The Neuropathology of Dementia
Authors: Francesco Scaravilli
Journal: Journal of the Royal Society of Medicine (2005)

The tremendous progress made since the original publication of The Neuropathology of Dementia is reflected in the larger size of the second edition. The number of contributors has also risen, because the specialist fields now require such a wealth of knowledge that, in the editors' opinion, no single expert could give an adequate account of more than one topic. Of the twenty-four chapters the first six and the eighth provide background for the more specific ones.

The relationship between the so-called 'ageing brain' and Alzheimer's disease (chapter 7) was one of the first thorny issues in neurodegenerative disorders encountered by neuroscientists and it is now clear that the clinical and pathological features of the brain in these two conditions are quite different; chapter 9 goes into a detailed description of Alzheimer's disease—by far the best known, the most investigated and most frequent form of dementia. The close pathological relationships between Alzheimer's disease and Down's syndrome, recognized for some time, are presented in the next chapter, which also tackles genetic similarities between the two. This is followed by a chapter on sporadic tauopathies. Chapters 12 and 14 deal with a group of dementias which include some recently described forms: those with a genetic background, the best known among which is that associated with a genetic mutation in chromosome 17, are included in the former, whereas the latter is devoted to the amyloid-related dementias, notably, the familial forms known as the British and Danish dementias. The pathology of vascular dementia, Parkinson's disease and other α-synucleinopathies, the changes related to alcoholism and the complex relationship this addiction has with dementia, the dementia in prion-related disorders, and the dementia related to hydrocephalus, head injury and inflammatory disorders are discussed in the following chapters.

Chapter 22 describes the association between schizo-phrenia and dementia on the one side and the correlation of the dementia with the underlying pathology on the other. This chapter illustrates what a difficult task it is to tackle the subtle pathological changes and give them meaning in terms of correlation with the clinical presentation. In addition, the author manages brilliantly to convey the message of how vast is the field of clinical and basic research still open to those daring to venture into this topic. The book ends with a chapter on all the other possible disorders that can cause dementia and another on use of transgenic animal models to further our understanding of dementia-inducing disorders.

I congratulate the editors on gathering in this second edition such a number of expert authors to deal with such a vast number of topics. The literary style of the various chapters varies considerably, reflecting national origin as well as personalities. Some are concise, some elegant and witty. Two comments must be added. The first is that the main topic, neuropathology, cannot be divorced from genetic, biochemical, epidemiological and pathogenetic information on the disorders. As the book shows, all these are key to a fuller understanding of various clinical and radiological presentations. The second observation is that this work is greater than the sum of its excellent parts. This, I think, is because the skilful editors arranged for the chapters on specific topics to be preceded by those of general interest. These background chapters should not be skipped, because they indicate the complexity of the entire subject, orientate the reader on where to look for the lesions specific to each pathology and underline the relevance of genetic studies to clinical neurosciences.