at least 4 million Americans and 16 million people worldwide have AD, with an incidence that doubles every 5 years after the age of 65. By 2050, the incidence of AD in the United States is projected to rise to at least 14 million unless we come up with a way to prevent, reverse, or cure AD through vaccines or preventive measures or medications. Ironically, AD is known as "the American disease" in many parts of the underdeveloped world, presumably because in these areas people die young before AD sets in and because some believe that forgetfulness is simply a normal part of aging. One author points out that if we could even delay the onset of AD for 6-24 months, we would save thousands of difficult caregiving hours for both formal and informal caregivers, as well as billions of dollars of care. It is estimated that the average lifetime cost per AD patient is at least $174,000.

There are many things we appreciate about this book. It is extremely well written and well edited, with excellent illustrations. The authors have also gone to considerable efforts to tell us all that is currently known about the research concerning AD and special populations (African Americans, Native Americans, those over age 85, and urban and rural elderly). Most interesting to us was a chapter outlining the known risks as well as protective factors (see page 65ff). Basically, of course, there is still much that we do not know about AD. It is still true that the only really definitive way to diagnose AD is through autopsy and that there are many other conditions (depression, alcohol or drug abuse, thyroid problems, dehydration, malnutrition, and much more) that need to be ruled out before looking at a possible AD diagnosis.

It is heartening to us to see a medical text designed for physicians and health care personnel that focuses to such an extent on treating the whole family and meeting the needs of caregivers; there are chapters on the diagnostic family conference in AD; care, caregiver issues, and communication with the demented patient; the importance of ongoing dental care of AD patients; long-term medical care issues; and supporting caregivers who are experiencing loneliness and depression. In many ways, physicians who are caring for AD patients are into caring and not curing, into pain management and palliative care and not curing. It is also important for physicians and other health care professionals to make sure that family members and caregivers have realistic expectations for the course of the disease, so, for example, Aricept will not "cure" AD, but in some cases it may slow the progression by 6, 12, to 24 months to give the patient and family just that much more time to plan for disability and to accomplish the things they would like. Also clearly laid out is how to distinguish early AD from normal aging and the advantages and disadvantages of using the currently available drug therapies. One key chapter also discusses important issues such as going from epidemiology to clinical trials, developing a true biopsychosocial model of AD, devising better outcome measures, focusing on ethical issues in AD research, and providing better support for health care professionals who are working with AD patients. Especially important was a section on tips for effective communication with severely impaired AD patients. We were especially gratified to see gender, racial, ethnic, and age differences in AD patients discussed in the book.

Many of the chapters in this substantial volume are quite short, but they are pithy and give us the latest findings from the research. We are happy to recommend this superb book to anyone with an interest, whether personal or professional, in the topic of AD.