Parkinson's disease in the older patient, 2nd edition

Thank goodness for fields such as gerontology which so enhance the single organ-based specialties and gene-centric approaches. Such cross-sectional disciplines improve all round management of individuals, as exemplified in this book, and ensure that we keep up to speed on life history, ecological and evolutionary concepts of disease.

This is important as the last 50-year track record of finding causes and cures of diseases of ageing, particularly in the face of rapid unexplained increases in longevity in rich nations, is not (lets be honest) that impressive considering the enormous effort largely from a laboratory-based research industry. Laboratory studies typically control the environment, unlike the real world, and that is an uncertain approach particularly given that genes have been known to be largely regulated by diet and stress signals since the birth of molecular biology and the discovery of genetic switches and the lac operon.¹Degenerative diseases that were solved earlier, such as B12 or B3 deficiency, affect more than one organ and involve both the supply of nutrients and personal genetic make-up. Neuroscientists working on sub-acute combined degeneration of the cord or pellagrous dementia armed with a modern brain and DNA bank but with minimal ecological data might well have been tempted down blind mechanistic alleys and struggled to figure out the root cause, yet this is now the central strategy for solving diseases of ageing.

In this edition the chapter authors ably inform us that we know a great deal about the interdisciplinary management of the ageing patient with Parkinson's disease and how it should be implemented often by breaking down artificial professional ties. Good chapters span conventional drug and surgical approaches and non-motor complications. The effect on quality of life gets ample room as do rightful concerns over nutrition, the carers, rehabilitation and palliation along with organisation of services and the vital role of nurse practitioners. Energetic management encouraging a ‘use it or lose it’ approach is implicit.

Tantalising hints as to the aetiology of Parkinson's disease are capably documented. I liked the book's cover picturing a forest showing light as the source of fluctuant energy and information forecasts from circadian rhythms illuminating both wood and trees. Is the human super-organism so different or just more complex with different sources of energy, more compartments and a greater panoply of homeostatic responses?

Medicine and education of the population in 50 years will surely be highly developed. Our long-lived, better developed and disease-free descendants may have to thank the theoreticians of ageing and development for seeing the common bioenergentic threads and available trade-offs between health and disease.

• © 2009 Royal College of Physicians