Review of "Mild Cognitive Impairment and Early Alzheimer's Disease"

In Mild Cognitive Impairment and Early Alzheimer's Disease: Detection and Diagnosis, Jeffrey M. Burns and John C. Morris present a comprehensive overview of the neurological and psychological features of Mild Cognitive Impairment (MCI) and Early Dementia of the Alzheimer Type (DAT).  The authors pointedly explain that MCI involves cognitive declines that do not reflect 'normal' age changes.  Albeit the symptoms associated with a MCI diagnosis are milder than those traditionally linked to dementia, MCI can be regarded either as a transitional state to full-blown dementia or as a separate pathological state with cognitive declines not expected to progress to levels characteristic of DAT and other forms of dementia. 

The authors of this book preview a comprehensive list of procedures for detection and diagnosis of MCI and early DAT, including some currently used and others that at the present time are at a developmental/testing stage.  Information regarding detection and diagnostic procedure is accompanied by detailed descriptions concerning treatment and is illustrated by cleverly presented case studies.  The authors clearly acknowledge the challenge, not only for lay persons but also for primary physicians, to distinguish healthy aging from MCI and early DAT.  Ingrained cultural beliefs linking aging to forgetfulness appear to be the main culprit and make early detection of these pathological syndromes arduous.  Of course, distinguishing between MCI and early DAT is not less difficult.  Furthermore, although a reasonable array of interventions appear to have been used to address both symptomatologies, whether effective interventions unique to MCI exist is not entirely clear.  

Mild Cognitive Impairment and Early Alzheimer's Disease: Detection and Diagnosis is a book awash with facts presented in a precise and readable format and peppered with hypotheses and preliminary data where the scientific enterprise has yet to produce consensus.  Although undeniable that the book contains valuable information, is there a target group for whom the content of this text would be particularly helpful? Undoubtedly, the text could serve as a reference book for a broad audience of readers whose interests are of a very practical and personal nature.  These individuals are readers concerned with the question of whether any of the MCI and DAT symptomatologies and related diagnoses applies to them or to their significant others.  For this audience, Chapter 1 and Chapter 7 may be considered the entryway to sections of the text devoted to detection, diagnosis, and treatment. Chapter 1 not only offers readers intelligible definitions of MCI and DAT, sprinkled with epidemiological evidence, but also focuses readers' attention on the distinction between healthy and impaired aging.  First, readers are reminded that although cognitive changes are to be expected in an aging brain (e.g., slowing), some changes exist that are so large a deviation from normal aging that they are to be considered pathological. Then, here and in later chapters, readers are given detailed and concrete information about the behavioral factors to consider when attempting to identity pathological manifestations of aging.  Of course, this information does not make an informal diagnostic process less arduous when persons with whom readers have emotional ties are to be evaluated. Chapter 7 takes a more practical approach to the challenges of distinguishing between healthy and impaired aging and between MCI and early DAT. This chapter narrates a few case studies that skillfully epitomize the information presented in the previous chapters regarding detection, diagnosis, and treatment. 

Of course, an audience with personal and practical concerns does not exclude a more professional audience for Mild Cognitive Impairment and Early Alzheimer's Disease: Detection and Diagnosis.  For instance, primary physicians whose client populations would greatly benefit from earlier detection of dementia could use the text as a reference guide.  Another use for this book might be found in academia where the work could serve as an introduction to diagnostic and treatment challenges posed by MCI and DAT in classes with a clinical focus.  The reference section could be particularly helpful to students in such classes when a more in-depth examination of both symptomatologies is required, even though, since publication of this text, a reasonable number of articles may need to be added.  Lastly, the chapter on innovative diagnostic tools and treatment interventions might be particularly valuable as a source for theoretically guided personal investigations to an audience of current and future practitioners.

Although the text is a read full of facts and reasonable assumptions mostly concerning the causes of MCI and early DAT and the effectiveness of diagnostic procedures and interventions, which can be absorbed by a broad audience of readers with different interests, is there anything missing? In all honesty, what appears to be omitted in this book is a serious discussion that older adults constitute a diverse group of individuals. Diversity may encompass factors such as educational attainment and cultural background, which can make detection, diagnosis, and treatment quite challenging.  For instance, the Clinical Dementia Rating (CDR) scale, used in conjunction with a structured interview, is widely considered an effective tool for detecting early DAT.   CDR scores, however, tend to be correlated with educational attainment and be influenced by culturally specific behavioral norms.  Both factors may increase the probability of misdiagnosing the aged if practitioners do not take them into consideration.

All in all, the book is an interesting and valuable read.  It is a scholarly written book that can be understood by a broad audience.  This is a must-have book for anybody who wants to learn about MCI and early DAT.

 

© 2009 Maura Pilotti

 

Maura Pilotti, Ph.D., Department of Psychology, Hunter College, New York