302 BOOK REVIEWS

Reservations concerning the book must reflect the poor service the author appears to have had from his publishers. A delay of over 2 years between submission and publication for a work of this type can have little justification. Moreover, it has become physically unwieldy in its new format, which also emphasises a certain lack of ‘user-friendliness’. For instance, there is but a single, essential, set of illustrative line drawings in some 650 columned pages, and a dearth of summary material, pictorial or otherwise, to assist student or

reference users with what is a rich but lengthy text. These administrative and editorial blemishes should not deny the author any of the gratitude due to him from the clinical community for the tremendous service that his book will continue to represent.

C. J. MACE Lecturer in Neuropsychiatry,

Institute of Neurology, London

Treatment Development Strategies for Alzheimer’s Disease. Edited by CROOK et al. Mark Powley Associates Inc., Madison, Connecticut. Pages: 699. 1986.

This is the third in a series of books resulting from a collaboration between the U S government, industry and academia, co-ordinated by the National Institute of Mental Health. The first in the series was published in 1981 under a similar title, Strategies for the Development of an Effective Peatment for Senile Dementia, with the goal of stimulating the development of innovative treatments for Alzheimer’s disease and related disorders. The present book has much the same objective, but takes account of the rapid growth of neuroscience research relevant to Alzheimer’s disease over the intervening years.

The book is rather long at just under 700 pages. The 29 chapters are mainly written by American groups, but there are also contributions from British, Italian and Swedish laboratories. Authors were asked ‘to develop a chapter providing a rationale to guide drug development in Alzheimer’s disease (AD) and to conclude the chapter with specific recommendations for future clinical trials.’ Only a minority of chapters concentrate on the cho- linergic system, the rest being more or less speculative. Many of the treatments considered are unorthodox. Sapolsky and McEwen, for example, fly their kite ‘Stress, glucocorticoids, and their role in degenerative changes in the aging hippocampus’ with gusto. The chapter ends unabashed: ‘A decade ago, to write a chapter such as this filled with recommendations about the management and

even the retardation of the onset of A D would have been considered floridly delusional. At present, it is merely speculative and extrapolative to an extreme.’

Inevitably there is some overlap in a book like this, where imaginations roam over the same territory. However, I began to find the constant therapeutic optimism jarring: we d o not really seem to be any nearer an effective treatment than we were 5 years ago. Of course, I am pleased that many clever researchers are interested in dementia, that funds are going towards support of their work, and that industry sees senile dementia as a major opportunity for new drugs, but I am not convinced that more knowledge leads inexorably to better treatment. Certainly, I would not feel highly motivated to mount clinical trials with most of the agents which are the object of speculation in the book.

Through the generosity of their procedures I have been sent free copies of all three books in this series from the USA, and I am grateful to my American friends and colleagues. I am bound to say that I think the second, Assessment in Geriatric Psychopharmacology, published in 1983, was the most successful. I still find that a useful reference source and I lend it to research workers new to the field of clinical trials in dementia. No doubt I will occasionally use the present volume to look up references, but I will not be recommending it to my co- workers nor would I have bought it for myself.

ROGER BRIGGS Professor of Geriatric Medicine,

University of Southampton