The 36-Hour Day (3rd Edition)

Book Review

Am J Geriatr Psychiatry 9:2, Spring 2001 179

what approaches succeed in accu-rately predicting or diagnosing AD.

Daniel L. Murman, M.D., M.S., isAssistant Professor, Department ofNeurology, Michigan State Univer-sity, East Lansing, MI.

The 36-Hour Day(3rd Edition)

Edited by Nancy L. MaceBaltimore, MD, Johns HopkinsUniversity Press, 1999ISBN 0-8018-6148-9, $39.95

Daniel Weintraub, M.D.

This is the third edition of The 36-Hour Day, which, for almost 20years, has been the standard guidefor caregivers to people with Alzhei-mer’s disease (AD) and other de-menting illnesses. Last published in1991, this edition aims to bring read-ers up to date on developments ofrelevance to caregivers.

Although the book was writtenfor a lay readership, psychiatrists andother physicians will find a wealth ofvaluable, practical information that israrely taught during medical schoolor residency training. The focus ofthe book remains the provision ofday-to-day care and the complica-tions inherent in that, to people withdementia. For the most part, the ma-terial is logically arranged, with 18subdivided chapters. The book be-gins with a good overview of demen-

tia and the assessment process forsomeone suspected of having AD.The assessment section seemedsomewhat outdated, as the model ofa dementia clinic staffed by a multi-disciplinary team currently existsonly at academic centers and is notlikely to be accessible to most peo-ple. The heart of the book thor-oughly addresses the cognitive, psy-chiatric, medical, and functionalimpairments that accompany thevarious stages of AD. The latter halfof the text starts with a discussion ofthe psychological impact that caringfor people with AD has on caregiversand families and ends with advice onplanning for the future, tips for ac-cessing resources, and a brief medi-cal overview of dementing illnesses.There are also several appendicesthat contain useful names and ad-dresses.

The book’s strengths are many.The writing style is simple andstraightforward. The middle sectionpainstakingly details symptom pre-sentation, differential diagnosis, andpractical solutions for almost anyconceivable problem that may be en-countered by caregivers. Subsequentchapters empathetically acknowl-edge and offer advice on coping withthe physical and psychological strainthat caregivers and their families en-dure. Also helpful is the provision ofessential information about financialand legal matters, support services,and various living arrangements.

The major weakness of the bookis its offering of suggestions to care-

givers that are obvious or ordinary tothe point of becoming cliches, mak-ing for a writing style that is toofolksy in sections. The word cata-strophic is misused to describe anyadverse reaction by someone withAD. Physicians, and even the lay read-ership, will find the medical discus-sion lacking in detail, particularly inlight of the book’s primary aim toprovide new information since thelast edition. For instance, there is lit-tle mention of psychopharmacology,yet many people with AD will re-ceive medication for a psychiatricsyndrome at some point. It alsowould be advantageous to have themedical discussion placed at the be-ginning of the book, where it can re-ferred back to at appropriate points.

The book is dense with materialin parts (although this is not a short-coming), so it is difficult to read largesections at a time. As a result, health-care practitioners will find the bookmost useful as a reference guide forthemselves and their patients’ fami-lies or as an educational text formedical students and residents.

The 36-Hour Day remains thegold standard of caregiver guides forAD and other dementing illnesses. Itspractical orientation, thoroughness,and focus on empathy and supportcontinue to make it as valuable a re-source as it was when it first burst onto the scene 20 years ago.

Daniel Weintraub, M.D., is Assis-tant Professor of Psychiatry, Univer-sity of Louisville School of Medicine,Louisville, KY.