Book Review

Behavioral Complications in Alzheimer's Disease

N Engl J Med 1995; 333:1652-1653December 14, 1995

Article

Behavioral Complications in Alzheimer's Disease
(Clinical Practice. No. 31.) Edited by Brian A. Lawlor. 272 pp. Washington, D.C., American Psychiatric Press, 1995. $35. ISBN: 0-88048-477-2

This ambitious book covers a diverse set of topics ranging from the biochemical correlates of behavioral aberrations in Alzheimer's disease to psychosocial interventions and long-term care in end-stage dementia. Let me begin by acknowledging that my bias as a geriatric psychiatrist is that the cognitive and “behavioral” complications of Alzheimer's disease are inextricably linked; they are merely different clinical manifestations of the same biologic process. I am therefore skeptical of any attempt to treat the behavioral manifestations of this disorder as distinct from the more widely recognized cognitive features. My bias notwithstanding, this book is a very readable, cohesive account of new developments in an area in which, until recently, anecdotal reports were the primary source of scientific information.

The book has 4 sections encompassing 14 chapters. All the authors are geriatric psychiatrists with considerable experience in the clinical and neurobiologic aspects of Alzheimer's disease. The book begins with an interesting foreword by Trey Sunderland and continues with a strong section on the phenomenology of behavioral disturbances in Alzheimer's disease. All three chapters in this section are well written. The chapter on depression, by Blaine Greenwald, stands out by virtue of its clarity, interesting case studies, and sophisticated discussion. The second section describes the medical and quantitative aspects of behavioral symptoms and links medical disorders, neurochemical changes, and behavioral disturbances. The concise chapter on delirium elegantly summarizes the state of the art on that subject. The third section includes five chapters on strategies of managing behavioral changes in Alzheimer's disease. I have some reservations about this section. The chapters on neuroleptic drugs and benzodiazepines in behavioral management are thorough and provide useful information. The chapters on the treatment of depression in Alzheimer's disease and the use of nonneuroleptic drugs in behavioral management, however, do not have enough material to stand alone. Although this problem may reflect the paucity of rigorous, controlled studies in this area, editorial discretion should have been exercised at this point. For example, the treatment of depression in Alzheimer's disease could easily have been incorporated in the earlier chapter on the clinical aspects of depression in Alzheimer's disease. Such an arrangement would have made all the chapters more or less comparable. The last section deals with the psychosocial aspects of Alzheimer's disease and covers such important issues as stress among care givers and long-term placement. These topics are germane to the care of patients with Alzheimer's disease but are often ignored or covered in insufficient detail in standard textbooks that describe the disorder.

Overall, I am impressed with this book, which has several strong chapters with up-to-date, readable discussions and interesting case vignettes, although some of the chapters could have been organized differently. This concise book on Alzheimer's disease will be useful to clinical neuroscientists and other health care providers interested in the complex behavioral aberrations commonly observed in this devastating neuropsychiatric disorder.

Anand Kumar, M.D.
University of Pennsylvania School of Medicine, Philadelphia, PA 19104