Book Review

Alzheimer Disease

N Engl J Med 1994; 331:620September 1, 1994

Article

Alzheimer Disease
Edited by Robert D. Terry, Robert Katzman, and Katherine L. Bick. 472 pp., illustrated. New York, Raven Press, 1994. $139. ISBN: 0-7817-0081-7

Alzheimer's disease, a major health problem, can have devastating consequences. In its early stages there is subtle loss of memory, which then worsens inexorably over five to seven years to a virtual vegetative state, robbing the patient of humanity, and necessitating total care. The incidence of the illness is approximately 10 percent in the population over 65 years of age and increases progressively with age. Its economic costs are staggering, with estimates as high as $90 billion yearly.

Alzheimer Disease is a multiauthored monograph on all aspects of the illness. It is an update of a symposium-based monograph that was published in 1978. Knowledge of Alzheimer's disease has expanded explosively since then, warranting the publication of this book. It has seven sections, covering history, clinical presentation, epidemiology, confounding disorders, anatomical pathology, biochemical pathology, and clinical management. The book is therefore quite comprehensive in its overview of the illness. The editors have done an outstanding job of assembling a superlative group of authors. The information in the book is current up to 1993.

After giving the history of Alzheimer's disease, the book discusses diagnosis, psychiatric aspects, neuropsychological features, clinical genetics, neuroimaging (including computerized tomography, magnetic resonance imaging, and positron-emission tomography), and epidemiology. The differential diagnosis is illustrated by a chapter on dementia associated with stroke, other degenerative diseases, and metabolic disorders. A review of the pathological features of other dementias is followed by detailed descriptions of the pathological features of Alzheimer's disease. These include the architectonic and connectional selectivity of the disease process. There is a nice review of the behavioral and neuropathological features of aging in nonhuman primates.

The book then proceeds to describe in detail the neurochemical aspects of Alzheimer's disease, with particular attention to the cholinergic system. There are excellent discussions of the biochemistry and neurobiology of amyloid and tau protein, which have been a focus of intense investigation in Alzheimer's disease. Chapters on neurotransmitter receptors and altered signal transduction cover the pharmacologic aspects of the disease. There are also reviews of the role of trace metals and magnetic resonance studies of brain energetics. Mitochondrial energetics and oxidative damage, unfortunately, are not covered. In a note added in proof, there is a brief discussion of apolipoprotein E4 as a major genetic risk factor for Alzheimer's disease.

The book ends with outstanding chapters on behavioral management, clinical trials, and experimental treatments, including one on neurotrophic factors. One can only hope that the pace of research on Alzheimer's disease will continue to accelerate. When one cares for patients with this devastating illness, the need for effective treatment is painfully clear. The prospects for effective treatment aimed at the underlying disease process are improving, and this monograph summarizes them nicely.

This is a superb book, both up to date and comprehensive. It covers all important aspects of the neurobiology and management of Alzheimer's disease. In my view, it is the best single book on the topic. It will be useful as a reference and as an initial guide to the literature on selected aspects of Alzheimer's disease. Because of the rapid pace of research in this area, it is likely that updates will be needed every three to four years.

This book is particularly strong on the current state of scientific knowledge of Alzheimer's disease, an appropriate emphasis because it has the greatest prospects for improving our understanding of the illness, and, in turn, improving therapy. This book deserves a place on the bookshelves of all physicians interested in Alzheimer's disease. The editors and authors are to be congratulated on their achievement.

M. Flint Beal, M.D.
Massachusetts General Hospital, Boston, MA 02114