Disorders having an impact on subcortical brain structures, such as Parkinson's disease, Huntington's disease, and progressive supranuclear palsy (to name a few), have long been known to disrupt basic motor functions. We have also come to understand, however, that these diseases result in cognitive and psychiatric alterations. Many of these cognitive and psychiatric changes are often unrelated to the motor abnormalities seen in these diseases, highlighting the multi-faceted processes mediated by different subcortical structures. In addition, these cognitive and behavioral changes can be more debilitating than the movement deficits experienced by these patients. Thus, it is imperative that clinicians further understand the characteristics of, and treatment options for, these types of symptoms. Further, our understanding of the mental and behavioral changes in these diseases has also informed us about the role of the subcortical brain structures (and their connections) in cognition and psychiatric functioning. From this work, it has become increasingly clear that frontal-subcortical pathways play an important (if not central) role in directing human activity.

In their edited book, Mental and Behavioral Dysfunction in Movement Disorders, Bédard, Agid, Chouinard, Fahn, Korczyn, and Lespérance, have assembled chapters highlighting these issues. The book is organized into six major sections (after an introductory chapter that provides a historical perspective), entitled Mental Processing in the Motor Structures of the Brain, Cognition in Movement Disorders, Neurophysiology of Cognition in Movement Disorders, Dementia in Movement Disorders, Neuropsychiatric Aspects of Movement Disorders, and Quality of Life in Parkinson's Disease. In his preface, Dr. Bédard states that one of the major aims is to “provide the reader with an authoritative account of the recent developments in the field set against a background of review material”. In short, the book has met this general aim admirably.

The chapter on the historical issues pertaining to Parkinson's and Huntington's disease (by Goetz) offers a nice backdrop to the book by discussing some of the more important historical questions that have been addressed in the study of these diseases including many which have not been completely answered and therefore are still important today. This chapter serves as an overview of issues that still need to be addressed.

In the section Mental Processing in the Motor Structures of the Brain, 4 chapters are included that address the role of the basal-ganglia in different aspects of cognition from a biological perspective, such as how the efferent and afferent connections of the basal ganglia influence cognition (by Middleton), the role of ventral, central, and dorsal aspects of the striatum in various aspects of behavior (by Haber), basal ganglia-cortical connections and habit learning (by Graybiel and Kubota), and the role of the cerebellum in cognition and emotion (by Schmahmann). This latter chapter was especially useful given that many books on subcortical disorders tend not to include information on cerebellar contributions to cognition.

In the next section of the book, Cognition in Movement Disorders, the 6 chapters include excellent reviews on the assessment of cognition in patients with movement disorders (by Stout and Paulsen), impairments in intention in patients with Parkinsonism (by Brown), the involvement of frontal and subcortical structures in cognitive control (by Richer and Chouinard), language deficits in Parkinson's disease (by Cohen), apraxia in corticobasal degeneration (by Leiguarda), and neuropsychological deficits in patients with cerebellar disorders (by Ackermann and Daum). This section of the book is unique in comparison to other books on subcortical disorders in that topics such as intention, cognitive control, and apraxia were included.

In the section entitled Neurophysiology of Cognition in Movement Disorders, 5 chapters address such interesting topics as cognition in animal models of Huntington's disease (by Palfi, Brouillet, Condé, and Hantraye) and Parkinson's disease (by Schneider), the role of catecholamines in cognition (by Robbins, Crofts, Cools, and Roberts), the role of neurotransmitter systems in cognition other than dopamine in Parkinson's disease (by Bédard, Lévesque, Lemay and Paquet), and the cognitive impact of various neurosurgical procedures in Parkinson's disease (by Saint-Cyr). Each of these chapters is excellent, providing very thoughtful discussions as to how the underlying neurophysiological deficits in movement disorders might contribute to the cognitive impairments in these diseases, and importantly, what implications such findings might have for treatment.

The next section provides several excellent chapters about Dementia in Movement Disorders, including an overview of dementia in movement disorders (by Kertesz), a discussion of neuropathological overlap among movement disorders resulting in dementia (by Jellinger), the contributions of synuclein and tau pathologies to dementia (by Hardy), epidemiology and risk factors for dementia in Parkinson's disease (by Levy and Marder), comparisons of neuropsychiatric correlates of dementia in patients with and without dementia (by Ballard and Thomas), neurotransmitter deficiencies underlying psychiatric problems in patients with dementia with Lewy Bodies (by Perry, Piggott, Johnson, Ballard, McKeith, Perry, and Burn), and pharmacological treatment options for dementia in Parkinson's disease (by Korczyn and Giladi).

The section entitled Neuropsychiatric Aspects of Movement Disorders contains 13 chapters. This section includes chapters on the role of globus pallidus circuitry in mood disorders (by Lauterbach), cortical-limbic circuitry involvement in depression (by Stefurak and Mayberg), the spectrum of agitation and apathy in movement disorders (by Litvan and Kulisevsky), treatment of depression in Parkinson's disease (by Kostic, Stefanova, Dragasevic and Potrebic), treatment of hallucinations in Parkinson's disease (by Aarsland and Larsen), sleep disturbances associated with movement disorders (by Boeve, Silber, Ferman, Parisi, Dickson, Smith, Lucas, and Petersen), psychogenic movement disorders (by Sa and Lang), treatment of psychosis and mood changes in Huntington's disease (by Guttman, Alpay, Chouinard, Como, Feinstein, Leroi, and Rosenblatt), treatment of aggression and frontal lobe symptoms in Huntington's disease (by Rosenblatt, Anderson, Goumeniouk, Lespérance, Nance, Paulsen, Ruben, Saint-Cyr, Sethna, and Guttman), mood alterations in Tourette Syndrome (by Robertson), pathophysiology in Tourette syndrome (by Leckman), pathophysiological changes in Obsessive-Compulsive Disorder (by Farchione, MacMillan, and Rosenberg), and movement abnormalities in patients with schizophrenia (by Bocti, Black, and Waddington). This section will be most helpful to clinicians who are involved in the diagnosis and treatment of psychopathology in movement disorders. The majority of the chapters in this section provide up-to-date information regarding treatment options.

The final section entitled Quality of Life in Parkinson's Disease provides several excellent reviews on often-neglected topics. Chapters in this section address medical and psychosocial correlates of quality of life in those with Parkinson's disease (by Schrag and Selai), sexual functioning (by Bronner, Royter, Korczyn and Giladi), sleep disorders (by Rye, Daley, Freeman and Bliwise), and the progression of the disease and life expectancy (by Poewe).

Overall, I highly recommend this book to anyone interested in movement disorders, no matter in what area the potential buyer might work. Mental and Behavioral Dysfunction in Movement Disorders will be of interest to clinicians who need a quick reference to options for treating dementia and psychopathology in these patients. This book will also be of interest to researchers who have a general interest in the role of the basal ganglia in cognition and behavior. The only minor criticisms I have about this book is that the roles of the basal ganglia in other aspects of cognition (e.g., memory) were not included and that there was some overlap among the chapters, which might be expected given how related are many of these chapter topics. These issues, however, are minor. In short, this is an excellent book.