600 Book Reviews

F. A. HUPPERT, C. BRAYNE and D. W. O ' C O N N O R (Edsl: Dementia and Normal Aging. Cambridge University Press, Cambridge (1994). xiii + 573 pp. £55.00.

The crucially important debate about the relationship between dementing conditions and the processes involved in aging is well covered in this considerable volume. The scope of the book is ambitious, covering historical, clinical, behavioural and neurobiological issues and making some reference to the implications of findings in these areas to health and social policy. The book is based on a simple but robust finding in the research literature on dementia. The older one is the higher the risk that one could develop a dementia. Not only this but this risk actually increases exponentially the longer you survive. This has to beg the question that is it the aging process itself that leads to progressive cerebral deterioration which if severe enough results in a dementing illness? Or should the dementias be regarded as a discrete set of diseases of the brain due to the action of agent or agents unknown? This book is an attempt to bring together theoretical considerations and research findings from a wide variety of fields in order to provide some guidance on this vexed question.

The book begins with a historical analysis by Lishmafi of how the field came to be as it is with a particularly good contribution on the relationship between the aging and dementia debate and how the dementia field has developed to give rise to this debate. There follow some contributions on the clinical appearance of dementia and how this relates to aging. There is a very important but rarely included section on population studies on normal aging and dementia and important risk factors for dementia. There is an outstanding contribution by Mortimer providing a succinct analysis of the various risk factors that have been postulated in Alzheimer's Disease.

The second half of the book deals with three principal topics: the differences in behaviour and cognition of those individuals with dementia and those without; some of the neurobiological issues involved in the debate; and the health and social implications of a cont inuum model of dementia. The section on cognitive and behavioural changes in dementia and normal aging comes out strongly in favour of a cont inuum model of dementia and aging. Most abilities decline with increased age and dementia seems to represent a quantitative rather than qualitative impaired ability. Huppert produces a good chapter on one of the central issues in the area; does memory functioning in dementia differ qualitatively from the decline usually associated with the aging process? Based on recent clinical and experimental evidence, the answer to this question would seem to be a clear "'no". The neurobiological markers distinguishing aging from dementing illnesses is an interesting topic and the there are also contributions on neurochemical and genetic linkage issues in ageing and dementia. Some of the implications of a continuum model of dementia for health care provision are discussed in the final chapters of the book.

Dementia and Normal Aging lives up to its title in providing a good source of the current understanding in various sciences on the relationship between the ageing process and the dementias. The evidence collected in this volume points clearly towards the existence of a cont inuum including both the cerebral changes that all individuals undergo as they age and the progressive neurodenegerative diseases which occur most commonly in older people. Naturally, a book on such a wide ranging subject suffers somewhat in its focus. This particularly appears to be the case with the health and social care policy implications of these findings which seem a little out of place in this volume. They are needed somewhere, however, and their inclusion does not ultimately detract from a generally excellent publication. This is probably a title for reference use for most because of its price but essential reading for practitioners as well as researchers working with older people.

STEPHEN DAVIES

M. HERSEN, R. EISLER and P. MILLER (Eds): Progress in Behaeior Modification (Vol. 29). Brookes/Cole, Pacific Grove, CA (1994). xii + 155 pp. $40.00

It is good to see this valuable series still going strong. It comes in a new format, under the imprint of a new publisher. The editors in their Preface state their plans for the future: to represent new directions in the field of behaviour modification, to print in-depth evaluations of theoretical underpinnings, to publish careful surveys of research findings, and to offer critical comparative analyses of existing technical applications and methodologies. The scope to be covered will be very wide, including all areas of behaviour modification including behavioural medicine. Scholars and students alike will be reassured by this editorial statement.

As for the present volume, which is quite attractively produced, it has six chapters covering a diversity of fields. They are: panic and agoraphobia, stereotypical behaviours in persons with visual impairments, parent adolescent conflict, role plays in behavioural assessment, behavioural medicine with military veterans, and helping parents of children with conduct disorders. Thus, there is a combination of widely discussed and well established areas and those less well established. The chapters are well written, and present good accounts of the state of play in their areas. Particularly commendable is the chapter on panic and agoraphobia which manages to be comprehensive despite the limitations of space. The comments on attrition and relapse are especially useful. The chapter on behavioural interventions to reduce stereotypical behaviour in the visually impaired makes a novel contribution and provides a thorough survey of the literature. The highlighting of these two chapters should not be taken as an adverse comment on the others. In fact, all the chapters are, in their different ways, excellent.

In summary, the editors have once again produced a most valuable volume. P. DE SILVA

MILTON G R E E N B L A T T and PAUL R ODE NHAUS E R: Anatomy of Psychiatric Administration. Plenum Press, New York (1993). xxv + 371 pp. $47.50.

With the explosion in the management in the health services on both sides of the Atlantic, it is interesting to observe that social psychiatry has taken the lead in the management and service issues. Social and community psychiatrists are in the forefront of assessing needs of patients, monitoring hospital closures, ascertaining health economy and exploring various other related issues. It is heartening as well as dispiriting. One can almost hear one's conscience crying out that clinicians