Principles of Behavioral and Cognitive Neurology

Rating:
Summary: An Outstanding Review of the Neurological Basis of Behavior
Review: I first became aware of M.-Marsel Mesulam's work at a Harvard sponsored Behavioral Neurology conference more than a decade ago. Several of the co-authors of this book including David Bear, Antonio Damasio, Hanna Damasio, and Elliot Ross also presented at that conference. I obtained a copy of the first edition of Principles of Behavioral Neurology shortly afterwards. The goal of the original book was to provide introductory information about several important areas in behavioral neurology. Since that time I have continued to follow the work of this group of physicians and scientists and have benefited greatly from their insights into human consciousness, cognition, and behavior. I looked forward to the second edition of this book.

Principles of Behavioral and Cognitive Neurology (Second Edition) provides more comprehensive coverage than the first edition. The overall layout of the book is similar with chapters covering the anatomic substrates of cognition and behavior, mental state assessment, attentional systems, memory, aphasia syndromes, prosody, visual processing, temporolimbic epilepsy and perspectives on aging and dementia. New chapters written by Robert Post ("Neural Substrates of Psychiatric Syndromes") and M.-Marcel Mesulam ("Aging, Alzheimer's Disease, and Dementia: Clinical and Neurobiological Perspectives") have been added. Three chapters on electrophysiology and brain imaging have been dropped from the previous edition.

Dr. Mesulam writes the opening chapter "Behavioral Neuroanatomy - Large Scale Networks, Association Cortex, Frontal Syndromes, the Limbic System, and Hemispheric Specializations." He uses this chapter to develop his theory about how brain function is determined by the interaction and overlap of several discrete systems. For readers familiar with Mesulam's work he provided a preview of parts of this chapter in Brain 1998; 121: 1013-1052. He presents a detailed review of the five major cortical subtypes including commentary on architectonic differences, response patterns, and implications for behavior. He extends his concepts of the network functioning of the brain in additional chapters on "Attentional Networks, Confusional States, and Neglect Syndromes" and "Aging, Alzheimer's Disease, and Dementia: Clinical and Neurobiological Perspectives." Mesulam is a scientist as well as a clinician. He writes authoritatively about all of the subject areas and cites a broad literature. His plasticity theory to explain neuropathology of Alzheimer's Disease is especially compelling. He discusses the controversies involved in explaining the evolution of the characteristic brain lesions of Alzheimer's Disease - neuritic plaques and neurofibrillary tangles. Current theories suggest that a particular lesion is more important or diagnostic than the other. He illustrates the significance of both lesions. He also correlates the time course of the development of these lesions with clinical features of the illness. His treatment of disorders of attention is equally rigorous.

Antonio Damasio and Hanna Damasio write the chapter "Aphasia and the Neural Basis of Language." They cover the standard definitions and syndromes of aphasia and extend it to a theory of language processing. The chapter is more specific to aphasia than the first edition which also included a discussion of acalculia, apraxia, and Gerstmann's syndrome.

Elliot F. Ross writes "Affective Prosody and the Aprosodias." He authored this chapter in the first edition. The current chapter places less emphasis on the analogy with various aprosodia syndromes to aphasia syndromes. New experimental data is included and the implications for theory is discussed.

Robert Post's chapter "Neural Substrates of Psychiatric Syndromes" covers new ground for this text. It is the first step toward the incorporation of a more purely psychiatric knowledge base. The presentation of this chapter specifically lists the diagnostic criteria for several disorders, also suggesting that the intended audience is not psychiatrists. Dr. Post reviews what is known about structural and functional imaging studies in these disorders and the implications of these studies for the localization of these syndromes and treatment.

The chapter "Neuropsychological Assessment of Mental State" by Sandra Weintraub is a useful update from the first edition of this book. The table of mental state tests arranged by domain is updated to include recent developments like the CERAD test battery for dementia and rating scales for noncognitive symptoms of dementia. The rationale for an individualized approach is presented. Attention, mood and motivation are all important factors that affect specific testing. Dr. Weintraub presents a logical approach looking at arousal, working memory, and attention as state functions that affect the testing of domain specific channel-dependent functions. Those specific functions are explained and clinical examples are given. There is a good summary of the issues related to testing the elderly that includes a review of typical changes with aging, ceiling and floor effects, and how to approach early dementia at the stage where there is amnesia but no other features of dementia.

"Temporolimbic Epilepsy and Behavior" is a multiauthored chapter by Donald L. Schomer, Margaret G. O'Connor, Paul Spiers, Margitta Seeck, M.-Marsel Mesulam, and David Bear. The clinical aspects of this disorder are well described including the necessary diagnostic testing and treatment. The authors also discuss difficult to treat symptoms such as interictal psychosis. Their opinion that these conditions "might be better termed paranoid schizophrenia or schizoaffective disorder in modern psychiatric nomenclature" is consistent with clinical observation. The importance of classifying symptoms on an ictal versus interictal basis and the implications for treatment are discussed.

Hans J. Markowitsch authors the chapter "Memory and Amnesia." He reviews the clinical subtypes of memory, anatomic substrates of memory problems, and common clinical syndromes. The section on functional amnesias is more elaborate than the earlier edition including some of the author's study of psychogenic amnesia. He discusses the neurology of psychogenic amnesias and some of the possible mechanisms. There is also a section on "Distorted Memory and Paramnesias." Dr. Markowitsch includes several conditions of interest to psychiatrists including Capgras syndrome and other reduplicative paramnesias. His discussion of these phenomena as memory rather than psychosis-related has theoretical and clinical importance to psychiatrists.

"Disorders of Complex Visual Processing" is authored by Antonio Damasio, Daniel Tranel, and Matthew Rizzo. The specific differences between true visual agnosia and other syndromes is discussed as well as the evaluation procedure. There is a detailed discussion and review of prosopagnosia and other disorders of facial recognition. The authors include reports and interpretations of several of their interesting experiments on nonconscious recognition of familiar faces and dissociations between electrodermal responses to stimuli in conscious and nonconscious facial processing. They show that these findings are consistent with separate representations of emotional and factual information relevant to specific stimuli. In addition to rare visual processing syndromes, the authors also discuss more common disorders of spatial orientation, constructional ability and dressing ability. The authors provide experimental and historical data consistent with their conceptualizations of the disorders.

This is an excellent book that works at many levels. This brief review does not capture the careful writing or density of information on the pages of this book. Clinical neurologists and psychiatrists can study the theories and neuroanatomy and correlate these with their ongoing clinical experience. Behavioral neurology has added a lot of information about subspecialization in the cortex of the human brain and that needs to be incorporated into clinical practice. I could also see this book as an excellent supplement to basic science courses in neuroanatomy and neurophysiology. Other specialists and researchers will find abundant information to enhance their understanding of the basic science of behavior. As I read through the theory sections, I found myself thinking about experiments that could test some of the key concepts. The book is written with a style that provides both historical context and a synthesis of current information. The authors of this text are leaders in the field. Their expertise covers both clinical and basic science aspects of human behavior and their approach is unique. The authors of Priniciples of Behavioral and Cognitive Neurology collect their essays in one place and provide you with a reference point for studying their current and future work.

George Dawson, MD

Rating:
Summary: An Outstanding Review of the Neurological Basis of Behavior
Review: I first became aware of M.-Marsel Mesulam's work at a Harvard sponsored Behavioral Neurology conference more than a decade ago. Several of the co-authors of this book including David Bear, Antonio Damasio, Hanna Damasio, and Elliot Ross also presented at that conference. I obtained a copy of the first edition of Principles of Behavioral Neurology shortly afterwards. The goal of the original book was to provide introductory information about several important areas in behavioral neurology. Since that time I have continued to follow the work of this group of physicians and scientists and have benefited greatly from their insights into human consciousness, cognition, and behavior. I looked forward to the second edition of this book.

Principles of Behavioral and Cognitive Neurology (Second Edition) provides more comprehensive coverage than the first edition. The overall layout of the book is similar with chapters covering the anatomic substrates of cognition and behavior, mental state assessment, attentional systems, memory, aphasia syndromes, prosody, visual processing, temporolimbic epilepsy and perspectives on aging and dementia. New chapters written by Robert Post ("Neural Substrates of Psychiatric Syndromes") and M.-Marcel Mesulam ("Aging, Alzheimer's Disease, and Dementia: Clinical and Neurobiological Perspectives") have been added. Three chapters on electrophysiology and brain imaging have been dropped from the previous edition.

Dr. Mesulam writes the opening chapter "Behavioral Neuroanatomy - Large Scale Networks, Association Cortex, Frontal Syndromes, the Limbic System, and Hemispheric Specializations." He uses this chapter to develop his theory about how brain function is determined by the interaction and overlap of several discrete systems. For readers familiar with Mesulam's work he provided a preview of parts of this chapter in Brain 1998; 121: 1013-1052. He presents a detailed review of the five major cortical subtypes including commentary on architectonic differences, response patterns, and implications for behavior. He extends his concepts of the network functioning of the brain in additional chapters on "Attentional Networks, Confusional States, and Neglect Syndromes" and "Aging, Alzheimer's Disease, and Dementia: Clinical and Neurobiological Perspectives." Mesulam is a scientist as well as a clinician. He writes authoritatively about all of the subject areas and cites a broad literature. His plasticity theory to explain neuropathology of Alzheimer's Disease is especially compelling. He discusses the controversies involved in explaining the evolution of the characteristic brain lesions of Alzheimer's Disease - neuritic plaques and neurofibrillary tangles. Current theories suggest that a particular lesion is more important or diagnostic than the other. He illustrates the significance of both lesions. He also correlates the time course of the development of these lesions with clinical features of the illness. His treatment of disorders of attention is equally rigorous.

Antonio Damasio and Hanna Damasio write the chapter "Aphasia and the Neural Basis of Language." They cover the standard definitions and syndromes of aphasia and extend it to a theory of language processing. The chapter is more specific to aphasia than the first edition which also included a discussion of acalculia, apraxia, and Gerstmann's syndrome.

Elliot F. Ross writes "Affective Prosody and the Aprosodias." He authored this chapter in the first edition. The current chapter places less emphasis on the analogy with various aprosodia syndromes to aphasia syndromes. New experimental data is included and the implications for theory is discussed.

Robert Post's chapter "Neural Substrates of Psychiatric Syndromes" covers new ground for this text. It is the first step toward the incorporation of a more purely psychiatric knowledge base. The presentation of this chapter specifically lists the diagnostic criteria for several disorders, also suggesting that the intended audience is not psychiatrists. Dr. Post reviews what is known about structural and functional imaging studies in these disorders and the implications of these studies for the localization of these syndromes and treatment.

The chapter "Neuropsychological Assessment of Mental State" by Sandra Weintraub is a useful update from the first edition of this book. The table of mental state tests arranged by domain is updated to include recent developments like the CERAD test battery for dementia and rating scales for noncognitive symptoms of dementia. The rationale for an individualized approach is presented. Attention, mood and motivation are all important factors that affect specific testing. Dr. Weintraub presents a logical approach looking at arousal, working memory, and attention as state functions that affect the testing of domain specific channel-dependent functions. Those specific functions are explained and clinical examples are given. There is a good summary of the issues related to testing the elderly that includes a review of typical changes with aging, ceiling and floor effects, and how to approach early dementia at the stage where there is amnesia but no other features of dementia.

"Temporolimbic Epilepsy and Behavior" is a multiauthored chapter by Donald L. Schomer, Margaret G. O'Connor, Paul Spiers, Margitta Seeck, M.-Marsel Mesulam, and David Bear. The clinical aspects of this disorder are well described including the necessary diagnostic testing and treatment. The authors also discuss difficult to treat symptoms such as interictal psychosis. Their opinion that these conditions "might be better termed paranoid schizophrenia or schizoaffective disorder in modern psychiatric nomenclature" is consistent with clinical observation. The importance of classifying symptoms on an ictal versus interictal basis and the implications for treatment are discussed.

Hans J. Markowitsch authors the chapter "Memory and Amnesia." He reviews the clinical subtypes of memory, anatomic substrates of memory problems, and common clinical syndromes. The section on functional amnesias is more elaborate than the earlier edition including some of the author's study of psychogenic amnesia. He discusses the neurology of psychogenic amnesias and some of the possible mechanisms. There is also a section on "Distorted Memory and Paramnesias." Dr. Markowitsch includes several conditions of interest to psychiatrists including Capgras syndrome and other reduplicative paramnesias. His discussion of these phenomena as memory rather than psychosis-related has theoretical and clinical importance to psychiatrists.

"Disorders of Complex Visual Processing" is authored by Antonio Damasio, Daniel Tranel, and Matthew Rizzo. The specific differences between true visual agnosia and other syndromes is discussed as well as the evaluation procedure. There is a detailed discussion and review of prosopagnosia and other disorders of facial recognition. The authors include reports and interpretations of several of their interesting experiments on nonconscious recognition of familiar faces and dissociations between electrodermal responses to stimuli in conscious and nonconscious facial processing. They show that these findings are consistent with separate representations of emotional and factual information relevant to specific stimuli. In addition to rare visual processing syndromes, the authors also discuss more common disorders of spatial orientation, constructional ability and dressing ability. The authors provide experimental and historical data consistent with their conceptualizations of the disorders.

This is an excellent book that works at many levels. This brief review does not capture the careful writing or density of information on the pages of this book. Clinical neurologists and psychiatrists can study the theories and neuroanatomy and correlate these with their ongoing clinical experience. Behavioral neurology has added a lot of information about subspecialization in the cortex of the human brain and that needs to be incorporated into clinical practice. I could also see this book as an excellent supplement to basic science courses in neuroanatomy and neurophysiology. Other specialists and researchers will find abundant information to enhance their understanding of the basic science of behavior. As I read through the theory sections, I found myself thinking about experiments that could test some of the key concepts. The book is written with a style that provides both historical context and a synthesis of current information. The authors of this text are leaders in the field. Their expertise covers both clinical and basic science aspects of human behavior and their approach is unique. The authors of Priniciples of Behavioral and Cognitive Neurology collect their essays in one place and provide you with a reference point for studying their current and future work.

George Dawson, MD

Rating:
Summary: Must read for behavioral neurologists
Review: I won't contribute a lengthy review here...Dr. Dawson's review above is quite comprehensive. I'm a clinical neurologist with an interest in cognitive neuroscience and dementia. I thought the book was excellent. Mesulam's first chapter on neuroanatomy, presented from the viewpoint of a behavioral neurologist, was particularly illuminating. Anybody with an interest in behavioral neurology shoudn't hesitate to carefully read this great book!

Rating:
Summary: Must read for behavioral neurologists
Review: I won't contribute a lengthy review here...Dr. Dawson's review above is quite comprehensive. I'm a clinical neurologist with an interest in cognitive neuroscience and dementia. I thought the book was excellent. Mesulam's first chapter on neuroanatomy, presented from the viewpoint of a behavioral neurologist, was particularly illuminating. Anybody with an interest in behavioral neurology shoudn't hesitate to carefully read this great book!