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Child in the BalanceZombies and Consciousness
The book is divided into 5 parts, beginning with a history of cognitive neuroscience and behavioral neurology; part two looks at perception and attention; part three is on language; part 4 on memory and prefrontal functioning, and finally, part 5 covers dementias and other development disorders. Farah is the well-known Director of the Center for Cognitive Neuroscience at the University of Pennsylvania, and Feinberg is the Chief of the Neurobehavioral and Alzheimer's Disease Center at Beth Israel Medical Center in New York City, amongst other appointments for both.
As the world ponders the oncoming revolution in personalized medicine, patient-centered approaches continue to offer the insights highlighted in a book of this caliber, as evidenced by the author list, a veritable who's who in the field of neuroscience. The overall dissatisfaction with a one-size-fits-all series of interventions in brain-behavior circles and elsewhere has led to the formation of bodies such as the Coalition for Personalized Medicine in Washington, but not too much treatment information is here.
This book then begins with the editor's chapter on the history of the field of cognitive neuroscience, and the first more topical chapter is by the Damasio team of Hannah and Antonio focusing on, predictably, structural imaging of patients and the effect of lesions on behavior. They discuss neuroimaging from the perspective of the BRAINVOX 3-D system and how the lesion method works in that setting using the template technique, as improved by BRAINVOX technology. The chapter concludes with a discussion of CT and MRI, the choice of specimens, and the timing of imaging, as well as the caveats associated with deciding if a negative image actually demonstrates the real current status of the brain.
The next chapter by Geoff Aguirre is on the basics of functional imaging, with two systems described, the first is the cognitive challenge leading to neuronal activity that is evoked; the second is the physiological response, with most research using the first system to examine the neuronal response. His focus otherwise is on the BOLD.fMRI system and the hemodynamic response and the presence of low-frequency noise that affect the design of investigations using this system. Price and Friston follow with a chapter that takes Aguirre further, with a more detailed analysis of functional imaging, and this is followed by Deouell, Ivry and Knight discussing electrophysiological methods such as TMS in cognitive neuroscience. In this, there is an attempt to manipulate neuronal activity directly. Activation or disruption of activity is thus attempted with magnetic stimulation. In particular, in terms of event related potentials, special focus is on traumatic brain injury, prefrontal damage and executive control, inhibitory modulation and sensory gating, and unilateral neglect. Linguistic processing in aphasic patients addresses the issue of a more fine-grain analysis of individual symptoms than a simple Broca-Wernicke-Disconnection-transcortical system would allow, again using ERP responses. The use of TMS as the possible inducer of experimental lesions is discussed in the final pages.
From virtual lesions to plasticity, and the next chapter is from Galaburda and Pascual-Leone in both damaged and normal brains, a hot topic in the neurogenesis world and in medication studies in personalized medicine in particular. These changes are only adaptive if the environment can support and maintain the resultant behavior. Thus plasticity is discussed in the context of the pathogenesis of disease such as acquired dyslexia, or in blindness and Braille reading.
Farah returns with a chapter on computational modeling, examining parallel distributed processing, and the application of such techniques to behavioral neurology and neuropsychology. PDP allows then for reasoned approaches to the effects of local lesions in distributed and interactive systems (page 103). To demonstrate this, she uses neglect dyslexia, covert face recognition, optic aphasia to raise and answer questions as an example of how the technique may be helpful given the difficulty in interpreting dissociations in neuropsychology.
In section two, on perception and imagery, Farah returns for the third time to investigate visual perception and imagery in terms of damage to the primary visual area and its afferents, as well as the surrounding association areas. Visual mental imagery is also discussed, albeit briefly, after right occipital lobectomy.
Farah returns yet again in the next chapter, this time with Feinberg, his second appearance, with a chapter on visual object agnosia. Not holding back, Farah is the author of the next very truncated chapter on Prosopagnosia, all of 2.25 pages, and again as the author of yet another, the fourth in a row, and the fifth of the first 11 chapters, this time in visuospatial function. Here, she examines visual guided reaching, impaired perception of location, and constructional apraxia.
A change is welcome, and it comes in the shape of Russell Bauer and Carrie McDonald. Bauer astounded the community in the 90's by producing a delightful article, which he never published as far as I know, on how brain injury could be incurred by colliding with a clinical Neuropsychologist. Their chapter however is on auditory agnosia and amusia, referring to cortical deafness and cortical auditory disorders as they prefer to call them. Pure word deafness is however the usual term for what follows, namely auditory agnosia for speech or verbal pronouncements, in Landau-Kleffner or Wernicke's conditions. Auditory sound agnosia and paralinguistic agnosias are discussed, as well as sensory or receptive amusia, not just a right-sided phenomenon, but with major input from both hemispheres.
Georg Goldenburg produced a chapter on body perception and representation with body part phantomism and autotopagnosia dominating. Again, he prefers the term somatotopagnosia, which didn't catch on. Neither did the meaningless gestures, or they wouldn't be meaningless, but some of them are in modern, especially gang society, or in teenagers posing and gurning for their class photos, and other cultures might recognise the 'meaningless' symbols for which there can be an apraxia in copying, after left hemisphere injury.
Heilman and Valenstein partner each other again, with Watson as well, to discuss neglect in terms of anatomical and clinical issues, mainly the assessment of neglect, with a short discussion of the treatment. The second part of this focus is authored by Chatterjee and Coslett who look at purely cognitive issues. Spatial and personal neglect dominate, as well as a short discussion on processing. A hallmark of this book is very short chapters, with 16 taken care of by Part III in only 177 pages.
This part of the book begins its focus on language with Michael Alexander on clinical and anatomical issues, including a wide ranging discussion on aetiology (pathology). The second part on aphasia is from Saffran, who looks at cognitive issues, as did the chapters on neglect previously. Caramazza and colleagues interesting work is a highlight of this chapter in terms of semantic constraints. There is an interesting paragraph on new directions, including simulation studies mentioned before, in Farah's work. The third chapter on aphasia is from Schwartz and Fink, on rehabilitation, discussing at first the various schools of traditional approaches, functional/pragmatic/social schools, and the cognitive psychology school, with much to offer, but not a panacea, as a modular approach. Maureen Dennis produces a chapter on acquired disorders in children, with a very helpful and descriptive set of tables on each condition with definitions, core features, epidemiology, age-and time-related factors, and neuropathological substrate.
Coslett returns with a chapter on reading disorders that are acquired, referring largely to the dyslexias, and again with some reference to the computational models. Aprosodias are tacked by Elliot Ross, with a short reference to the neurology of kinesics and prosody, leading into part four, on executive function, memory and other cognitive processes.
Bruce Miller, Frank Benson and Julene Johnson discuss the clinical and anatomical issues, with a discussion based on pathologies seen in the clinic, and then Farah returns, with the by now predicable follow up to the clinical/anatomical chapter, namely the cognitive issues. These include sequencing, verbal production, response inhibition, delayed response and span tasks, decision making tasks, and disorders of the supervisory attentional system, working memory, and adaptive coding. Brand and Markowitsch follow on with clinical anatomical issues in amnesia, with predictable information, with a very complex diagram from the latter's work providing an overview. Keane and Verfaellie follow with the cognition offering, on retrograde, semantic, explicit, implicit, and other aspects of amnesic nosology. Feinberg returns, this time with Giacino to look at confabulation, with the interesting insights that confabulation is not necessarily accompanied by memory impairment, executive dysfunction is common, but not necessary, confabulation involves disruption of a retrieval process, but direct damage or disconnection involving the ventromedial and orbitofrontal cortices is involved in seemingly all cases.
Farah once again emerges for chapter 27, with Grossman, looking at semantic memory in a typically brief chapter, and Dehaene follows with aculculia as a discussion point, with a topical look at the parietal lobe, interesting given recent findings of its involvement. Heilman returns with Watson alone this time, but adds in Gonzalez Rothi in discussing limb apraxia, followed in turn by Baynes and the well-known Gazzaniga in callosal disconnection. This closes off section four, leading to the dementias section.
Quite rightly the focus is immediately on the most prevalent condition, namely Alzheimer's. Looking at semantic memory and then attentional components, Milberg and McGlinchey-Berroth give way to Mendez on frontotemporal dementia and its variants including primary progressive, semantic and motor variants. Jacobs, Levy and Marder take on the dementias related to movement disorders, with an interesting comparison table. Voeller follows with mental retardation, including here a host of disorders, discussed in very limited detail. Chapter 35 is by Pennington and Chhabildas on ADHD. They include a very tight look at etiology, environmental illnesses, brain mechanisms, neuropsychology and treatment. Although the authors are happy with the evidence for treatment with stimulants, they are less happy with the clinical techniques used or unused in diagnosis. Psychosocial interventions are regarded as less than effective compared to medication, and better carried out by teachers. The NIMH study is discussed, in that the main effects variance was explained by medication alone, without valuable augmentation by the addition of behavioural measures. No mention is made of other treatments being successful, although there is at least anecdotal evidence for neurofeedback without much science behind it yet, although a major new multicenter study is beginning.
Minshaw and Meyer look at Autism and related pervasive developmental conditions, and while on the subject, Lovett and Barron look at development al reading disorders. This chapter is a little different to the one by Coslett earlier, not focusing on dyslexia, a relatively long chapter with a more neurological focus and treatment section.
In the final chapter, Swanson et al look at molecular genetics of the cognitive developmental disorders, and a short glossary closes the book.
The book is an exhaustive look at the subject, but limited by the truncated chapters, 38 of which are stuffed into just over 460 pages. Each chapter's authors have done their best to be concise, and this makes it a valuable resource, but with no sign that the authors have been able to develop any major treatment or etiology themes. However, each chapter manages in some way to dovetail with the next, and the one before, to overall provide a very comprehensive look at the individual afflicted by a Neurocognitive condition. As a stand-alone reference, it is most useful, and sure to go into a third edition, no doubt with several more, tightly written and terse chapters from Farah, if not others.
© 2007 Roy Sugarman
Roy Sugarman PhD, Director of Clinical and Neuropsychological Services, Brain Resource Company, Ultimo, Australia