Book Review: APA Handbook of of Dementia Anthony F. Tasso, PhD Fairleigh Dickinson University Chair, Department of Psychology & Counseling
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eurocognitive disorders are one of the most destructive and life-altering ailments, with the fear of developing dementia even surpassing the fear of a cancer diagnosis. At its worst, dementia, that includes vascular dementias, AIDS-related, Lewy body (LBD), frontotemporal, and of course, Alzheimer’s disease (AD) completely eradicates any semblance of the individual, wreaking havoc on the inflicted, as well as the loved ones forced to bear witness to the figurative, and eventual actual, disappearance. Even less severe neurodegenerative deficits have grave effects, resulting in significant quality-of-life issues undeniably interfering with one’s ability to love, work, and play. With almost six million Americans currently diagnosed with some form of dementia, the emotional tab of these illnesses is immeasurable; although the annual Medicare and Medicaid tally comes in at an astonishing $160 billion (Alzheimer’s Association, 2016). The fact funding from the national Institute of Health for dementia significantly lags behind cancer and AIDS does not help, particularly as death rates from neurocognitive diseases are accelerating, adding further dread among the US population. Given this increasing impact on the population at-large, the American Psychological Association (APA) published a comprehensive text on the broad domain of dementia. As part of the APA’s highly productive “Handbook series” (20-plus and counting), the nearly 700-page APA Handbook of Dementia (2018) provides wide-ranging assistance to psychologists by offering an overview of the extant empirical and practical literatures on neurocognitive disorders. Editor-in-Chief Glenn Smith brings together more than 70 pre-eminent scholars to plumb the breadth and depth of this most dreaded illness. APA Handbook opens by discussing diagnostic criteria for dementia (e.g., declining cognitive functioning in at least two domains, including social abilities), as well Winter 2020
Smith, G.E. (Ed.) (2018) Washington, DC: American Psychological Association.
as the non-linear progression of the disease, noting how 10-30% of individuals have neuropathological biomarkers (e.g., neuritic plaques, neurofibrillary tangles), yet do not exhibit discernable manifestations of the disease for decades, or ever. The text underscores how the apparent etiological x-factor is neuronal loss suggesting that AD and other dementias can lie dormant until the inflicted experiences a significant loss of neurons. APA Handbook outlines the data identifying upwards of 20 AD risk genes, with particularly attention to apolipoprotein E (APOE), and explains how Alzheimer’s is characterized by extracellular amyloid-B (AB) and intracellular tau deposits. The text explicates two types of Alzheimer’s disease: hippocampal-sparing AD that affects more of the cortex and less of the hippocampus and has an earlier onset (mean onset 63 years-old). This subtype is on contrast with the more limbic-based, hippocampus-focused AD, with a mean onset of 76 years-old. APA Handbook describes the common trajectory of AD’s presentation, with the typical first stage comprised of anterograde episodic memory, followed by impaired executive and attentional functioning along with possible deterioration in semantic and visuoperceptual capabilities. This contrasts Lewy Body Disease that is characterized by more motoric symptomatologies concurrent with cognitive decline, with neuronal loss experienced in the substantia nigra, caudate, and putamen with a concomitant underfunctioning of dopamine. APA Handbook devotes a separate chapter to the assessment of the different dementias beginning with Alzheimer’s Disease that accounts for 60-80% of all dementia cases and affects 11% of people 65 and over and those numbers increasing to 32% for those 85 years old and older. As the sixth leading cause of death, APA Handbook highlights factors associated with AD pathology (e.g., neuronal atrophy, synapse loss, abnormal accumulation of amyloid plaques and neurofibrillary
tangles in the limbic structures and cortices). The text also examines AD’s clinical presentation: episodic memory impairment, followed by impaired memory consolidation and encoding that creates difficulty in transferring newly learned information into longer-term memory. It is later characterized by diminished semantic memory and compromised use of language, eventually giving way to executive functioning deficits. The text identifies how Lewy body disease and Parkinson’s disease both follow a similar progression, although they vary in severity that has a subset of investigators hypothesizing that the two diseases represent different stages of the same underlying pathology rather than disparate conditions. Frontotemporal dementia (FTD, or Pick’s disease) is the third most common neurodegenerative dementia (behind Alzeimer’s and Lewy body) and is denoted by its early onset, with a mean age of onset is 58 years old. APA Handbook overviews the clinical symptoms of FTD that include motor disinhibition, apathy or inertia, compulsatory behaviors, diminished executive functioning, and language deterioration. The book describes how strokes or even “minor” cerebral hemorrhages can lead to alterations in white matter, the likely cause of vascular dementia (VaD). APA Handbook addresses the pathogenesis of HIV-associated neurocognitive disorder (HAND) that is the virus’ ability to cross the blood-brain barrier and infiltrate the central nervous system. The book reports on the early accounts of HAND during the heyday of the AIDS crisis, first seen in a subset of men with AIDS demonstrating impaired abstract thinking, trouble with learning, and slowed cognitive processing. This disease has witnessed a significant reduction in symptomatology thanks to today’s more sophisticated HIV/AIDS treatments. Traumatic brain injuries and subsequent longer-term neurological sequelae are studied by exploring chronic traumatic encephalopathy (CTE, now more commonly called trau23
