Principles of Behavioral Neurology and Cognitive Neurology.

Mesulan, M-Marcel, Ed. Principles of Behavioral Neurology and Cognitive Neurology. 2nd Edition. New York: Oxford University Press, 2000. xviii + 540 pp. $79.95 This is an excellent book. It covers in a clear and comprehensive manner the neuroanatomy of the brain and how this anatomy relates to behavior. The neurological exploration of behavior is based primarily on the traditional disruptions of normal functions, e.g., aphasias, visual distortions, aprosodias, etc., but is supported by the latest findings of functional imaging and cognitive neuroscience. There is a nice mix of clinical observation and data. For example, "Traditional neurological textbooks tend to confine the discussion of the cerebellum to its motor functions. However, the clinical examination of patients with cerebellar damage and the functional imaging of neurologically intact subjects have raised the possibility that the cerebellum may have nonmotor behavioral affiliations. Even unilateral cerebellar lesions, for example, can impair performance in tasks of attention (as assessed by digit span), verbal fluency, and reasoning and can lead to a flattening of affect and to the emergence of disinhibited behaviors" (p. 70). Although at times one gets the feeling that they are reading Hesiod's Theogeny (the genealogy of the Greek gods) in that the subject matter of necessity is often presented as "... this area is connected to this nuclei," the writing is clear, enthusiastic, logical, and interesting. One gets the feeling that there has been a distinct effort to make this text a useful teaching device, as the figures and tables are done with great care and add a great deal to the coherence of the presentation. Other evidence of this concern for teaching, is the development of general themes or principles. For example, at the conclusion of the first chapter (which is one of the clearest presentations of behavioral neuroanatomy that I have ever read), the author notes that there are "... at least five large-scale neurocognitive networks ..." (p. 88). The author then goes on to group the previous detailed discussions into five broad areas: dorsal parietofrontal network for spatial orientation; the limbic network for memory and emotion; the perisylvian network for language, ventral occipitotemporal network for face and object relations; and prefrontal network for executive function and comportment. The book has 10 chapters: Behavioral Neuroanatomy; Neuropsychological Assessment of Mental State; Attentional Networks, Confusional States, and Neglect Syndromes; Memory and Amnesia; Aphasia and the Neural Basis of Language; Affective Prosody and the Aprosodias; Disorders of Complex Visual Processing; Temporolimbic Epilepsy and Behavior; Neural Substrates of Psychiatric Syndromes; Aging, Alzheimer's Disease and Dementia. The chapters on behavioral neuroanatomy and memory are some of the clearest presentations of this material that I have yet to read. But this is not to belittle the other chapters as they are all excellent. The other chapters are clear and basically stick to the data with little speculation. For an edited volume, there is little overlap of material. The book is very well edited and reads as if one author had written it all. This book could be read with profit by psychiatrists, neurologists, and psychologists. This is not a neurology textbook but a fine contemporary discussion of how the central nervous system causes the behaviors we observe in clinical practice and daily life. It is also not a textbook of psychopathology. Its subject matter is how insults to the central nervous system disrupt and illuminate normal behavioral function. For example, the common clinical problem of delirium, with its plethora of psychopathological phenomena, is covered rather briefly, whereas neglect syndromes and their relation to neuroanatomy are covered in some detail. But perhaps we could learn from the behavioral neurologist, who has made great progress in understanding behavior by exploring more discrete aspects of behavior rather than broad arbitrary diagnostic syndromes. Robert Post in his excellent and circumspect chapter on "Neural Substrates of Psychiatric Syndromes" notes "It is perhaps premature (but tempting) to write a chapter on the neural substrates of the major psychiatric syndromes.... The goal is not to show that psychiatric diseases are based on fixed lesions but, instead, to show that they are associated with patterns of dysfunction that have neuroanatomical substrates and specificities" (p. 406). To find more consistency of neuroanatomical correlation with psychopathologic behaviors, perhaps we should be narrowing our investigative focus. There have been more consistent neuroanatomical findings when the behavior studied is very distinct and simple, e.g., in obsessive-compulsive behaviors and panic disorders, rather than the broad categories of affective disorder and schizophrenia. G. J. Tucker, M.D. Professor Emeritus; Department of Psychiatry and Behavioral Science; University of Washington School of Medicine; Seattle, WA