In “The Problem of Alzheimer’s Disease” Dr. Jason Karlawish, the co-director of the Penn Memory Center at the University of Pennsylvania School of Medicine in Philadelphia, provides a superb and comprehensive analysis of “the disease of the century”, from the standpoint of a clinician who routinely diagnoses and treats patients with all forms of dementia, including Alzheimer’s disease, who is also a physician researcher, bioethicist, and medical historian who has spent his career studying this dreaded and pervasive illness that has afflicted millions of people around the world, and adversely affected many other family members of the sufferers.

Karlawish begins by noting a landmark 1976 editorial in the journal Archives of Neurology by Dr Robert Katzman, the chairman of the Department of Neurology at Albert Einstein College of Medicine, titled “The Prevalence and Malignancy of Alzheimer Disease,” which first sounded the alarm about the high prevalence of this underrecognized cause of morbidity and mortality in elderly Americans, a disease that he estimated to be the fourth or fifth most common cause of death in the United States. His commentary did not fall on deaf ears, as the National Institute of Aging, a new division within the National Institutes of Health, chose Alzheimer’s disease as its primary focus, bipartisan political support for this dreaded disease led to more funding and greater public attention on this malady, and researchers worked tirelessly to discover diagnostic techniques that would permit earlier and more definitive diagnoses, and uncover new medications targeted at the processes that caused the disease to progress. Forty five years have passed since Dr Katzman’s call to action, yet Alzheimer’s disease has neither been cured nor alleviated to an appreciable degree.

Part 1 of "The Problem of Alzheimer’s" describes what Alzheimer’s disease is, how it is diagnosed, and how it differs from other forms of dementia, such as Lewy body disease. The stages of the disease are characterized, the burden of moderate and severe Alzheimer’s on spouses, children and other family members is chronicled, and the astronomical cost of care is mentioned. The modern history of Alzheimer’s disease is recounted, with detailed descriptions of the researchers and clinicians whose studies were the most important in advancing knowledge about it. Part 2 recalls the early history of the disease, which was first described by the German psychiatrist Dr Alois Alzheimer in the first decade of the 20th century, based on a small number of patients he cared for, along with meticulous studies of biopsied and stained brain tissue after their deaths, which first demonstrated the plaques and tangles that are characteristic of this form of dementia. In Part 3, Dr Karlawish describes the sociopolitical barriers that prevent Alzheimer’s patients from receiving adequate and optimal care for the disease and its sequelae, and Part 4 serves as a second call to action, while acknowledging the limitations and barriers that must be overcome to give the best care for these patients, along with the great distance that must be bridged before a true cure is achieved.

"The Problem of Alzheimer’s" is written for a lay audience, yet it has enough detail to satisfy scientists, clinicians and policy makers who wish to understand more about the science behind the different medications and diagnostic modalities available for people with the disease. My mother has moderate Alzheimer’s disease and is followed by one of Dr Karlawish’s colleagues at the Penn Memory Center, so this book was both essential and very helpful, now that I have assumed the role of primary caregiver of Mom after my father’s recent death. ( )