Defying dementia

OVERALL RATING Poor

STRENGTHS Interesting and important topic

WEAKNESSES Unsupported statements; inappropriate language for intended audience

AUDIENCE Intelligent lay-people

Defying Dementia is a disappointing offering that doesn’t adequately serve the needs of its intended audience of “intelligent lay people” who want to learn about dementia and its prevention. While recent research indicates we might be able to delay the onset of dementia by treating vascular risk factors and following a healthy lifestyle, the author goes beyond the available data to make unwarranted statements. Levine does not deal well with the potential of harm arising from some of his suggestions. I can’t recommend this book to either the general public or family physicians.

The first part of Defying Dementia deals with dementia, its confounders, and causes. It is too long, taking up approximately two-thirds of the book. The terminology used is more appropriate for a medical audience. How many well-educated lay readers would even understand terms like “amyloid beta derived diffusible ligands” and abbreviations such as APOE-4, PSEN1, or PSEN2? Family physicians who want an introduction to the various forms of dementia would be better served by a recent review article such as “The primary care of Alzheimer disease” by C.D. Rubin.1

The lifestyle recommendations, though difficult to argue against, have not been proven as ways to prevent dementia. We already have convincing reasons for patients to be more active and to follow a healthier diet. I have greater concerns about other suggestions; for example, Levine states that daily acetylsalicylic acid is “one of the major weapons in our arsenal in the battle against … dementia.” Yet the observational data for this is inconclusive.2 In fact, a controlled trial examining whether ASA prevented cognitive decline was negative.3 And no mention is made of the increased risk for both hemorrhagic strokes and gastrointestinal bleeding with ASA.4 When advising individuals on disease prevention, we must be confident that we’ll see the greatest good for the greatest number. We aren’t there yet for the prevention of dementia.

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