Most neuropsychologists specializing in assessment and treatment of adults will receive a fair share of referrals for assessment of memory and cognitive functions in older patients. The past 15 to 20 years have been marked by an impressive increase in the amount known about the neurobiological basis of aging and dementia. Keeping up with this field has been like monitoring a “moving target,” as a result of increasing refinements in diagnostic categories, technological developments in neuroimaging, and continuing discoveries in the fields of genetics and molecular biology. The field has needed an accessible reference that reviews all of these important areas while also providing an integration of the literature from a uniquely neuropsychological perspective. I am pleased to report that the book, Geriatric Neuropsychology: Assessment and Intervention, meets this important need.
The book has two parts, with Part I focusing on assessment and Part II on intervention. The editors, Deborah K. Attix and Kathleen Welsh-Bohmer, are to be commended for providing a coherent, organized structure to the book that makes it comprehensive, yet very readable. Many of the chapters, particularly in the first section, follow a predictable sequence, which will make this book valuable as a “quick and easy” reference source for both clinicians and researchers.
Chapter 1 provides a model and an organizing structure for the book's section on assessment. Chapter 2 provides a rationale and outline for the diagnosis of mild cognitive impairment (MCI), an important entity that all clinicians must now contemplate when evaluating geriatric patients. Whereas the chapter provides extensive detail on the spectrum of memory disorders in the elderly, some clinicians, particularly those working with specific neurological populations such as epilepsy or multiple sclerosis, may come away from this chapter with questions about whether the diagnosis of MCI can be applied appropriately to their patients.
The assessment section continues with an excellent Chapter 3 on neurodegenerative dementias; providing a concise update on Alzheimer's disease in addition to Frontotemporal dementia, Parkinson's disease; and Diffuse Lewy Body dementia. What is missing is a detailed discussion on the state of the art regarding the use of biological markers such as tau (T-tau, P-tau) and beta-amyloid (Abeta-42) in making differentiations among these various forms of dementia. The section concludes with reviews of a range of neurological, medical, and psychiatric conditions classified as slowly progressive dementias (Chapter 4) or potentially reversible cognitive syndromes (Chapter 5). Each chapter provides a clear review of the physiological basis of these conditions while also furnishing insights on their resulting neuropsychological test profiles.
The first section continues with a series of chapters focusing on specific issues relevant to neuropsychological assessment as performed in the geriatric population. Chapter 6 addresses the use of norms, and outlines many of the challenges encountered when developing and using performance-based norms on an aging population. There is also information on how to assess change in scores on tests administered longitudinally, which is one of the major applications for neuropsychological testing in this age group. Chapter 7 introduces us to methods for conducting a functional assessment, accompanied by information on how to assess medical decision-making and financial capacities. Chapter 8 emphasizes the impact that cultural issues play in assessment of elderly patients, including the confounding role that literacy and socioeconomic factors play in assessment of patients from various ethnic minority groups. The section's concluding Chapter 9 on feedback provides a number of important points that will be helpful to those conducting assessments on patients at any point along the age spectrum.
Chapter 10, introducing Part II, is likely to change the minds of those who hold the outdated view that psychological based interventions are useless in patients with neurodegenerative disorders. It gives the impression that all is not hopeless for these patients and that a great deal can be accomplished with appropriately targeted therapies. The quality of the chapters is more variable in Part II. For example, authors of one of the chapters provide new data and presuppose the reader's familiarity with their particular approach to treatment, whereas a chapter on language intervention reviews interesting work on the treatment of primary progressive aphasia, without providing details on what might be done for the semantic impairments commonly seen in more prevalent forms of dementia.
Another intervention chapter provides a convincing introduction to the method of spaced retrieval (Chapter 12), with results that will certainly capture the attention of those neuropsychologists who focus their practice on assessment rather than intervention. Chapter 13 on multitechnique program approaches provides an informative review of how much therapeutic work has actually been done on the geriatric population, which is more than many might think. Chapter 15 includes a discussion on the use of external aids for compensating for memory deficits, which many might recognize as useful from a common-sense standpoint without actually knowing how to implement their use. The chapter gives a reasoned and detailed approach to using these devices with elderly, memory-disordered patients.
The final section includes chapters on a number of specific psychotherapeutic approaches. Chapter 16 contains not only a nice review of the behavioral treatment literature but also a discussion of many of the concrete details critical to developing a successful behavioral intervention program. Much of the information from this chapter will be useful for clinicians for inclusion in the recommendation section of their neuropsychological test reports. Chapter 17 provides valuable tabular listings of behavioral treatments for specific behavioral conditions and related discussion on these topics. Many will be interested to read Chapter 18 on group psychotherapy that offers specific recommendations for how one can successfully provide treatment to geriatric patients using this modality. Chapter 19 on pharmacological approaches, which will be anticipated by many readers, is well worth the wait until the book's end. The chapter provides a comprehensive review of drug treatment strategies for treating memory disorders including details regarding the pharmacological properties of various agents. Reviewing this information from the neuropsychologist's standpoint makes this a unique contribution to the often dense pharmacological content contained in many other texts.
Those who decide to obtain this book will be very happy with their purchase. The book is comprehensive and well organized, which makes it an ideal selection as a resource to place on one's bookshelf. It is up-to-date and differs from similar books by providing a uniquely neuropsychological point-of-view about neurodegenerative disorders and related syndromes rather than simply rehashing methods for conducting a differential diagnosis. The book's viewpoint is helpful for the situation commonly encountered in most current clinical settings, when a multidisciplinary team makes the diagnosis and the neuropsychologist is asked to provide a functional assessment of the patient as well as an appropriate intervention. The sections on intervention are provided in a particularly useful and digestible format. The outline and theoretical rationale for neuropsychological intervention in geriatric patients is presented in an accessible manner, more useful than what is typically found in most sources on cognitive rehabilitation, including those books addressing traumatic brain injury intervention strategies. Whether a veteran or a recent entrant into the field, neuropsychologists from all backgrounds and specialties will benefit from this book's well-presented introduction to contemporary practice in geriatric neuropsychology.
