Neurocognition in neurology

Abstract

This book is a concisely written reference text for neurologists, old-age psychiatrists and geriatricians, general physicians, specialists in endocrine, metabolic, vascular, or infective disorders, and practitioners of professions allied to medicine who have contact with patients with cognitive impairments. Larner outlines that in some neurological disorders, such as dementias, to look for neurocognitive impairment is obvious; however, we should also think of dementia more often in other disorders, which he describes in detail in the book. He points out that the standard neurological examination is mainly focussed on the function of the parietal and occipital lobes, and frontal and temporal functions are relatively untested. Adequate neurocognitive testing is, however, essential for the diagnosis of dementia, and might help in the differential diagnosis of other neurological and general medical disorders and in case management. Alleviation of neurocognitive impairment can also be used as a sign of therapeutic efficacy. Because of the limited time the clinical practitioner has to test neurocognitive function, Larner takes a pragmatic approach in his book, with a modest excursion into examination tools. Neuropsychiatric features of neurological disorders are left aside because the author felt they were well covered by others; however, they are referenced for any reader with a special interest. Likewise, depression-related cognitive dysfunction is referred to only briefly. The book starts with a concise description of neurocognitive domains and so-called “bedside tests” that take about only 10 to 30 min to complete. Larner points out that because these tests are brief, they might have shortcomings, and a particular raw score is not necessarily diagnostic, although it can increase the likelihood of a particular diagnosis. He also stresses the importance of obtaining collateral history from relatives, friends, or carers of the patient. He then reviews the deficits found across the spectrum of other neurological disorders. Overall, Larner has put together an intelligent discussion of the evidence for the profiles of neurocognitive impairment found in neurological and general medical conditions and the difficulties of assessing these functions. The book is well suited as a reference text, with tables that review the profiles of deficits typical of a specific disorder and detailed references for readers with a deeper interest in the topic.