824 BOOK REVIEWS

Vitamin Bl2 DeJiciency in Dementia Disorders. BJORN REGLAND. Departments of Psychiatry and Neuro- chemistry, St Jorgen Hospital, University of Goteborg, Sweden, 1991. No. of pages: 148.

This book is a doctoral thesis from the Departments of Psychiatry and Neurochemistry of the University of Goteborg, in Sweden. It maintains the tradition of tech- nically excellent, thoughtful Swedish doctoral theses on the subject of dementia.

The department from which this thesis comes has for some years been championing the possibility that dementias of later onset are often more usefully approached as the result of a multifactorial process rather than of a single if complex disorder such as Alz- heimer’s disease or cerebrovascular disease. This idea can be approached from at least two viewpoints. One, which is well accepted, is that a variety of different dis- orders can cause dementia in the elderly. The second, less well accepted, is that a variety of different disorders often converge in the same patient, pushing that indivi- dual above the threshold of clinical disability.

Dr Regland’s thesis focuses on B12. It starts with a masterful, comprehensible review of this complex and well-studied area of metabolism. He then describes stu- dies in over 250 patients, both retrospective and prospec-

tive, which indicate that low B12 values are 4 5 times more common in patients with late onset Alzheimer’s disease than in an unselected population of the same age, and are more common among men than women. Treatment tends to improve the biochemical abnormali- ties associated with B12 deficiency. There is no discussion of the clinical effects of replacement therapy. The author proposes that functional B I Z deficiency may sometimes result from failure of transport mechanisms at the level of the blood-brain barrier, and that B12 deficiency might contribute to the white matter damage which is an increasingly recognized cause for the dementia syndrome in the elderly. B12 deficiency is, of course, known to cause white matter damage in younger patients with combined systems disease. Dr Regland implies that B12 supplemen- tation would have to begin before brain damage deve- loped in order to be effective.

The study of B12 in relation to dementia, schizophre- nia, and other neuropsychiatric disease has a long his- tory, and Dr Regland’s thesis is not the last word on the subject. It is, however, a valuable contribution and a stimulus for further research.

JOHN P. BLASS The Burke Rehabilitation Center, White Plains, New York

Subcortical Dementia. Edited by JEFFREY L. CUMMINGS. Oxford University Press, New York, 1990. No. of pages: 267. Price: &35.

According to the preface, this book is intended primarily for a clinical audience and these intentions are well met. Subcortical Dementia is a concise yet comprehensive review of what is still a difficult and controversial area. The editor’s introduction usefully discusses terminologi- cal controversies and criticisms of the concept and includes an informative comparison of the main charac- teristics of cortical and subcortical dementias.

The rest of the volume has three main components. In chapters 2-6 the concept of subcortical dementia is presented and discussed first from an historical and then from a neuroanatomical, neurochemical and neuropsy- chological perspective. These chapters are written in a succinct and well-structured manner that will provide an excellent introduction for the newcomer to the area.

The following nine chapters are individually devoted to examining those disorders that comprise the subcorti- cal dementia syndrome, including Huntington’s disease,

Parkinson’s disease, progressive supranuclear palsy, multiple sclerosis, and the AIDS dementia complex. In each case, the dementia syndrome produced by the differ- ent neuropathologic conditions and the distinguishing clinical and neuropsychological characteristics are conci- sely described by acknowledged experts in the field. Again, these chapters will more than satisfy those seeking a comprehensive overview of the various conditions des- cribed, although they will prove rather too succinct for those with a well-developed interest in any particular subcortical disorder. At the end of the book a frontal- subcortical model of normal ageing is proposed and human thought is all too briefly discussed in terms of subcortical mechanisms.

In summary, in bringing together a wealth of infor- mation regarding the concept of subcortical dementia, this excellent text has much to offer clinicians, neuropsy- chologists and geriatricians alike.

ADRIAN OWEN Institute of Psychiatry, London