Book Review
Neuropsychiatry
Psychiatric and Cognitive Disorders in Parkinson’s Disease. Sergio E Starkstein, Marcello Merello. Cambridge (UK): Cambridge University Press; 2002. 229 p. US$75.00.
Reviewer
rating*: Very Good
Review by: Erwin K Koranyi, MD
Ottawa, Ontario
This work comprises 8 well-researched and informative chapters, an 18-page appendix containing neurological and psychiatric clinical assessment scales, 46 pages of references, and a useful subject index. After a brief introduction, the authors present the epidemiological, clinical, and therapeutic aspects of Parkinson’s disease (PD), characterizing it as a dopaminergic denervation process at the pre- and postsynaptic level. They highlight the alarmingly high prevalence and the malignant course of the disease, particularly its akinetic-rigid subform. They profile 5 stages of severity and the clinical heterogeneity and describe the cardinal symptoms. While the cause of the PD is still unknown, its neurodegenerative process and metabolic, environmental, histopathologic, and genetic factors are well detailed. The modern neuroimaging studies, well sketched in the text, contribute to the understanding of PD. These are followed by an account of the physiology of dopamine receptors, including the differential distribution of the D1 and D2 receptors in the striatum, the neurochemical mechanisms, and the well-demonstrated hypoactivity in the premotor and prefrontal areas. This chapter closes with a discussion of the physical treatment aspect of PD, including the different surgical approaches to relieving various symptoms. Unfortunately, the authors fail to mention the current status of stem-cell research, which may well be the most promising procedure for the future.
Chapter 3 deals with the differential diagnosis of PD vs parkinsonism, reviewing in detail the diagnostic soft spots between PD and progressive supranuclear palsy, multisystem atrophy, dementia with Lewy bodies, and drug-induced and toxic parkinsonism.
Chapter 4 deals with the cognitive deficit occurring in many patients with PD and with the inequalities of the different diagnostic systems, pointing out that while dementia prevalence was 3.1% according to the ICD-10 system, it became 29.1% when the DSM-III criteria were applied. The authors outline Cummings and Benson’s cortical-vs-subcortical forms of dementias and their differences in relevance to PD. Here, they discuss the magnetic resonance imaging (MRI) alteration of the hippocampal volumes, current single photon emission computerized tomography (SPECT) studies, specific cognitive deficits in PD, visuospacial deficits, and speech and language problems prevalent in PD. The importance of cortical and limbic Lewy bodies are emphasized.
Chapter 5 offers a detailed discussion of the psychosocial dimensions, the neurotransmitter deviations, and cerebrospinal fluid (CSF) findings in PD patients with depression (which occurs with a frequency of some 40%). The authors detail treatment approaches, indicating the optimal medications and discussing the use of electroconvulsive therapy (ECT) and effective supportive social and psychotherapeutic measures. Chapter 6 provides further commentaries on the premorbid personality, anxiety, phobias, and apathy occurring in PD.
In a pivotal Chapter 7, the authors describe the psychiatric side effects of antiparkinsonian drugs—the visual and other types of hallucinations, delusions, deliria, vivid dreams, and transient psychoses—along with their causes, mechanisms, and treatment. The following and final Chapter 8 deals with the treatment of psychiatric disorders in PD. As noted above, the Appendix offers useful scales for clinical assessment.
The authors’ expertise regarding the neurological and psychiatric domain of PD is beyond question, and their research is impressively thorough. Their work is to the point, and their language is well focused and distinct. The book abundantly meets their objectives and provides the reader with an up-to-date panorama of PD and many other neurodegenerative issues. The book is well organized, and the layout is appealing, but the bright yellow hard cover does not go well with the seriousness of the topic. The price is fair. I highly recommend this book.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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