I am not one of those psychiatrists who quote Derrida casually on ward rounds; I find philosophy fascinating, but difficult. I have learned something of the great thinkers by listening to lectures on YouTube and podcasts, reading beginners guides with pictures in, and even some books without pictures in. But the language philosophers use is often a barrier to my understanding. One page into this book there is a quotation from Wittgenstein's Tractatus – “the facts in logical space are the world.” It is phrases like that that put me off. If I am honest I am probably a bit lazy; I prefer to read through a book without going back over sentences I do not quite grasp. So I was a good subject on which to test for Julian Hughes’ skill as an author! Would he be able to persuade me that the discipline of rigorous thinking and understanding conceptual frameworks could help me in my clinical practice of working with people with dementia?

In the preface the author tells us the book's purpose, which is to encourage clear thinking about dementia. By the process of “thinking through” dementia, he hopes that we will not only gain a greater understanding of dementia, but also of aging, illness, and even life itself. Dementia, a condition affecting not only the internal life of the mind, but also the relationships the person with the disorder has with other people and the world, is an ideal concept through which to explore life's big questions – what does it mean to be a person, what is a disease, what is the mind? and so on.

The book challenges our “slipshod thinking” about dementia through precise analysis. A section on the assumptions underpinning the term “dementia” itself opens the book. Hughes concludes that the word “dementia” is a “conceptual mess,” and that we would be better served by a more precise term such as “acquired diffuse neurocognitive dysfunction.” Well, yes, possibly, if it was not so long! His point is important though; words such as “dementia” carry a history and are laden with connotations; they also mean different things to different people. And in the post- Memory Clinic world, when we are being encouraged (rightly) to diagnose the causes of cognitive problems, vague terms such as “dementia” may have outlived their usefulness. I started off reading this section with some gloom, as it always seems so glib to suggest changing the name of something in an attempt to dissolve a complex web of misunderstanding and confusion. But by the end of the argument, while not completely won round to the term “acquired diffuse neurocognitive dysfunction,” I was certainly thinking! And that, surely, means the author had achieved his aim.

My favorite parts of the book were the parts like this, and the section in Chapter 5 analyzing the “disease model” of dementia, when discussions concerned real clinical concepts where I felt I knew enough to engage with the debate. I found some bits of the book hard going; concepts such as the “situated embodied agent” view of persons and the discussions on personhood left me rather cold, or, to be more precise, I suppose I felt the language could have bit simpler and easier to follow, and the chapters shorter. To be fair, however much Julian Hughes veered into discourse on more theoretical aspects of philosophy, he always brought the discussions back to enlighten how we might think through issues raised in lively and realistic case vignettes. The book displays the intellectual rigor of an academic philosopher, tempered by the compassion and pragmatism of a good clinician.

For whom is this book written? According to the back cover, “psychiatrists, philosophers, psychologists, and anyone involved in the care and management of those with dementia.” Well, perhaps not anyone. It is quite long, and dense in parts for the causal reader. I think to get the most out of the book you need to have some understanding of basic philosophical concepts. Those, like me, whose knowledge is more superficial, will still get a lot from the book, but will probably wish to skip some of the more theoretical sections. Reading the book has helped sharpen my thinking. It is a book you can use disrespectfully – dip into it and skim through the parts you do not quite grasp or find dull, and you will still find stimulating ideas and real clinical wisdom. I will I am sure flick through this volume again to further enrich my thinking about dilemmas in people with dementia. (Sorry, I mean “acquired diffuse neurocognitive dysfunction”!)