- Email: [email protected]
Cognitive neuropsychology in clinical practice
133
B~IK REVIEWS
mentioned by several authors, a complete chapter on the importance of preoperative brain pathology, including not only serial lesion work but also, for example, work on the effects of alcohol related brain damage on the consequences of subsequent brain injury would, in my view, have strengthened the overall content. Book reviewers can so easily sound grudging and negative. That is not my intention. This is an interesting and informative book. It is described by its Editor as a collection of”essays” and that is exactly what it is. As such it makes no claim to be a systematic and comprehensive review of the whole area. Let me complete the quotation begun above: “This book is an invitation
to think further on these issues and what they may be telling us about brain function.”
It is, perhaps, a measure of the extent to which the book achieves its objective of stimulating readers may now seek the sort of systematic and comprehensive review referred to above.
further
thought
that
F. D. Rest:
The Handbook of Neuropsychological Assessment, Edited M(.KIXLAY. Lawrance Erlbaum, Hillsdale, NJ, 1992.
by J. R. CKAWI;OKII, D. M. PAKKEK and
W. W.
Handbook of Neuropsychological Assessment: A Biopsychosocial Perspective, Critical Issues in Neuropsychology, Edlted by A. E. PUENTI:and R. J. MCCAF~RLY. Plenum Press, New York, 1992. Clinical Syndromes Amsterdam, 1992.
in Adult Neuropsychology:
Cognitive Neuropsychology
The Practitioner’s
Handbook,
Edited
in Clinical Practice, Edited by D. I. MAKGOI.IN. Oxford
by R. F. WHITE. Elsevier,
University
Press, Oxford,
1992.
FOUR neuropsychology texts amounting to 1571 pages: three different titles (two almost identical), and containing the word Neuropsychology or Neuropsychological. What can they tell us about the current status of neuropsychology? It is very difficult to form any coherent overview offour diverse texts, but a first approximation might be to look at the target audience of the different books. Crawford er al. aim firmly at the clinical psychologist or the inexperienced and beginning neuropsychologist. White aims both at the novice and the experienced neuropsychologist. Puente et cri. do not indicate a specific target audience, although I do note that their preferred aim is to “produce a more comprehensive paradigm shift in clinical neuropsychology -one that aggressively (yet diplomatically) questions the validity of our knowledge _“_Margolin explicitly aims to reach a “broad audience”, including those with no background in psychology, although he suggests that “perhaps clinical neuropsychologists have the most to gain from this volume”. So. given that the books are aimed at very different audiences, what are their preferred messages’? (.‘rawford er crl. producca rather conventionally organized text. They begin with basic principles of assessment, and mclude a thorough account of measurements of premorbid intelligence. They then move on to the assessment of “major psychological functions” such as memory, etc., before dealing with specific clinical problems such as dementia and traumatic brain injury, concluding with some specialised issues such as medico-legal assessment. Puente and McCaffrey, in a text having almost an identical title, take an utterly diffcrcnt route. splitting their text into four sections beginning with “constitutional and demographic factors”, allowing discussions of issues such as perinatal factors. childhood, adult development, sex and gender, handedness, etc.-topics that are rarely brought together in one coherent neuropsychological text. The second section deals with what the editors refer to as “psychopathological factors”, and deals with largely psychiatric disturbance including anxiety disorders. depression. schizophrenia, pseudo-neurological disorders, before ending with the issue ofdeception and malingering. The third part is dcvotcd to biological factors including peripheral nervous system pathology, the effects of medication, and other toxic effects, before ending with a single chapter devoted to an overview. White takes a totally different view, and one which appealed greatly to the reviewer. White’s aim is to try to product what is essentially a handbook in which specific disorders are described in a consistent manner including nature and variability in clinical presentation, pathqphysiology, neuropsychological evaluation, etc. The disorders include the clrects of toxins, HIV, traumatic brain injury, neurodegenerative disorders, and others. including (unusually and most valuably), a chapter on the adult preseritation of learning disabilities. This book also contains a very useful appendix on some commonly used t&s, and a brief account of an idealised neuropsychological history. Margolin takes what is clearly the most radical approach to neuropsychology. He takes the modular approach of cognitive science to try to deal with a number of issues including intellectual decline, attention in its many manifestations. memory (in rather brief detail), language, and “other domain-specific disorders“, which include dyscalculias, higher level motor disorders, higher visual processing dividers, and the neuropsychological rehabilitation of musicians and other artists--an interesting chapter but one which sits uneasily with the others in this section. Finally, there is one chapter on neuroimaging and cognition. Are the books value for money?-yes and no. Would I as the reviewer buy the books?-some of them. Should
I34
BOOK REVIF~S
readers of Nrurops~c’holocliu buy the hooks‘!&it depends on their interests. This is not a very helpful conclusion, but it results from the very diverse nature of the texts. For those interested in basic information about the presentation of cognitive dysfunction, then Crawford rr ul. will serve that need. although it is arguable that it does not supply very much to add to the current texts in this arca (those by Walsh, 1985, and Kolb and Wishaw, 19X5), and the chapters are often rather short, and uneven in quality. Some take an explicitly modular cognitively based approach (chapter by Ellis on facial processing, and Seymor on reading disorder). However. for the nai’ve clinical psychologist wanting a brief overview of some of the concerns ofclinical neuropsychology this book will suffice, but the naive reader will not end up a neuropsychologist simply by virtue of having read this text. Similarly, the nai’vc reader would not end up a neuropsychologist after having read the text by White, however he/she would be w,ell along that road, having gained a grounding in relevant aspects of clinical neurology, pathophysiology, cognitive and behavioural deficits and their examination, and a knowledge of the typical clinical presentation of patients with a variety of neurological disorders. There is no question that White’s text fil!s a great gap in this area wjhich up till now had only partly been filled by Walsh’s clinical text (19X5). I liked White’s book and I would certainly buy it. Puente and McCatTrey’s text ia unusual. It deals with issues that are rarely considered to be a central focus of neuropsychology with its typical concern on adult cognitive and behavioural deficits. Furthermore it deals with issues huch as gender, handedness, and socio-educational issues that impinge on the clinical practice of neuropsychology, but which rarely appear in neuropsychology texts. While the reviewer has no doubt that it ia “a good thing” to include issues such as “socio-educational” factors, the problem is that there is not a large literature hcrc, and the authors appear to he rather struggling to flesh out what should he a substantive issue, but which does not appear to be so in the literature. This text also deals with affective disturbance such as anxiety and depressive disorders. While some aspects of anxiety and depression clearly have an obvious neurobiological underpinning, and also have a clear cognitive component, these topics have typically stood at the absolute periphery of neuropsychology, yet patients with cerebral lesions present with affective disturbance. Frequently the disturbance is considered to be “a reaction to” the consequences of brain damage, rather than central symptomatology, and the chapters on anxiety and depression are thought provokmg, and supply information that should he of immediate practical value to the practising ncuropsychologist. The coverage of topics in this text seems slightly idiosyncratic, and to he stretching the boundaries of neuropsychology, but that is also a strength, and is a central aim ofthe book. On balance, I would buy the book too. Because it would cause me to think more biologically about affective disturbance. The final text for detailed consideration is that by Margolin. This takes an explicitly cognitive. modular approach to neuropsychological function, an approach that has been extremely revealing both in research (for example the teasing apart of the components of attention and memory to name but two areas). and in tackling individual clinical problems. However, the fact remains. that most clinical neuropsychology is practised on rather an ad hoc basis, drawing perhaps somewhat on clinical neuropsychological findings hut very little on cognitive neuroscience. Should it draw more on cognitive neuroscience? Obviously the answer is that it should, hut this is not the hook to convince me partly because the range of topics seems to be rather idiosyncratic. Intelligence has a specific chapter, but rather than taking a modular approach to cognition, the chapter really deals with the cognitive neuropsychology of Alzheimer’s disease--an important topic, but perhaps not the most convincing of models for the modular basis of human intelligence. The section on attention deals with schizophrenia, hut also eating disorders (an unusual choice in the text of neuropsychology). It contains one chapter on “organisational and attentional research” which at first sight looks to he a rather dry account of attentional research yet in fact proves to he full of rich clinical information--hats off to DI Robinson, the author. The same could he said ofthe chapter by Shelton YI u/. on short-term memory deficits. Reading impairments have lent themselves readily to a cognitive approach. and a substantial part of this book is devoted to reading disturbances. with a variety of models. hut with some useful and rich clinical information. This book would not he top of my list for purchase, hut would he one that I would rcommcnd to graduate clinical psychology and neuropsychology students to alert them to the interface between clinical neuropsychology and cognitive science. and to ensure that they draw upon their psychology background in assessing patients, rather than simple clinical custom and practice. In conclusion, these are four very different texts. They are aimed at different audiences, and with different messages. Any rank order is inappropriate, and while the author’s preference is very much for the text by White. that ia simply because that text more meets the reviewer’s current needs. Those just beginning on the neuropsychology road would benefit from the text by Crawford rr rrl. More experienced practitioners wanting more information from the border areas of neuropsychology. psychology and psychiatry, would benefit from the text by Puente and McCaffrcy. and those wanting a more explicitly cognitive underpinning to clinical practice would benefit from the text by Margolin. Are any of the texts not worth buying‘! No.
REFERENCES K. Clntle~sr‘rntliny Brcri~ Lhmqr. Churchill-Livingstone, ?. 1985. Ko~.e. B. and WISHAW. I. Q, F~ciltltrnl~,r/a/s o/‘Hurncm h’r~rrop.s!,c,hr)/o~!, 2nd Edn. Freeman,
WALSH,
New York.
19X5
B~IK REVIEWS
mentioned by several authors, a complete chapter on the importance of preoperative brain pathology, including not only serial lesion work but also, for example, work on the effects of alcohol related brain damage on the consequences of subsequent brain injury would, in my view, have strengthened the overall content. Book reviewers can so easily sound grudging and negative. That is not my intention. This is an interesting and informative book. It is described by its Editor as a collection of”essays” and that is exactly what it is. As such it makes no claim to be a systematic and comprehensive review of the whole area. Let me complete the quotation begun above: “This book is an invitation
to think further on these issues and what they may be telling us about brain function.”
It is, perhaps, a measure of the extent to which the book achieves its objective of stimulating readers may now seek the sort of systematic and comprehensive review referred to above.
further
thought
that
F. D. Rest:
The Handbook of Neuropsychological Assessment, Edited M(.KIXLAY. Lawrance Erlbaum, Hillsdale, NJ, 1992.
by J. R. CKAWI;OKII, D. M. PAKKEK and
W. W.
Handbook of Neuropsychological Assessment: A Biopsychosocial Perspective, Critical Issues in Neuropsychology, Edlted by A. E. PUENTI:and R. J. MCCAF~RLY. Plenum Press, New York, 1992. Clinical Syndromes Amsterdam, 1992.
in Adult Neuropsychology:
Cognitive Neuropsychology
The Practitioner’s
Handbook,
Edited
in Clinical Practice, Edited by D. I. MAKGOI.IN. Oxford
by R. F. WHITE. Elsevier,
University
Press, Oxford,
1992.
FOUR neuropsychology texts amounting to 1571 pages: three different titles (two almost identical), and containing the word Neuropsychology or Neuropsychological. What can they tell us about the current status of neuropsychology? It is very difficult to form any coherent overview offour diverse texts, but a first approximation might be to look at the target audience of the different books. Crawford er al. aim firmly at the clinical psychologist or the inexperienced and beginning neuropsychologist. White aims both at the novice and the experienced neuropsychologist. Puente et cri. do not indicate a specific target audience, although I do note that their preferred aim is to “produce a more comprehensive paradigm shift in clinical neuropsychology -one that aggressively (yet diplomatically) questions the validity of our knowledge _“_Margolin explicitly aims to reach a “broad audience”, including those with no background in psychology, although he suggests that “perhaps clinical neuropsychologists have the most to gain from this volume”. So. given that the books are aimed at very different audiences, what are their preferred messages’? (.‘rawford er crl. producca rather conventionally organized text. They begin with basic principles of assessment, and mclude a thorough account of measurements of premorbid intelligence. They then move on to the assessment of “major psychological functions” such as memory, etc., before dealing with specific clinical problems such as dementia and traumatic brain injury, concluding with some specialised issues such as medico-legal assessment. Puente and McCaffrey, in a text having almost an identical title, take an utterly diffcrcnt route. splitting their text into four sections beginning with “constitutional and demographic factors”, allowing discussions of issues such as perinatal factors. childhood, adult development, sex and gender, handedness, etc.-topics that are rarely brought together in one coherent neuropsychological text. The second section deals with what the editors refer to as “psychopathological factors”, and deals with largely psychiatric disturbance including anxiety disorders. depression. schizophrenia, pseudo-neurological disorders, before ending with the issue ofdeception and malingering. The third part is dcvotcd to biological factors including peripheral nervous system pathology, the effects of medication, and other toxic effects, before ending with a single chapter devoted to an overview. White takes a totally different view, and one which appealed greatly to the reviewer. White’s aim is to try to product what is essentially a handbook in which specific disorders are described in a consistent manner including nature and variability in clinical presentation, pathqphysiology, neuropsychological evaluation, etc. The disorders include the clrects of toxins, HIV, traumatic brain injury, neurodegenerative disorders, and others. including (unusually and most valuably), a chapter on the adult preseritation of learning disabilities. This book also contains a very useful appendix on some commonly used t&s, and a brief account of an idealised neuropsychological history. Margolin takes what is clearly the most radical approach to neuropsychology. He takes the modular approach of cognitive science to try to deal with a number of issues including intellectual decline, attention in its many manifestations. memory (in rather brief detail), language, and “other domain-specific disorders“, which include dyscalculias, higher level motor disorders, higher visual processing dividers, and the neuropsychological rehabilitation of musicians and other artists--an interesting chapter but one which sits uneasily with the others in this section. Finally, there is one chapter on neuroimaging and cognition. Are the books value for money?-yes and no. Would I as the reviewer buy the books?-some of them. Should
I34
BOOK REVIF~S
readers of Nrurops~c’holocliu buy the hooks‘!&it depends on their interests. This is not a very helpful conclusion, but it results from the very diverse nature of the texts. For those interested in basic information about the presentation of cognitive dysfunction, then Crawford rr ul. will serve that need. although it is arguable that it does not supply very much to add to the current texts in this arca (those by Walsh, 1985, and Kolb and Wishaw, 19X5), and the chapters are often rather short, and uneven in quality. Some take an explicitly modular cognitively based approach (chapter by Ellis on facial processing, and Seymor on reading disorder). However. for the nai’ve clinical psychologist wanting a brief overview of some of the concerns ofclinical neuropsychology this book will suffice, but the naive reader will not end up a neuropsychologist simply by virtue of having read this text. Similarly, the nai’vc reader would not end up a neuropsychologist after having read the text by White, however he/she would be w,ell along that road, having gained a grounding in relevant aspects of clinical neurology, pathophysiology, cognitive and behavioural deficits and their examination, and a knowledge of the typical clinical presentation of patients with a variety of neurological disorders. There is no question that White’s text fil!s a great gap in this area wjhich up till now had only partly been filled by Walsh’s clinical text (19X5). I liked White’s book and I would certainly buy it. Puente and McCatTrey’s text ia unusual. It deals with issues that are rarely considered to be a central focus of neuropsychology with its typical concern on adult cognitive and behavioural deficits. Furthermore it deals with issues huch as gender, handedness, and socio-educational issues that impinge on the clinical practice of neuropsychology, but which rarely appear in neuropsychology texts. While the reviewer has no doubt that it ia “a good thing” to include issues such as “socio-educational” factors, the problem is that there is not a large literature hcrc, and the authors appear to he rather struggling to flesh out what should he a substantive issue, but which does not appear to be so in the literature. This text also deals with affective disturbance such as anxiety and depressive disorders. While some aspects of anxiety and depression clearly have an obvious neurobiological underpinning, and also have a clear cognitive component, these topics have typically stood at the absolute periphery of neuropsychology, yet patients with cerebral lesions present with affective disturbance. Frequently the disturbance is considered to be “a reaction to” the consequences of brain damage, rather than central symptomatology, and the chapters on anxiety and depression are thought provokmg, and supply information that should he of immediate practical value to the practising ncuropsychologist. The coverage of topics in this text seems slightly idiosyncratic, and to he stretching the boundaries of neuropsychology, but that is also a strength, and is a central aim ofthe book. On balance, I would buy the book too. Because it would cause me to think more biologically about affective disturbance. The final text for detailed consideration is that by Margolin. This takes an explicitly cognitive. modular approach to neuropsychological function, an approach that has been extremely revealing both in research (for example the teasing apart of the components of attention and memory to name but two areas). and in tackling individual clinical problems. However, the fact remains. that most clinical neuropsychology is practised on rather an ad hoc basis, drawing perhaps somewhat on clinical neuropsychological findings hut very little on cognitive neuroscience. Should it draw more on cognitive neuroscience? Obviously the answer is that it should, hut this is not the hook to convince me partly because the range of topics seems to be rather idiosyncratic. Intelligence has a specific chapter, but rather than taking a modular approach to cognition, the chapter really deals with the cognitive neuropsychology of Alzheimer’s disease--an important topic, but perhaps not the most convincing of models for the modular basis of human intelligence. The section on attention deals with schizophrenia, hut also eating disorders (an unusual choice in the text of neuropsychology). It contains one chapter on “organisational and attentional research” which at first sight looks to he a rather dry account of attentional research yet in fact proves to he full of rich clinical information--hats off to DI Robinson, the author. The same could he said ofthe chapter by Shelton YI u/. on short-term memory deficits. Reading impairments have lent themselves readily to a cognitive approach. and a substantial part of this book is devoted to reading disturbances. with a variety of models. hut with some useful and rich clinical information. This book would not he top of my list for purchase, hut would he one that I would rcommcnd to graduate clinical psychology and neuropsychology students to alert them to the interface between clinical neuropsychology and cognitive science. and to ensure that they draw upon their psychology background in assessing patients, rather than simple clinical custom and practice. In conclusion, these are four very different texts. They are aimed at different audiences, and with different messages. Any rank order is inappropriate, and while the author’s preference is very much for the text by White. that ia simply because that text more meets the reviewer’s current needs. Those just beginning on the neuropsychology road would benefit from the text by Crawford rr rrl. More experienced practitioners wanting more information from the border areas of neuropsychology. psychology and psychiatry, would benefit from the text by Puente and McCaffrcy. and those wanting a more explicitly cognitive underpinning to clinical practice would benefit from the text by Margolin. Are any of the texts not worth buying‘! No.
REFERENCES K. Clntle~sr‘rntliny Brcri~ Lhmqr. Churchill-Livingstone, ?. 1985. Ko~.e. B. and WISHAW. I. Q, F~ciltltrnl~,r/a/s o/‘Hurncm h’r~rrop.s!,c,hr)/o~!, 2nd Edn. Freeman,
WALSH,
New York.
19X5