Non-Alzheimer's and atypical dementia

This is a multi-author book with 15 chapters, starting with introduction and covering almost all aspects of atypical dementia including management strategies.

The first chapter gives a general introduction to the common non-Alzheimer's type dementias both degenerative and non-degenerative which include metabolic, vascular, toxic, infective and immune mediated. The second chapter deals with the multidisciplinary evaluation of the patients with dementia. This is one of the best chapters which stress upon the importance of clinical evaluation of all the symptoms as they start, which is important in the categorization of these disorders. Information on most of the common genetic factors, neuropsychological assessment techniques, neurochemical, neurometabolic and neuropathological assessment, role of CSF (cerebrospinal fluid), EEG (electroencephalography) and imaging has been provided. This chapter will be useful for students of neurology with special interest in cognitive disorders, although it is suggested it is for research purposes only.

The next chapter deals elaborately with the pitfalls in the diagnostic instruments used in the diagnosis of Alzheimer's disease and highlights the need for revised diagnostic criteria incorporating clinical presentation with biomarkers and special imaging techniques. This highlights the problems in clinical diagnosis as the phenotype is defined by the distribution of the neurofibrillary tangles and may not define the disease as such. Therefore, the role of molecular biomarkers and also the need for biologically specific therapies are probably relevant.

Chapter 4 deals with the diagnostic and therapeutic aspects of vascular dementia, where the diagnosis, epidemiology and genetic aspects are dealt with, along with typical illustrative cases. This chapter highlights the varied presentations of vascular dementia and the lack of a specific phenotype which points the diagnosis. Also there is a detailed write up of prevention as well as treatment of cognitive symptoms. Concurrent occurrence of degenerative dementia along with vascular dementia has been highlighted. Chapter 5 deals with frontotemporal dementia in which there is an elaborate description of the consensus criteria for diagnosis, radiological, neuropsychological features, the overlap syndromes including those with lower motor involvement, subcortical involvement like PSP (progressive supranuclear palsy) and the role of multiple distinct pathologies and the wide variety of genetic mutations and current lack of any disease-modifying treatments.

Chapter 6 deals with Lewy body dementias namely DLB (dementia with Lewy bodies) and PDD (Parkinson's disease with dementia). The commonest differential diagnosis is Parkinsonism-dementia complex. Differentiating both is essential as the respective treatment and prognosis are entirely different. This aspect is nicely highlighted with interesting case studies and pathology. The need for a better biomarker apart from the features elaborated is emphasized. Chapter 7 deals with corticobasal degeneration (CBD) and PSP syndromes. The spectrum of related syndromes and their diagnostic criteria including biomarkers are highlighted.

Chapter 8 deals with all the repeat expansion disorders including illustrative cases and differential diagnosis, given the clinical heterogeneity of these syndromes. Chapter 9 deals with rapidly progressive dementias where the main highlight is on all the characters of prion diseases. Differential diagnosis of rapidly progressive dementias is also discussed. Chapter 10 deals with autoimmune encephalitis and discusses the antibodies which are associated with malignancies of various types serving as a comprehensive approach to plan the search for the appropriate malignancy. Flowchart-based treatment option is also provided.

Chapter 11 deals with toxic and metabolic dementias. This elaborately deals with metals, insecticides, recreationally abused substances, solvents and food-related toxins which cause dementia and their respective treatment methods. There is a need for a high degree of suspicion in the diagnosis of these conditions as treatment and prognosis are entirely different from the degenerative dementias.

Chapter 12 deals with leucoencephalopathies and leucodystrophies and their differential diagnosis. This is a useful chapter for clinicians as leucoencephalopathies are common in clinical practice and specific diagnosis is often difficult. Chapter 13 gives the summary of viral, bacterial, fungal and parasitic diseases which cause cognitive dysfunction, their diagnosis and prevention as most of these diseases are amenable for public health intervention.

Chapter 14 deals with immune dementias and rheumatological disorders. As these disorders are counted under treatable disorders, information on the wide manifestations of these disorders is important for clinicians to have suspicion so that the appropriate line of investigations can be initiated.

Chapter 15 deals with all management options, non-pharmacological which includes safety issues, fall prevention, safety concerns for caregivers in specific diseases, occupational rehabilitation, legal formalities to be carried out, dealing with request for driving licence, end of life care and need for requesting for autopsy, etc.

Although this book is introduced as a useful resource for people interested in research, this will be more useful for clinicians as all the information is comprehensively presented for anyone who wants to pursue a career in cognition related disorders. No new information is available, however, what is provided in an easily understandable format.