1290_1291_BR_JON_2003 30.09.2005 08:09 Uhr Seite 1290

J Neurol (2005) 252 : 1290–1291 DOI 10.1007/s00415-005-0003-0

Neuropsychological Assessment, Fourth Edition

JON 2003

Muriel D. Lezak, Diane B. Howieson and David W. Loring (Eds.) Oxford University Press, New York, USA, 2004 1029 pp. Hardback ISBN: 0-19-511121-4 £54.00

This is the fourth edition of a classic textbook in Neuropsychology which was first published in 1976. Most practising clinical neuropsychologists and many research neuropsychologists will have used the book at one stage or other in their work, and this revision represents an important addition to the library of clinicians and academics alike. The book is now multi-author, with Muriel Lezak being joined by four other contributors. The page size is larger, and the 1016 pages compared with 1026 pages in the third edition belie the significant new input in this revised edition.The structure of the book is similar to that of the previous edition, with the chapter headings across the 20 chapters being broadly similar to those in the 1995 edition. There are close to 200 pages of references alone,almost as many pages as some other books on neuropsychological assessment!

BOOK REVIEW As before, the book is divided into two broad sections, the first dealing with background issues and topics, and the second section providing a compendium of tests, inventories, rating scales, etc. Chapter 1 provides an Introduction to the practice of neuropsychological assessment, and outlines the various reasons why neuropsychological assessment may be useful in clinical, research and legal settings. It offers a useful glimpse into what we may expect of neuropsychological assessment in the 21th century – in addition to the points in this section, it is likely that there will be increasing interaction between cognitive testing procedures and functional brain imaging to yield novel indices that will be of value in neuropsychological assessment (cf. Bigler 2001). Chapter 2 provides a discussion of important background issues in neuropsychological assessment, and I would particularly guide the reader to the section dealing with the concept of intelligence and the use of IQ scores in neuropsychological assessment. It is hard to quarrel with the conclusion of Lezak et al. that in the realm of neuropsychological assessment “IQ – whether concept, score or catchword – has outlived whatever usefulness it may once have had and should be discarded” (p. 22). As well as the cogent argument put forward in this section, it is also worth considering the concept of intelligence in the context of the multiple intelligence framework espoused by Howard Gardner and his colleagues (Gardner 1999). Chapter 3 provides a synopsis of the various neuropsychological disorders associated with particular anatomical regions, and for some readers may perhaps duplicate what they have learned in general neuropsychology texts. Chapter 4 provides a useful overview of the rationale behind various

forms of deficit measurement in neuropsychological assessment. Together with Chapter 6, which deals with interpretation of test performance, there is valuable discussion of issues that will strike a cord with most clinical neuropsychologists. Two perspectives which one hopes will gain more prominence in such discussions in the future are automated procedures for interpreting neuropsychological signs and symptoms, and the related topic of the reasoning and decision-making processes that lie behind accurate and inaccurate interpretations of neuropsychological data. Psychologists, with their eclectic background, have an ideal opportunity to make a contribution in these areas, and while there have been relevant studies in the medical literature, there appears to have been relatively little in the area of clinical neuropsychology. Chapter 5 deals with the ‘nittygritty’ of neuropsychological assessment procedures. Although it may be perhaps be more beneficial to newcomers rather than to experienced clinicians, sections such as that on special clinical populations offer useful reminders to us all. Chapter 7 devotes around 130 pages to neuropsychological conditions associated with various forms of cerebral pathology. All five authors have contributed to this chapter, and in a sense it provides a synopsis of what is found in standard textbooks of ‘organic psychiatry’ (Lishman 1998), but with more of a neuropsychological slant. Chapter 8, which deals with ‘neurobehavioral variables and diagnostic issues’ will perhaps be particularly attractive to experienced and novice clinicians alike, since it covers topics that are problematical and ever present, such as teasing apart neurological and psychogenic variables in patients presenting with cognitive or behavioral disturbance.

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Turning to section II, which takes up the major part of the book, this comprises 12 chapters that cover the major domains of cognitive function. As well as the usual subdivisions of orientation/attention, memory, language, perception, language skills, construction, reasoning, executive function, and motor performance, there are separate chapters on neuropsychological assessment batteries, observational methods/rating scales, personality adjustment/emotions, and a valuable final chapter on response bias/effort. The chapter on observational/methods rating scales in-

cludes detailed coverage of brief assessment scales, such as are commonly used to screen for dementia. While they have generally been used by neurologists and psychiatrists, rather than by neuropsychologists, they should perhaps be more carefully considered by the neuropsychology community. There are now more empirical data on issues relating to validity of brief assessment scales, and there may be situations where a brief scale that does not have floor or ceiling effects and may, for example, helpfully prune referrals in busy clinical settings. In summary, Neuropsychological

Assessment remains a classic and has been enhanced by the updated fourth edition.Although I did spot a few typos that by-passed the proof readers, the finished product is an invaluable resource that will continue to have its place in every setting where neuropsychological assessments are carried out to professional standards. Narinder Kapur Clinical Neurosciences Addenbrooke’s Hospital Cambridge, UK