As I grew up in the pre-Internet era, when Pubmed was available only in a university library and the medical schools mainly used textbooks, I am rather fond of heavy volumes and used to getting quite excited by new publications on the subject. However, in the rapidly developing field of neuroscience where research papers are already slightly outdated by the time they go to press, there is a risk that a newly published book will not deliver the most up-to-date knowledge and opinion.
This first edition of the Handbook is the work of over 30 contributing authors, most of them US-based neurologists. It promises to be a thorough, cutting-edge, and up-to-date compendium of the current research into the field.
The book is organized in four main sections, but to me it appears to be broken down into two distinctive parts. The first part is a series of chapters on specific disorders, starting with Alzheimer's Disease (AD), moving on to vascular dementia, dementia with Lewy bodies (DLB) and in Parkinson's disease, the frontotemporal spectrum, and closing with a chapter introducing less common forms of dementia. The chapters are very well narrated, and – despite being rather compact – they offer a thorough and well-balanced overview of pathological and clinical aspects of specific disorders as well as thoughtful discussion of diagnostic criteria and nosological validity. At this point, readers looking for more in-depth information relating to specific aspects – for example neuropathology – may be disappointed with somewhat superficial coverage. They need not worry – they will find it (and more) in the second part of the text, in chapters discussing pathogenesis and disease mechanisms, cognitive and behavioral dysfunction, and finally neuroimaging. This is where the book becomes a truly useful reference guide.
I was quite impressed and even a little daunted by the thoroughness of the content of these chapters. They include a wealth of detail and are well referenced. However, some topics are quite vulnerable to the implications of rapid progress in these fields versus publishing timelines. The neuroimaging section, for example, contains very little on the most recent techniques, such as amyloid imaging, or methods of analysis based on machine-learning protocols such as automatic classification.
Is this the right way of organizing the text? It probably makes the book more likely to be used as a reference source to look for specific information rather than a volume that can be read naturally cover-to-cover. The advantage, although, is better accessibility for readers who want to gain general knowledge about specific disorders by reading the first part, but may be less inclined to delve into, for example, the splicing isoforms of tau protein, unless absolutely necessary.
The US origin of the text is noticeable across the book where references are made to types of insurance and contractual arrangements to be considered when planning investigations and treatments. However, I don't think this necessarily detracts from formulating the plans for local conditions. There are some sections where slightly older evidence is cited, for example, for treatment of behavioral and psychological symptoms, elsewhere an enthusiastic endorsement for the use of cholinesterase inhibitors and memantine in the treatment of vascular dementia may be surprising to the British reader.
As the book is authored by a number of contributors, there are differences in how the chapters are written (and read). Some include an impressive number of references per paragraph, thus ensuring scientific value of the text but perhaps hindering the ease of reading. The discussion of symptoms, while thorough and intelligent, is at times rather cold and detached – some might raise an eyebrow at specific terminology, for example, referring to a patient as a “demented host.”
For a book that has the potential to be the reference text on the subject of dementias, there is a lack of illustrations and diagrams. The figures, rather than being next to the relevant text, are placed in the middle of the book in a meager plates section. I would like to see many more illustration – and of better quality – especially showcasing neuroimaging aspects of the discussed disorders.
In summary, despite clear disadvantages relating to some content being inevitably not as up-to-date and state-of-the-art as the authors hoped it to be, it is a rather brilliant book. The disease-specific chapters give a good scientific and clinical overview of disorders. The detailed reference chapters are impressively thorough and meticulously researched if at times offering a slight bias of personal interest and experience.
I believe this textbook will be useful to a variety of readers from different backgrounds and at different stages of training and experience and I would be very glad to have it in my library.
