Nutrition and Huntington's Disease, A practical guide--A multidisciplinary approach. (Book Reviews).

van Broekhoven-Grutters E, Gassbeek D, Veninga-Verbans M, Atlant Zorgroep, Apeldoorn, 2000, 70 pages, $30.00, ISBN 90-805882-1-0

This book is the result of the extensive knowledge and practical expertise of a dietitian, nursing home physician and a speech pathologist who work in a nursing home in The Netherlands which has a specialised unit for patients with Huntington's disease. It is an excellent practical guide and extensively covers the Huntington's disease area. It is a small book that is easy to read and the information is well presented. The problems encountered in Huntington's disease are thoroughly outlined and management solutions given. The topics covered include: Huntington's disease genetics, clinical presentation and stages of progression; nutritional needs and how to achieve optimum nutrition; communication and swallowing problems and management; malnutrition screening; limitations in feeding behaviour (including the impact of cognitive problems); other nutritional problems--vomiting and constipation; tube feeding and also the ethical aspects of tube feeding; medication and nutrition.

The book has a number of strengths. The focus is on maintaining the quality of life of the person with Huntington's disease and the maintenance of their independence for as long as possible. This is very important as no cure for Huntington's disease currently exists and patients can live for many years. The section on communication is written from the perspective of the patient which is excellent and adds to improved understanding and management of the disease. There is a large section on swallowing problems and included in this is a discussion on how swallowing problems can be hidden among other clinical signs and symptoms. The section on limitations in feeding behaviour clearly outlines from the patient's perspective, the influence of cognitive deterioration and involuntary movements on the logistics of obtaining food, particularly in activities such as shopping and meal preparation and the impact that this can have on nutritional status. Case examples throughout the book are also a special feature.

There are minor English translation issues and country terminology differences which do not detract from the quality of the book. The book has limited specific details of suitable food and fluid consistencies for dysphagia management. The chapter on 'Ethical aspects of tube feeding' is very controversial in Australia and legal differences exist between Australia and The Netherlands on this issue. The book contains references at the end but is not referenced throughout the body of the work making it difficult at times to determine what is the authors practical observation and experience and what is the results of scientific research.

I have previously worked in a specialised Huntington's disease unit and I would recommend this book for any health professional who is either specialising in this area or who may see Huntington's disease patients as part of their hospital, community or private practice work. The book provides a large amount of information and practical advice at an inexpensive price.