This edited collection of perspectives on Atypical Parkinson's Disease, or Parkinson's plus as it is often called, is both a treasure and a pleasure. The editor, Irene Litvan, ably accomplishes the daunting task of bringing order to what might be considered a grab bag of diagnostic leftovers in Chapter 1. To the generalist, fair warning that Parkinson's plus may be misconstrued as Parkinson's minus, since tremor, the most commonly recognized symptom may not be a feature of at least some of these syndromes. Litvan provides us with an organizational structure for summarizing clinical features and surmising etiologies. An extensive literature review is distilled to give impressions of when to suspect these diagnoses, hints to the natural progression, and discussion of the validity of specific diagnoses within the atypical PD spectrum. Chapter 2, on historical perspectives, is one that is so tempting to skip in the rush to get to the most up to date science. Please don't, because it is one of the gems of this tome. In his readable style, Christopher Goetz reminds us that clinical skill begins with being a good observer and this will serve the field throughout time. His selection of historical anecdotes, literary passages, and classic photographs illustrates the timelessness of some of these clinical entities. The photograph from the 1925 Lhermitte et al. report so captured the syndrome of cortical basal degeneration, that I suddenly recalled several similar patients and was reassured that there was something more than idiosyncratic imposition of this diagnosis.
A feature of this edition is the succinct structure of the chapters. Each is quite focused making it easy to find a specific topic and capture its depth. For example, Chapter 3 on epidemiology focuses only on Progressive Supranuclear Palsy and Multiple System Atrophy, because these diagnoses reflect the most well developed knowledge base. Chapters 4, 5, and 6 on neuropathology, tauopathies, and synucleinopathies provide focused reviews of relatively current literature. Several of these, of course, may not stand the test of time because they can only be as current as the moment. Several chapters deal at length with assessment of clinical aspects of the disease, including chapters on general clinical assessment, specific ocular motor assessment, neuropsychological, and neuropsychiatric assessment. Six chapters were syndrome specific and reflected re-organization and synthesis of material in other chapters.
Several chapters presented specific research methodologies, including computer modeling of brain structure activation for motor tasks. As the author acknowledges, these models are oversimplifications of highly integrated behavior. The strength of these models is in their ability to integrate what we know about the motor, mood, and cognitive interactions occurring in multiple brain structures. The limitation is their inability to model the progressive degenerative nature of these diseases.
The companion DVD can be a useful technology by expanding the description of the book. The DVD holds PDF files of each of the chapters and several have informative video clips described within the text. These videos have superb visual quality and are excellent illustrations of various movement disorders and apractic phenomena. However, sound quality was only fair. This may not present a problem because the written text in which the link to video is embedded is quite clear.
If there is a missing theme it may be absence of reflection on how these conditions may compare and connect to typical PD or not addressing in more detail how molecular genetics of these entities may direct future therapies. These themes are touched on in several chapters but may be worth addressing in specific chapters in any future edition. Despite these minor omissions, the volume is well worth owning. It is well written, well organized, and an invaluable resource of highly integrated and very thoughtful reflections on a complex topic.
