188
Elsevier Scientific Publishers Ireland, Ltd.
BOOK REVIEWS
e d i t e d by H . P E T S C H E and JOHN R. H U G H E S
The neurology of aging. - - R. Katzman and R.D. Terry (Davis,
Philadelphia, PA, 1982, 249 p., U.S. $38.00)
The groundswell of interest in the neurology of aging relates
to two f a c t o r s - the large and growing number of elderly
individuals, and the observation that the major cause of disabil-
ity in the aged is neurologic disease. Now, Drs. Robert Katz-
man and Robert Terry have written and edited a highly reada-
ble book on this subject for the Contemporary Topics in Neurol-
o,~v series. In less than 250 pages they have thoroughly sum-
marized much of the current knowledge in this area.
Clinically, The Neuroloyo' of Aging deals most extensively
with cognitive and memory impairment (dementia) and espe-
cially with Alzheimer's disease. Motor dysfunction, peripheral
nerve disease, auditory and visual losses, and sleep disturbances
are also discussed.
Two difficult themes run through this book: (1) what com-
prises 'normal' aging effects as distinct from 'diseases' of the
aged; and (2) how are the functional neurologic deficits related
to anatomic, biochemical pharmacologic, and physiologic
changes that are found in the brain? Overall, the authors take
the position that diseases, rather than involution, account for
the disability of the elderly, although recognizing that func-
tional decline inevitably occurs with age. And, they consider
the numerous changes in brain structure and function to account
for the neurologic decline of the aged, even though they are not
precisely linked.
Each of the chapters in this volume is a treasury of informa-
tion and bibliographic references. Katzman's initial chapter on
'Demography, Definitions, and Problems' reviews theoretical
considerations of 'primary' and 'secondary' aging, 'functional'
age and the definition of senescence. There are useful discus-
sions of the heterogeneity of the aging population, and of the
difficulties inherent in the design of clinical studies of function
in the aged.
Drs. Katzman and Terry next struggle with the difficult
issue of what is 'normal' in the aged. They consider a signifi-
cant part of the apparent decline with age to be due to the use
of 'cross-sectional studies, where younger subjects have educa-
tional advantages over an aged cohort.' They discuss briefly
some of the electroencephalographic and evoked response
changes that occur, as well as alterations of cerebral blood flow
and metabolism, and anatomic and pharmacologic changes. A
chapter on senile dementia of the Alzheimer type (SDAT)
presents a state-of-the-art review of this problem.
Teravainen and Calne note that much of the motor impair-
ment of the elderly is of an extrapyramidal nature, and that the
distinction between the changes in normal aging and those of
Parkinsonism are largely a matter of degree. The reader here, as
elsewhere, may be perplexed by the difficulty of differentiating
0013-4649/84/$03.00 ~,' 1984 Elsevier Scientific Publishers lreland, Ltd.
Electroencephalography and clinical N europhysloloy(v, 1984, 57:188 192
the consequences of 'normal aging" from "disease.'
A discussion of the peripheral nervous system in the aged
presents an accounting of the sensory and motor losses . -
functional, anatomic and physiologic that may be expected
in the elderly.
There are useful chapters on hearing loss and visual impair-
ment in the elderly - - disorders which are often overlooked by
physicians. The late Dr. Elliott Weitzmann comprehensively
reviewed sleep disorders occurring in the aged. He included
valuable discussions of alterations of other cyclical phenomena
(e.g., neuruendocrine changes) and of autonomic disorders.
Blass and Plum discuss the metabolic encephalopathies that
occur in the aged. They make a useful observation that is both
common knowledge and frequently ignored: in a brain where
the population of neurons has been reduced to a critical level,
even a mild metabolic disorder can reduce function below the
threshold for clinical manifestations. "Furthermore. metabolic
insults which can transiently affect a younger person and leave
no trace, often create in the elderly a wake of permanent
residual damage.' Endocrine, electrolyte, toxic and metabolic
encephalopathies are reviewed.
The book concludes with a chapter on "The Neurologic
Consultation at Age 80" in which a common-sense approach to
the neurologic evaluation of the aged patients is presented.
The Neurology of Aging represents a lucid, succinct review
of a current area of increasing importance. It is well written
and carefully edited, and its more than 1300 references repre-
sent a remarkably comprehensive bibliography. It is difficult to
imagine an neurologist, or other physician interested in the
problems of the aged, who will not profit from the reading of
this volume.
DAVID A. I)RACHMAN
Unwersi(v of Massachusetts Medwal Center,
Worcester, MA 01605 (U.S.A.)
Biomagnetism. An interdisciplina~, approach. - - S.J. William-
son, G.L. Romani, L. Kaufman and I. Modena (Eds.) (Plenum,
New York, 1983, 706 p., U.S. $95.00)
This volume represents the proceedings of a NATO Ad-
vanced Study Institute held in September, 1982 in Rome, Italy.
The topic of biomagnetism is current and exciting and new
laboratories studying these phenomena are springing up each
week, as a reflection of recent developments in apparatus which
do not require expensive shielding. This area of investigation
has implications for many different disciplines within medicine,
but especially for neuroscientists, since the continuous electri-
cal currents of the brain often have a significant magnetic
BOOK RF.VIEWS
component. The 18 chapters are authored by 20 lecturers,
including 5 from Italy (Carelli, Fenici, Modena, Romani+ Tac-
cardi), 3 from Finland (Kalliomaki, Kariniemi+ Katila), 2 from
W. Germany (Erne, Lehman) and 10 from the U.S.A.
An introduction by Cohen is clearly written in the author's
easy style and provides an excellent perspective for the reader.
Technical considerations are presented with the assumption
that the reader will know little of biomagnetism; topics include
magnetic quantities and cryogenics, required of the SQUID
sensors and detection coils. The chapter on physical concepts
and mathematical models will necessarily overwhelm readers of
this journal by the intricate calculus. The next two chapters on
electrophysiology of cells and cellular action currents provide
an excellent general summary for the reader and presumably
for many of the lecturers, 70% of whom came from Physics or
Electronics Departments. Cardiac studies account for 17% of
the book and include clinical magnetocardiography (MCG) and
fetal MCG. Interesting chapters on the steady fields of the
body (Cohen) and magnetic fields of the eye (Finnish group)
precede brain studies, which account for 18% of the book.
Lennie presents a fine summary (presumably for the par-
ticipants) of the functional organization of the brain, single unit
activity and evoked potentials before Kaufman's excellent
chapter on event-related potentials and fields.
Okada is responsible for the superb chapters on evoked
magnetic fields, clearly explaining why it is the intracellular
current that predominates as the source of these fields. All past
and current data on the somatosensory evoked field (SEF) are
summarized, with emphasis on the lateralization of the SEF, as
opposed to the bilateral SEP. The chapter on motor fields
includes the description of the magnetic components of the
slow, pre-motion, motor and corollary discharge potentials. The
studies on the auditory evoked field are clearly presented, as
are those on the visual, both concluding that the evoked
magnetic field need not be the same as the evoked potential.
since the former reflects only the tangential component of the
dipolar source and the latter both the tangential and radial
components. The last chapter by Okada on endogenous mag-
netic fields, although essentially a reprint of a study recently
published in this Journal, provides a good example of the way
to localize in a 3-dimensional way the origin of brain activity
that spreads over the surface of the head. The short chapter on
magnetoencephalography (MEG) by the group from Italy sum-
marizes the few studies on the relationship between the MEG
and EEG, emphasizing both alpha and paroxysmal activity.
The last 5 chapters begin with a fascinating account of ' the
magnetic biopsy,' a measurement of tissue iron, especially in
patients with hemachromatosis and thalassemia. Some of the
newest of studies are presented in biogenic ferrimagnetism,
dealing with magnetic constituents in various organs of differ-
ent animals, including pigeons, whose 'magnetic compass' is
now well known. Magnetopneumography for inhaled iron par-
ticles and chapters on shielded room and analog filtering
techniques precede the last (complex) chapter on signal
processing. Finally, as a summary, the Editors have provided
the reader with a clear retrospective account of the entire book.
This book, summarizing the current world literature on
189
biomagnetism, is long awaited by the few of us who have
worked in the area, but should be welcomed by any neuroscien-
tist interested in setting up a station in this new frontier. The
Editors have done an excellent job in the insuring of clarity of
expression and individual lecturers seem to be aware that most
of the readers may not be physicists, as most of them are. At a
relative high cost, the book will be purchased only by those that
have a very special interest in the field, but the reviewer would
encourage neuroscientists to give serious consideration to this
new, exciting way to look at the central nervous system.
JOHN R. H U G H E S
University of Illinois Medical Center,
Chicago, IL 60612 (U.S.A.)
Epilepsy. Diagnosis and management. - - T.R. Browne and R.G.
Feldman (Lillle, Brown and Co., Boston, MA, 1983, 376 p., U.S.
$32.50)
Although many books have recently been published on
epilepsy, this one by Drs. Browne and Feldman is one of the
most comprehensive. The inside jacket of the book makes the
claim that 'virtually all essential aspects of the diagnosis and
management of epilepsy are covered' and this claim proves to
be correct. The preface implies that the book is written for
physicians (other than full-time epileptologists) who are not
aware of new information about diagnosis and management
and the inside jacket states that neurosurgeons, internists, and
allied health personnel 'will want this book close at hand." This
reviewer would maintain that all full-time epileptologists and
neurologists with a specialty in seizure disorders need this book
as an encyclopedic reference, since nearly all aspects of epi-
lepsy are really covered in detail. For other personnel who do
not specialize in this area, they may wish to explore the
contents of the book to see if it tells them more than they want
to know.
The senior author of Epilepsy is responsible for 15 of the 31
chapters and the junior author for 5 of them. The first 10
chapters, covering one-third of the book, deal with detailed
descriptions of the different kinds of clinical seizures. The
authors are aided in this section by other experts, like M.
Trachtenberg introducing the epilepsies with an excellent
chapter on basic mechanisms, G. Erba on simple partial seizures
and on Lennox-Gastaut syndrome, A. Mirsky on absence
seizures and C. Lombroso on infantile spasms. The reader will
find many helpful tables and graphs, in addition to excellent
use of headings and subheadings, not only in these chapters,
but throughout the book. At times, the details become a bit
esoteric, especially for non-full-time epileptologists who may
not be interested in 5-ethyl-5-phenyl-2-pyrrolidone as a possi-
ble agonist at GABA receptors and di-n-propylacetate as a
GABA transaminase inhibitor. Occasionally, old references
from the 1950"s are found, exemplified by the statement that
focal discharges are found in only 40% and up to 85% of
patients with simple partial seizures.
As a bridge between the latter section and the next third of