The ever-rising number of elderly in the world population has made aging a source of great public concern. Even those professionals who have not trained to work specifically with the geriatric population are likely to end up treating an older adult at some time during their career. This book was intended to provide practical information to physicians, psychologists, medical students, and other professionals who serve the geriatric population. It clearly meets the goal of providing a relatively comprehensive compilation of information regarding specific neurologic issues encountered in the older adult. In comparison with the first edition, the editors provide information regarding genomics, particularly in the section on dementia, and updated information regarding neuroimaging techniques and their applications, and the neuroanatomical basis of disease is discussed to a greater extent.
The book is divided into four sections. Section I focuses primarily on neurologic issues and common diagnostic procedures in the older adult. Chapters included an overview of gerontology and neurology (Reichard); the neurologic examination of the older adult (Sirven and Mancall); imaging of the aging brain (Hollander and Flanders); diagnostic neurologic tests, including electroencephalogram (Drazkowski) and electromyography (Goodman); age-related changes in pharmokinetics, drug interaction, and adverse effects (Cloyd and Conway); neurologic considerations in the postmenopausal women (Liporace, Willcox, and Thomas); and cognitive changes associated with normal aging (Pickholtz and Malamut). The chapter on postmenopausal women was a welcome addition and a rare find given that this topic is rarely covered in most neurology textbooks.
Section II includes chapters on common signs and symptoms in the older adult, including seizures and syncope (Nei and Ho); definition and epidemiology of falls and gait disorders (Alexander); and a companion chapter on interventions to prevent and treat falls (Segebart). The chapter by Solomon, Newman-Toker, and Durmer on dizziness and vertigo was thorough in terms of explaining the etiology of the disorder as well as assessment. Other chapters in this section included a comprehensive discussion about the acquired disorders of swallowing, cognition, and speech and language (McNett and Armbruster); tremor (Simuni); neuro-ophthalmology (Osborne, Foroozan, and Moster); sleep (Avidan); headaches (Dodik and Capobianco); back and neck pain (Deen); and incontinence and sexual dysfunction (Ko, Vaish, Novicki, Wingerchuk, and Frohman).
Specific neurologic conditions affecting the older adult comprised the chapters included in Section III that was by far the most extensive section of the book and the section likely of most interest to neuropsychologists. Chapters provided information about cerebrovascular changes, including ischemic cerebrovascular disease (Kasner, Chalela, and Hickenbottom), cognitive effects of stroke and hemorrhage (Riordan and Flashman), spontaneous and traumatic cerebral hemorrhage in the elderly (Wijdicks), and cognitive effects of head trauma in the older adult (Ryan and O’Jile). Chapters covering dementia and dementia-related issues included risk factors and genetics (Caselli), diagnostic evaluation and treatment (Woodruff), behavioral and cognitive aspects (Malamut and Ryan), and mild cognitive impairment and the role of imaging (Flashman, Malamut, and Saykin). Woodruff’s chapter on diagnostic evaluation and treatment of dementia (21.2) provides several excellent tables describing the clinical features of the various dementias. Movement disorder in the older adult (Dahodwala and Hurtig) and the cognitive aspects of Parkinson’s disease and other neurodegenerative movement disorders (Steinerman, Sebastian, and Stern) were informative and as comprehensive as could be expected given the space provided. Additional chapters discussed other specific neurologic conditions such as diseases of the spinal cord and vertebrae (Deen) and welcome chapters on common peripheral neuropathies in the older adult (Snyder and Smith), neuromuscular diseases (Seneviratne and Ross), nonviral infectious diseases of the nervous system (Roos), and viral illnesses of the nervous system (Nagel and Corboy). Neuro-oncology of the elderly (Hammack) was an important chapter given that cancer is the second leading cause of death in persons older than 65 years. This section also included subchapters on the neurologic manifestations of systemic disease including cardiology and pulmonary (Bhakta) and gastrointestinal and endocrine disorders (Shanker) and a chapter on disturbances of the kidneys, electrolytes, water balance, rheumatology, hematology/oncology, alcohol, and iatrogenic conditions (Biglan). A final chapter in this section was on acute and chronic seizures (Noe and Sirven).
The book’s final section focuses on psychosocial issues in the older adult. Again, these chapters should be required reading for all professionals working with the elderly, particularly the chapters on driving and ethical and legal issues in the care of the older adult patient. The editors included a chapter on driving by the elderly with medical conditions (Drazkowski). Physicians and practitioners are often reluctant to discuss driving with their elderly patients since loss of a driver’s license leads to loss of independence. This chapter discusses a variety of reporting laws regarding driving and neurologic conditions and includes information regarding conditions that affect the elderly and that affect driving, such as Alzheimer’s and Parkinson’s disease. There is a short but informative discussion on “Breaking the News” when a diagnosis of a disease process that adversely impacts driving is made and the patient must be told they cannot drive. The chapter on ethical legal issues in the care of older patients with neurologic illnesses (James and Karlawish) covers several important points on decision-making capacity as well as a description on assessing competency and decision making and includes questions the clinician can ask the patient to determine decision-making capacity. Other important chapters in this section include the recognition and management of late-life mood disorders (Ellison and Gottlieb), medically unexplained symptoms in older adults (Bortz), and long-term care options for the aging (Frazer).
Overall, Clinical Neurology of the Older Adult was comprehensive and well written. Most impressive was the uniformity of the chapters in terms of quality of writing. Every chapter included excellent tables and diagrams providing useful “snapshot” information and flowcharts to assist in differential diagnosis. This book should be essential reading for all primary care physicians, medical and graduate students, nurses, and other allied health professionals who care for and treat the elderly.
