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Chief, Neurology Division Veterans Administration WNY Healthcare System Buffalo, New York
| By Mary S Mittelman DrPH, Cynthia Epstein ACSW, and Alicia
Pierzchala CSW. Published by the American Medical Association, Chicago, 2003.
ISBN 1-57947-262-1. Paperbound, vii + 346 pp. (23 x 15.5 cm), $39.95.
www.amapress.com
|
Published Online, February 20, 2003. www.theannals.com, DOI 10.1345/aph.1C411
This book contains 13 chapters that guide the reader from learning about the diagnosis of AD to counseling spouses and other family members about the progression of dementia over time. Checklists for counselors are provided at the end of each chapter. Support groups are addressed in one chapter, whereas other chapters focus on individual or family counseling. A particularly good chapter is the one on behavioral and psychological symptoms of AD. It explains the progressively lowered stress threshold of AD patients and the many lifestyle changes required of caregivers.
Several features of this book make it an excellent reference text for physicians to use when patients and their caregivers are seen in the office. In the chapter on behavioral symptoms, for example, there is a section titled, "Behaviors Typical of the Moderate and Severe Stages of AD." Separate paragraphs in this section discuss agitation, sleep disturbances, and delusional thinking. A real-life case is provided as an example of the interchange between caregiver and counselor. Nonpharmacologic strategies for managing difficult behaviors are stressed, but use of medications was alluded to (no specific drug names were mentioned).
The first chapter provides an excellent explanation of the Global Deterioration Scale (GDS), a tool that is useful in practice to track the progression of AD over time. Counseling notes are provided from real-life situations, illustrating the 7 stages of the GDS as a way to help family members cope with the patient's change in personality and performance.
Another interesting chapter discusses relationship-related issues: the long-distance caregiver, the adult child caregiver, and change of living arrangements required to accommodate the illness. Again, the inserts providing examples of real-life situations and positive counseling interventions are an important strength of this book. One weakness of this book is that there was only brief mention of the Clinical Dementia Rating scale, a tool that is easier to use in practice because only 3 stages of dementia are involved (mild, moderate, severe).
The lead author, Mary Mittelman, is the lead investigator of the NYU Spouse Caregiver Intervention Study. This clinical trial showed that caregivers in the treatment group were able to postpone placement for about 1 year longer than those in the control group. This "effect size" is as great as that seen with each of the cholinesterase inhibitors or with vitamin E. Her study also showed that a counseling intervention would improve quality of life for both the patient and the caregiver.
The quality of writing in this book is excellent. No spelling or grammatical errors could be identified on several readings of this text. The references are appropriately grouped at the end of the book instead of at the end of each chapter because they address general issues and not specific research findings. The index could have included more specific behavioral problems (hoarding, shoplifting, compulsive behaviors), but most of the common behavioral symptoms were included. The price is appropriate for counselors who practice in physicians' offices, assisted living facilities, and nursing homes. It is also an important addition to the bookshelf in day-care centers and volunteer organizations in the community.
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