The Senile Brain

PSYCHOSOMATICS The authors display a rich experience in the psychological evaluation of the individual with cerebral palsy. The book is a helpful manual that alerts the worker to observational modalities, the complications of testing resulting from handicaps, and handy hints in communication difficulties. Although the authors indicate strongly their belief that the same assessment principles apply to the disabled individuals as evolved out of work with non-disabled persons, their volume would have been strengthened further if more space were given to relationship to subject tested and management of unexpected problems. Six pages is much too brief for a discussion of personality appraisal. Perhaps this is indicative of research that is still needed. The authors should be highly commended in stressing the need for efficient techniques, resourcefulness, and scientific inventiveness in the appraisal of the effects of cerebral palsy. This manual is a courageous example of an attempt to respond to that need. BENJAMIN KOTlwv, PH.D.

THE SENILE BRAIN. By R. S. Allison, M.D. 288 pages. Baltimore: Williams and Wilkins Co., 1962. $10.00.

The author makes a plea for careful investigation of middle-aged and elderly people before the label of "presenile dementia" is applied. Focal brain disease, such as vascular accidents or tumors, as well as toxic or metabolic disturbances besides pure affective disorders must be taken into account. He suggests the use of "organic mental state" as more appropriate than "dementia"; the latter is so closely identified with irreversible and progressive changes that it should be used only when it is justified. This book reviews the early symptoms and signs of intellectual decline, with an emphasis on clinical examination, differential diagnosis and treatment. The clinical material used as the basis of this review consists of 198 patients. According to the author, one of the principal difficulties of "case-taking in organic mental states" is to assess how much importance should be attached to psychogenic factors. In his experience, these rarely play an important role. He is much more impressed with the importance of ruling out subdural hematoma, cardiac decompensation ( with cerebral circulatory failure), alcoholism, diabetes (possible hypoglycemia reactions) etc. The importance of the physical examination is underscored. The physical appearance may provide clues for the diagnosis of myxedema, malignant disease, Parkinsonism, hepatic insufficiency, and pernicious anemia. "Cerebral circulatory insufficiency", where the effects of anoxia produce mental symptoms, may be due to congestive heart failure as well as other possible etiological factors. Atheromatous changes producing obstruction in the arteries of the neck with resultant ischemia of the brain necessitate appropriate examinations. Disorders of speech and language were found in 64 (about l') of all the organic mental cases in this series. 21 were accounted for by vascular accidents,

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17 by tumors and 26 by diffuse cortical atrophy. Slurring dysarthria, difficulties in word finding, defective sentence construction, perseveration and inability to discuss abstract topics were all noted. Two chief problems arise in the differential diagnosis of organic brain disease: its recognition and its cause. The first offers little difficulty when mental symptoms are accompanied by unequivocal focal neurological signs, or when illness is ushered in abruptly with fits, hemiplegia or aphasia. However, when symptoms are unfolded gradually, and no definite neurological signs are found, the condition must be differentiated from psychoneurosis or affective disorders, especially depression. Psychoneurosis and organic disease often co-exist, adding to the difficulties in diagnosis. In organic brain disease the patient conveys the impression of trying to conceal his defects; the neurotic more frequently tries to influence the examiner into believing that his symptoms are of great severity. The affective disorders are common in later life and often recur without any co-existing brain disease. This book, with its wealth of medical and neurological information, is a vigorous attempt to help the physician in the diagnosis and the subsequent management of many of the problems of the older patient. W.D.

NEUROPSYCHOPHARMACOLOGY. Proceedings of the First International Congress, Rome, 1958. Editors: P. B. Bradley, P. Deniker, and C. RadoucoThomas. Amsterdam, Netherlands: Elsevier Publishing Co., (D. Van Nostrand Co., Princeton, N. J.). This book is divided into two parts: symposia (and plenary sessions) and communications in the fields of experimental and clinical research. In the first symposium, dealing with drug-induced behavior in animals, P. B. Bradley reported on methology used to elucidate the site and mode of action of drugs. Through the use of permanently implanted electrodes in cats, effects on behavior and electrical activity could be observed simultaneously. He cautioned against the extrapolation of animal results in terms of human behavior. James Olds, also reporting on the effects of stimulation of implanted electrodes, reported that certain areas of the brain are concerned with gratification and noted the effects of different drugs. The second symposium considered methods and analysis of drug-induced abnormal states in man. The main paper was given by Doctors Hoff and Arnold of Vienna in German. Fortunately, one of the discussants, Dr. Max Rinkel of Boston, reviewed some of their findings (in English) and indicated that they believed in a multifactorial genesis of mental disturbances, inclusive of hereditary, constitutional, metabolic and neurophysiologic factors as well as life experiences. The third symposium compared the effects of psychotropic drugs in animals and man. Dr. Jules Masserman presented some of his studies on the effects of drugs on the central nervous system and Volume IV