A Caregiver’s Guide to Communication Problems from Brain Injury or Disease edited by Barbara O’Connor Wells & Connie Porcaro, Johns Hopkins University Press, 2022, 256 pp.

This volume is a comprehensive presentation of what caregivers can do to help patients with communication problems caused by brain disorders. The authors are distinguished speech and language pathologists who carefully consider both the needs of the patient and the family. Chapters consider important issues of healthy and pathological aging, swallowing, aphasia, and neurodegenerative disorders. The authors wisely consider the biological basis of communication problems, as well as important psychological and social issues, including quality of life. The effects of Alzheimer’s, Parkinson’s, and stroke are carefully presented from both a medical and psychological viewpoint.

The authors unfortunately present an incorrect view of dementia. They report that “ . . .  dementia is a general term for various diseases and conditions characterized by a decline in memory, language, problem solving and other thinking skills that affect a person’s ability to perform everyday activities”. They also state that “Dementia is a progressive disorder...” This is a widespread and unfortunate misunderstanding. Dementia is a syndrome, and not a disease. It is important to recognize that using the term “dementia” as a diagnosis is to miss the opportunity to identify the cause of cognitive impairment. Moreover, patients with dementia do not always have a progressive disorder. A person may have dementia and have a completely reversible condition, such as hypothyroidism, vitamin B12 deficiency, drug toxicity or countless other conditions. Use of the term “dementia” as a diagnosis in such a patient obscures recognition of what is really happening.

The authors present a valuable discussion of the biological basis of the communication problems they address. However, they incorrectly refer to neurofibrillary tangles as “knots of brain cells made of tau protein” (they are knots of tau protein inside brain cells). The consideration of dementia with Lewy bodies would have been an important addition to the book.

The book contains valuable advice about how to interact with patients with communication disorders The authors present an important discussion of the interactions of physical, intellectual, social and emotional issues which influence brain diseases with aging.

The book is a highly worthwhile guide for caregivers to assist in dealing with communication problems suffered by patients with brain injury or disease. I recommended the book highly to caregivers and as well as nurses, social workers, speech language pathologists and others who are involved in the care of these persons and their families.

Robert P. Friedland, MD

Professor of Neurology

University of Louisville School of Medicine

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