Book Review

Textbook of Geriatric Neuropsychiatry

N Engl J Med 1994; 331:1780December 29, 1994

Article

Textbook of Geriatric Neuropsychiatry
Edited by C. Edward Coffey and Jeffrey L. Cummings, with Mark R. Lovell and Godfrey D. Pearlson. 720 pp., illustrated. Washington, D.C., American Psychiatric Press, 1994. $94.50. ISBN: 0-88048-391-1

As the world's population ages, the interdisciplinary field of geriatric medicine has begun to expand. With the recognition that aging brings with it changes in neurobiologic, psychosocial, and physical functioning, geriatric psychiatry has become an important subspecialty of psychiatry, with its own society, textbooks, and subspecialty boards. Several excellent textbooks on geriatric psychiatry and geriatric psychopharmacology are available. To this list must now be added the Textbook of Geriatric Neuropsychiatry, an outstanding multiauthored work that focuses on the neurobiologic basis of mood, behavior, and cognition in later life. This new book represents an attempt to integrate, in the editors' words, “a diversity of fields” including “psychiatry, neuropsychiatry, neurology, neuroscience, neuroimaging, neuropsychopharmacology, neuropsychology, gerontology, molecular biology, genetics, epidemiology, and psychodynamics.”

There are five thematic sections. The introductory section reviews the epidemiology of aging and the neurobiologic changes associated with the aging process and introduces the neurobiologic basis of behavior. The colored photographs of age-associated macroscopic and microscopic brain changes, as well as reviews of alterations in neurotransmission systems and their relation to specific anatomical brain disturbances and clinical syndromes, are particularly useful.

The seven chapters of the second section focus on the diagnostic and functional assessment of the elderly neuropsychiatric patient. Of particular interest are the discussions of anatomical imaging of the aging human brain, ventricular size, cerebrospinal fluid spaces, cortical atrophy, subcortical hyperintensity, metabolism (positron-emission tomographic studies), and quantitative electroencephalography.

The seven clinically oriented chapters of the third section review mood disorders, psychosis of late-life onset, anxiety, sleep disorders, substance abuse, pain, and delirium. They emphasize the neuropsychiatric aspects of these symptoms and disorders. Thus, in the discussion of depression, the emphasis is on depression in patients with Parkinson's disease, stroke, and dementia; in the chapter on psychosis, alterations in brain structure and function and neuropsychological tests are highlighted; with respect to anxiety disorders, the stress is on neurologic and toxic causes. An excellent chapter reviews alcohol and substance abuse among the elderly, a topic neglected in the professional literature.

The neuropsychiatric focus of this book becomes even more apparent in the fourth section, devoted to such neuropsychiatric disorders as dementia, movement disorders, Parkinson's disease, stroke, and epilepsy. The chapter on Alzheimer's disease and the frontal-lobe dementias is surprisingly brief, whereas that on movement disorders, a topic rarely covered in other textbooks of geriatric psychiatry, is comprehensive and helpful. The section concludes with a disappointing review of the neuropsychiatric aspects of pharmacologic therapies for medical illness. Many of the references here are not recent, and some of the information, presented in tabular form, is too superficial to be clinically useful.

Five chapters, making up the fifth section, deal with treatment. The excellent and comprehensive review of the use of pharmacologic and neuroendocrine probes in neuropsychiatric illness is likely to be extremely useful to researchers but of less interest to clinicians. The chapter on geriatric neuropsychopharmacology is comprehensive, up to date, and lucid, as are those on electroconvulsive therapy, psychosocial therapies, and treatment within nursing homes.

Textbook of Geriatric Neuropsychiatry, a state-of-the-art textbook, will serve both geriatric psychiatrists and neurologists. It may be too weighty for the average clinician and may contain more research information than he or she needs. For the academic and research community, however, it will serve as a basic reference book in this rapidly expanding field.

Carl Salzman, M.D.
Massachusetts Mental Health Center, Boston, MA 02115