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Published online by Cambridge University Press: 01 May 2004
The starting point of this interesting compact book is the recognition that two camps of professionals specialize in understanding cognitive functions: neuroscientists who primarily evaluate healthy individuals, and clinicians who work with brain-injured patients. Each group has a select acquaintance with cognitive functions, conditioned by the populations that it addresses, while having more limited understanding of the cognitive processes associated with the other group. Thus, this book attempts to bridge health and disease by showing how normal cognitive functions may be corrupted by brain illness, and thereby foster an improved understanding of cognitive processes in general.
The starting point of this interesting compact book is the recognition that two camps of professionals specialize in understanding cognitive functions: neuroscientists who primarily evaluate healthy individuals, and clinicians who work with brain-injured patients. Each group has a select acquaintance with cognitive functions, conditioned by the populations that it addresses, while having more limited understanding of the cognitive processes associated with the other group. Thus, this book attempts to bridge health and disease by showing how normal cognitive functions may be corrupted by brain illness, and thereby foster an improved understanding of cognitive processes in general.
The book's chapters address 11 cognitive disturbances that are each discussed by a different behavioral neurologist. Topics covered include spatial neglect, Wernicke aphasia, semantic dementia, and topographical disorientation. Each chapter is formatted to provide a representative brief case report, followed by an overview of clinical manifestations, supporting diagnostic test results, and a detailed summary of neuroimaging and cognitive evaluations from brain-lesioned and healthy subjects. Through these presentations the reader gains an up-to-date acquaintance with how brain illness may distort normal cognitive processes, as well as hypothetical models for how information is processed by the respective cognitive operations.
The book is thus essentially an album of cognitive neuroscience: the chapters are short, the book encompasses diverse disturbances, and a consistent format is maintained throughout. The volume succeeds in linking health and disease mechanisms and is expertly written, illustrated, and edited.
At the same time, as with albums in general, the coverage is not encyclopedic. Eleven topics, even with the included discussions of related disturbances, do not embrace the gamut of cognitive disorders in brain disease. However, this was intentional; the effort here is to demonstrate how clinical and experimental neuroscience may interact through a handful of carefully selected, well-defined disorders.
Although the spirit of the book is to encourage an exchange of information between these two groups of professionals, I sense that the audience most likely to benefit will be nonclinicians who have limited acquaintance with brain disease. For these individuals the book provides a concise introduction to behavioral neurology. On the other hand, practicing neuroclinicians either will not much care to understand normal cognitive mechanisms, or if they are so motivated, will probably consult more comprehensive behavioral neurological treatises, such as Heilman and Valenstein's Clinical Neuropsychology or Mesulam's Principles of Behavioral and Cognitive Neurology, both of which have been recently revised and do not cost much more. While neither of these works explores cognitive mechanisms in as much detail as does D'Esposito's volume, these books partially fill in the gaps among the eleven topics by reviewing considerably more disorders. Thus, the curious reader whose appetite has been whetted by a discussion of the varieties of aphasia can conveniently reach for comprehensive coverage of other closely related neurologic disorders (e.g., dementia, psychosis, aprosodia) simply by turning the page.
I have a few concerns. All of the authors in Neurological Foundations are neurologists, practicing clinicians who are also recognized leaders in cognitive research. Although by being clinical investigators, the contributing authors are well qualified for this volume, it is unfortunate that the book intentionally excludes academic nonphysicians (neuropsychologists, speech-language pathologists) or even nonneurologist physicians (psychiatrists, geriatricians) who nonetheless manage neurologic disorders and are competent to integrate clinical and experimental observations. Second, the diverse disorders in this book emphasize disturbances that follow focal brain illness, associated with a specific brain region in most cases. Readers who are new to neurology, neuropsychology, or cognitive science might presume that a specific cognitive disorder does not merit much attention if it lacks a localizable lesion. However, there is clearly much to learn from cognitive disturbances that are not well localized, such as schizophrenia, depression, Williams syndrome, and the reduction in cognitive processing speed that comes with aging.
Last, it would have been helpful if the book had provided a critical overview of the techniques used to evaluate cognitive processes that are used throughout the book. For example, how well founded are the assumptions concerning the localization of operations through subtraction functional neuroimaging? Do differences in temporal resolution of various functional imaging techniques (e.g., magnetic source imaging vs. PET) affect conclusions regarding localization? What does recovery after a permanent structural brain lesion tell us about the “localization” of the particular affected function? What are the limitations of single case reports versus series studies of clinical phenomena? How much do order effects, familiarity with the test methods or environment (e.g., laboratory vs. home), educational level, or hand preference affect the outcomes from cognitive testing? How specific are particular cognitive tests for the functions they are purported to assess? Can case reports that use cognitive assessments with little psychometric validation still be instructive?
Such overview by itself could well devour an entire book. However, since Neurological Foundations targets an introductory audience, its aims would be better served through presenting a condensed critical regard for the methods of cognitive assessment, which would prepare the reader to more skillfully interpret the summaries in the chapters that follow. The laudable goals of Neurological Foundations merit subsequent updated editions, which, it should be hoped, would more flexibly embrace and represent the spectrum of professional backgrounds and disorders that are associated with cognitive neurologic illnesses.