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Alzheimer Disease, Down Syndrome and Their Relationship. - book reviews

Age and Ageing, Nov, 1994 by Alistair Burns

Edited by J. M. Berg, H. Karlinsky and A. J. Holland

Oxford: Oxford University Press. 1993. 297 pp. Price 55.00[pounds] (hardback).

Alois Alzheimer was aged two when John Langdon Haydon Down described the characteristic phenotype of Down's Syndrome (now known as Down Syndrome). It took over 100 years for the two to be connected, at first glance not a promising prospect with a neurodegenerative disease affecting the elderly and a disorder with a characteristic chromosomal abnormality affecting children. The key association was finding Alzheimer's disease (clinically and pathologically) in the majority of patients with Down's Syndrome who were in their 40s and 50s. It has taken less time since that observation for this rather clumsily titled text to appear; it summarizes comprehensively the association between the two conditions.

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Edited by major players in the field, the book kicks off with an overview of each disorder followed by a review of the evidence of an association and a section on diagnosis and management (consisting of an excellent overview followed by an `experiences' chapter). The last two sections sit somewhat uneasily--specific assessment and diagnostic research in patients with Alzheimer's disease and Down Syndrome and aetiological factors.

One of the inevitable problems of the book is the synthesis of the two conditions. With some exceptions, most of the authors are better known for their work on Down Syndrome and this gives the impression of one-way traffic (a bit like asking directions to a particular destination only to be met with the reply `I wouldn't start from here') . As with all books, some chapters are better than others and of particular interest are the contributions on aetiological factors, clinical observations, diagnosis and neuropathology.

For researchers in Alzheimer disease, Down Syndrome represents the rather distastefully described `natural experiment', ignoring the inherent complexities introduced by such a tangential scientific step. There is no doubt that looking at the changes in Down Syndrome can `partial out' some of the processes occurring in Alzheimer's disease. Only if those are exploited can advantage be taken for two groups of people who have been relatively neglected by the caring professions--those with learning disabilities and the elderly mentally ill. If such a combination were to lead to real scientific advance it would be somewhat of an irony.

This is an excellent book and should be an essential starting point for anyone interested in either disorder, and in particular anyone launching themselves into a study combining the two.

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Alzheimer Disease, Down Syndrome and Their Relationship. - book reviews

Age and Ageing, Nov, 1994 by Alistair Burns

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