- Email: [email protected]
Transcultural perspectives of dementia
In Context
Books A bridge from bedside to clinical electrophysiology?
Clinical Electrophysiology: A Handbook for Neurologists By Peter W Kaplan and Thien Nguyen Wiley-Blackwell, 2010. Pp 200. £39.99. ISBN 978-1-4051-8529-5
Around the beginning of the 20th century, the development of electroencephalography (EEG) gave hope that the technique would enable us to read a person’s mind. Although the method did not meet those expectations, it gained merit later that century as a clinical diagnostic tool. Some neurophysiologists even became overenthusiastic, claiming that specific diagnoses could be derived from the EEG, such as specific brain tumours or psychiatric diseases. With the advent of further diagnostic techniques, in particular highresolution brain imaging, the importance of the EEG in the specification of structural pathological changed drastically and—quite rightly—declined. The localising value of evoked potentials (EP) always remained helpful, but the relevance of the EEG in the 21st century shifted towards the differential diagnosis of functional alterations of cognition and seizure disorders. Clinical Electrophysiology focuses on these disorders: mainly seizures and states of altered consciousness ranging from confusion to prolonged unresponsiveness. The states of reduced consciousness are met mainly in the critical care inpatient setting and are those in which neurophysiology test results can indeed affect treatment decisions, whereas in other disorders the value of electrophysiological tests is merely of academic and confirmatory nature. The interpretation of traces recorded from neurologically critically ill patients is difficult for the neurophysiologist, and it is equally difficult for the treating physician to correctly judge the potential of the test and
the specificity of its results. Accordingly, Kaplan and Nguyen intentionally focus on helping the “neurologist in the middle” who has to order appropriate tests after assessment of the patient and then translate the results into treatment. The authors give a brief introduction to each syndrome and then describe clinical differentials associated with individual prototypical EEG and EP examples; they then conclude with—at times somewhat bold—explicit prognostic statements. This approach can be very helpful if the patient under investigation fits a given example. However, there are times when the physician will be unsuccessful in trying to match the patient he or she faces to a specific example in the problem-oriented book, especially because its structure takes EEG and EP patterns as starting points. In my opinion, the authors’ goal to create a book that serves “to accompany you on your rounds” is not met in its first edition, and, although stimulating, the concluding casebook section also does not emphasise the character of a “portable aid”. In a future edition, this book could benefit from adding more example figures with detailed comments. In conclusion, Kaplan and Nguyen have bravely created a book “in the middle”, between a detailed electrophysiology textbook (a “comprehensive tome”), a case book, and an atlas; this book is worth reading, but probably not during rounds.
Helmut Laufs [email protected]
Transcultural perspectives of dementia Dementia: A Global Approach Edited by Ennapadam S Krishnamoorthy, Martin J Prince, and Jeffrey L Cummings Cambridge University Press, 2010. Pp 210. £60. ISBN 978-0-52185-776-5.
306
There was a time when knowledge from the East was considered only in exotic tales, hazily referred to in mystical tones. Today, however, we feel encouraged to take into account different opinions and practices to those that prevail in the West. This shift in recognition is particularly noteworthy in the dementia field, since fast rates of population ageing are taking place in developing countries, where a challenging epidemic of dementia could occur in the near future. To face that epidemic properly, we should be prepared with reliable data about this new “old problem”. Dementia: A Global Approach intends to fill this gap. The book collates an extensive amount of knowledge, mostly from non-western societies. It is divided into 11 sections and covers important topics in dementia with a cross-cultural perspective. The book addresses
assessment, psychosocial factors, service delivery, and management in patients with dementia, touring the clinical approach to dementia in different cultures around the world. It also highlights the contribution of the 10/66 Dementia Research Group on cross-cultural research and concludes with a plea for increased global awareness of the disease. The first chapter poses the cultural dimension of being an elderly individual in Asia and portrays the challenges of treatment of elderly patients in a developing country. Although the focus shifts in the next few chapters to more general topics in dementia research (mild and vascular cognitive impairment), most of the book then resumes discussion on cross-cultural themes. There is much debate about nature versus nurture and the different contribution of genetics versus the www.thelancet.com/neurology Vol 10 April 2011
In Context
environment on the causation and manifestation of dementia. Although some forms of dementia seem to be highly dependent on genetics, others seem to be more affected by environmental factors such as lifestyle and food habits. This book touches on this debate many times when discussing variations in dementia prevalence according to different societies with diverse cultural backgrounds. In chapter 4B, for instance, there is an interesting debate between opposing views on the existence (or not) of different prevalence rates of vascular dementia around the world. Obviously, a book of 202 pages is not intended to be encyclopaedic; therefore, some topics are not addressed thoroughly. The laudable intention of providing a global view of the problem of dementia in all major regions of the world is hence not fully achieved. In section 9, for instance, when considering the clinical approach to individuals with dementia, the editors seem to have randomly picked countries that supposedly represent a whole continent. Peru, for example, was selected
to represent South America at the expense of Brazil, which accounts for half the continent’s population, with different ethnic groups, language, and customs from Peru. But can a continent be properly represented regarding the complex multifactorial disorders that make up the dementias? This question remains a challenge not only for the editors of this book, but also for every clinician and researcher in the dementia field. In recent years, research on the topic of ethnic and racial issues in dementias has increased dramatically. At the same time, the need for cultural competence in all of geriatric care, including dementia care, is increasingly being acknowledged. Researchers and providers are beginning to recognise the impending so-called ethnogeriatric imperative, as the number of elderly people from diverse ethnic and cultural backgrounds continues to rise.
Leonardo Caixeta [email protected]
Changing concepts in Parkinson’s disease Parkinson’s disease, one of the most frequent neurodegenerative disorders, is no longer thought of as a motor disorder characterised by extrapyramidal symptoms, but as a progressive multisystem (multiorgan) disease with variegated neurological and non-motor deficiencies. In addition to degeneration of the dopaminergic nigrostriatal system, which causes the core motor deficits, there is multifocal involvement of the nervous system and other organs, resulting in many biochemical changes that cause a heterogenous clinical picture. Non-Dopamine Lesions in Parkinson’s Disease is edited by a neuropathologist and two neurologists from the UK and Australia, and is written by an international panel of experts. The book provides a comprehensive overview of the lesions outside of the classic dopaminergic domain, thus allowing deeper insight into the complex pathology of non-motor and other heterogeneous symptoms of Parkinson’s disease. The book is divided into 12 chapters, starting with lesions associated with the classic motor triad of Parkinson’s disease and those associated with motor speech disorders and their therapy. Further topics reviewed are lesions associated with eye movements; olfactory dysfunction in Parkinson’s disease and related disorders, emphasising their diagnostic relevance; and lesions associated with autonomic dysfunction, including swallowing disorders and drooling, the gastrointestinal disorders that often occur very early in the disease, and orthostatic hypotension. The book also reviews www.thelancet.com/neurology Vol 10 April 2011
lesions associated with pain and sensory abnormalities, in addition to the pathology of pain pathways, and treatment regimens for pain, which is not uncommon in Parkinson’s disease. Other chapters discuss lesions associated with sleep-related disturbances, olfactory dysfunction, depression and apathy, swallowing disorders, dyskinesias and the dopamine dysregulation syndrome, visual hallucinations and psychoses, cognitive impairment, and dementia. The heterogenous changes in Parkinson dementia are presented. The final chapter on systemic manifestations of Parkinson’s disease from multiorgan involvement discusses the protean nature of this disorder. All chapters are well written, with many informative subheadings, tables, colour pictures, and extensive reference lists, and many chapters have a summary or conclusion. This comprehensive review of the nondopaminergic lesions in Parkinson’s disease, their pathology, and potential treatments bridges a gap in our understanding of the effects and progression of this detrimental disease, as a worthwhile addition to a number of other recent books about non-motor symptoms of Parkinson’s disease. The book will serve as an excellent reference for neurologists, psychiatrists, neuroscientists, and general practitioners who work on or are interested in the complexity of parkinsonian disorders.
Non-Dopamine Lesions in Parkinson’s Disease Edited by Glenda Halliday, Roger Barker, and Dominic Rowe. Oxford University Press, 2010. Pp 336. $99.95. ISBN 978-0-19-537108-6.
Kurt A Jellinger [email protected]
307
Books A bridge from bedside to clinical electrophysiology?
Clinical Electrophysiology: A Handbook for Neurologists By Peter W Kaplan and Thien Nguyen Wiley-Blackwell, 2010. Pp 200. £39.99. ISBN 978-1-4051-8529-5
Around the beginning of the 20th century, the development of electroencephalography (EEG) gave hope that the technique would enable us to read a person’s mind. Although the method did not meet those expectations, it gained merit later that century as a clinical diagnostic tool. Some neurophysiologists even became overenthusiastic, claiming that specific diagnoses could be derived from the EEG, such as specific brain tumours or psychiatric diseases. With the advent of further diagnostic techniques, in particular highresolution brain imaging, the importance of the EEG in the specification of structural pathological changed drastically and—quite rightly—declined. The localising value of evoked potentials (EP) always remained helpful, but the relevance of the EEG in the 21st century shifted towards the differential diagnosis of functional alterations of cognition and seizure disorders. Clinical Electrophysiology focuses on these disorders: mainly seizures and states of altered consciousness ranging from confusion to prolonged unresponsiveness. The states of reduced consciousness are met mainly in the critical care inpatient setting and are those in which neurophysiology test results can indeed affect treatment decisions, whereas in other disorders the value of electrophysiological tests is merely of academic and confirmatory nature. The interpretation of traces recorded from neurologically critically ill patients is difficult for the neurophysiologist, and it is equally difficult for the treating physician to correctly judge the potential of the test and
the specificity of its results. Accordingly, Kaplan and Nguyen intentionally focus on helping the “neurologist in the middle” who has to order appropriate tests after assessment of the patient and then translate the results into treatment. The authors give a brief introduction to each syndrome and then describe clinical differentials associated with individual prototypical EEG and EP examples; they then conclude with—at times somewhat bold—explicit prognostic statements. This approach can be very helpful if the patient under investigation fits a given example. However, there are times when the physician will be unsuccessful in trying to match the patient he or she faces to a specific example in the problem-oriented book, especially because its structure takes EEG and EP patterns as starting points. In my opinion, the authors’ goal to create a book that serves “to accompany you on your rounds” is not met in its first edition, and, although stimulating, the concluding casebook section also does not emphasise the character of a “portable aid”. In a future edition, this book could benefit from adding more example figures with detailed comments. In conclusion, Kaplan and Nguyen have bravely created a book “in the middle”, between a detailed electrophysiology textbook (a “comprehensive tome”), a case book, and an atlas; this book is worth reading, but probably not during rounds.
Helmut Laufs [email protected]
Transcultural perspectives of dementia Dementia: A Global Approach Edited by Ennapadam S Krishnamoorthy, Martin J Prince, and Jeffrey L Cummings Cambridge University Press, 2010. Pp 210. £60. ISBN 978-0-52185-776-5.
306
There was a time when knowledge from the East was considered only in exotic tales, hazily referred to in mystical tones. Today, however, we feel encouraged to take into account different opinions and practices to those that prevail in the West. This shift in recognition is particularly noteworthy in the dementia field, since fast rates of population ageing are taking place in developing countries, where a challenging epidemic of dementia could occur in the near future. To face that epidemic properly, we should be prepared with reliable data about this new “old problem”. Dementia: A Global Approach intends to fill this gap. The book collates an extensive amount of knowledge, mostly from non-western societies. It is divided into 11 sections and covers important topics in dementia with a cross-cultural perspective. The book addresses
assessment, psychosocial factors, service delivery, and management in patients with dementia, touring the clinical approach to dementia in different cultures around the world. It also highlights the contribution of the 10/66 Dementia Research Group on cross-cultural research and concludes with a plea for increased global awareness of the disease. The first chapter poses the cultural dimension of being an elderly individual in Asia and portrays the challenges of treatment of elderly patients in a developing country. Although the focus shifts in the next few chapters to more general topics in dementia research (mild and vascular cognitive impairment), most of the book then resumes discussion on cross-cultural themes. There is much debate about nature versus nurture and the different contribution of genetics versus the www.thelancet.com/neurology Vol 10 April 2011
In Context
environment on the causation and manifestation of dementia. Although some forms of dementia seem to be highly dependent on genetics, others seem to be more affected by environmental factors such as lifestyle and food habits. This book touches on this debate many times when discussing variations in dementia prevalence according to different societies with diverse cultural backgrounds. In chapter 4B, for instance, there is an interesting debate between opposing views on the existence (or not) of different prevalence rates of vascular dementia around the world. Obviously, a book of 202 pages is not intended to be encyclopaedic; therefore, some topics are not addressed thoroughly. The laudable intention of providing a global view of the problem of dementia in all major regions of the world is hence not fully achieved. In section 9, for instance, when considering the clinical approach to individuals with dementia, the editors seem to have randomly picked countries that supposedly represent a whole continent. Peru, for example, was selected
to represent South America at the expense of Brazil, which accounts for half the continent’s population, with different ethnic groups, language, and customs from Peru. But can a continent be properly represented regarding the complex multifactorial disorders that make up the dementias? This question remains a challenge not only for the editors of this book, but also for every clinician and researcher in the dementia field. In recent years, research on the topic of ethnic and racial issues in dementias has increased dramatically. At the same time, the need for cultural competence in all of geriatric care, including dementia care, is increasingly being acknowledged. Researchers and providers are beginning to recognise the impending so-called ethnogeriatric imperative, as the number of elderly people from diverse ethnic and cultural backgrounds continues to rise.
Leonardo Caixeta [email protected]
Changing concepts in Parkinson’s disease Parkinson’s disease, one of the most frequent neurodegenerative disorders, is no longer thought of as a motor disorder characterised by extrapyramidal symptoms, but as a progressive multisystem (multiorgan) disease with variegated neurological and non-motor deficiencies. In addition to degeneration of the dopaminergic nigrostriatal system, which causes the core motor deficits, there is multifocal involvement of the nervous system and other organs, resulting in many biochemical changes that cause a heterogenous clinical picture. Non-Dopamine Lesions in Parkinson’s Disease is edited by a neuropathologist and two neurologists from the UK and Australia, and is written by an international panel of experts. The book provides a comprehensive overview of the lesions outside of the classic dopaminergic domain, thus allowing deeper insight into the complex pathology of non-motor and other heterogeneous symptoms of Parkinson’s disease. The book is divided into 12 chapters, starting with lesions associated with the classic motor triad of Parkinson’s disease and those associated with motor speech disorders and their therapy. Further topics reviewed are lesions associated with eye movements; olfactory dysfunction in Parkinson’s disease and related disorders, emphasising their diagnostic relevance; and lesions associated with autonomic dysfunction, including swallowing disorders and drooling, the gastrointestinal disorders that often occur very early in the disease, and orthostatic hypotension. The book also reviews www.thelancet.com/neurology Vol 10 April 2011
lesions associated with pain and sensory abnormalities, in addition to the pathology of pain pathways, and treatment regimens for pain, which is not uncommon in Parkinson’s disease. Other chapters discuss lesions associated with sleep-related disturbances, olfactory dysfunction, depression and apathy, swallowing disorders, dyskinesias and the dopamine dysregulation syndrome, visual hallucinations and psychoses, cognitive impairment, and dementia. The heterogenous changes in Parkinson dementia are presented. The final chapter on systemic manifestations of Parkinson’s disease from multiorgan involvement discusses the protean nature of this disorder. All chapters are well written, with many informative subheadings, tables, colour pictures, and extensive reference lists, and many chapters have a summary or conclusion. This comprehensive review of the nondopaminergic lesions in Parkinson’s disease, their pathology, and potential treatments bridges a gap in our understanding of the effects and progression of this detrimental disease, as a worthwhile addition to a number of other recent books about non-motor symptoms of Parkinson’s disease. The book will serve as an excellent reference for neurologists, psychiatrists, neuroscientists, and general practitioners who work on or are interested in the complexity of parkinsonian disorders.
Non-Dopamine Lesions in Parkinson’s Disease Edited by Glenda Halliday, Roger Barker, and Dominic Rowe. Oxford University Press, 2010. Pp 336. $99.95. ISBN 978-0-19-537108-6.
Kurt A Jellinger [email protected]
307