Diagnosis and Management of Dementia: A Manual for Memory Disorders Teams
This is a well thought out, well edited, comprehensive overview of all aspects of establishing and running a memory disorders center. The contributors are primarily from the United Kingdom, with additional chapters from experts in Australia, Canada, and the United States.
The first section of the book takes a hands-on approach to the details of establishing and organizing a dementia clinic—including ideal location, physical plant layout, database setup, consideration of referral sources, and the composition of an effective memory evaluation team. The minutiae of recordkeeping as it pertains to memory disorders are succinctly dealt with. Ideal formats for the diagnostic visit and the informing visit, where the diagnosis is conveyed to families, are discussed. Patient follow-up is recommended at 6 months after the first visit, then at 12 months, then at 24 months. Thereafter, annual telephone contact is suggested. (This frequency of follow-up is probably less than the reviewer would be comfortable with.)
The medical, psychiatric, and laboratory investigations needed to arrive at a diagnosis are reviewed, as well as the use of neuropsychological and computerized cognitive batteries. A comparison of standardized neuropsychological tests from samples sited in the United Kingdom and the United States is illuminating, revealing more of a skew toward American tests such as the Wechsler Memory Scale in the United States. Computerized batteries are rightly felt to be adjunctive tools and not adequate substitutes for traditional test administration.
The role of speech and language therapy in patients with dementia is addressed through representative cases. The functional assessment, utility of home visits, and methods of using memory disorders clinics for research are discussed and illustrated with case studies.
The book's second section defines and discusses age-related cognitive decline, Alzheimer's, and other dementias. The third section deals with management. These two sections, however, are brief compared with the earlier detailed section. Pharmacological and behavioral interventions, cognitive therapy, and caregiver management are described, and there is a useful list of the Internet addresses of websites that serve as sources of information for memory disorders.
A fascinating final chapter, authored by the editors, examines the composition and current practices of 28 memory disorder clinics represented by the contributing authors to the book. The specialist makeup, tests administered, referrals arranged, and other details are described, giving a glimpse into the standard working practices of an array of memory clinics worldwide.
This book covers, from the ground up, most foreseeable issues involved in the implementation and management of a memory disorders clinic and would prove useful not only to persons involved in establishing a memory disorders center, but also to those who are interested in expanding currently offered services at their offices. The merging of British and American viewpoints in the evaluation and management of dementia is refreshing and informative.
Dr. Devi is director of New York Memory and Healthy Aging Services and an attending physician in the Departments of Psychiatry and Medicine (Division of Neurology), Lenox Hill Hospital, New York, NY.
