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Neuropsychology of Everyday Functioning

Alan D. Schmetzer, MD

Indiana University School of Medicine, Indianapolis, IN, USA

Daniel F. Rexroth, PhD

Indiana University School of Medicine, Indianapolis, IN, USA

Edited by Thomas D. Marcotte, PhD, and Igor Grant, MD. New York, NY: The Guilford Press; 2009; ISBN: 978-1-60623-459-4; pp 455; $65.00 (paperback).

This is the fifth book in a 6-book series entitled The Science and Practice of Neuropsychology, with Robert A. Bornstein, PhD, as series editor. Drs. Marcotte and Grant are both senior members of the faculty at the University of California, San Diego HIV Neurobehavioral Research Center, but the remainder of the book’s 43 authors are scattered across the United States and Canada, and include one writer from Israel. However, nearly all are well-recognized names in their areas of expertise.

Perspectives on functionality come from occupational therapy and psychiatry as well as psychology. Each discipline demonstrates its unique point of view on functionality and its assessment. Dr. Bornstein makes a point in his Series Editor’s Note regarding the emergence of neuropsychology from the lab into the realm of clinical application. Working, as the authors do, at the medical school where Ralph Reitan initiated a neuropsychology clinic in 1951 to expand upon his work with Ward Halstead, and from which such well-known clinical neuropsychologists as Kathleen Fitzhugh-Bell launched their careers, our personal bias was that clinical application was at the forefront of what neuropsychology was all about. But having read the book, we believe that Dr. Bornstein’s point has to do with the following: (1) The specificity of neuropsychologic assessment for functional impairment has been controversial from the beginning; (2) Much of the field does, indeed, remain experimental; and (3) There is a great deal of translational work yet to be accomplished.

It must be remembered that neuropsychology defined its original subject matter in terms of detection and localization of brain pathology. This book discusses the related but separate issues of functionality and prediction that have gained neuropsychologic prominence as new brain imaging techniques have come online, changing the thrust of questions now routinely posed to neuropsychologists. The book also reminds us of the current limitations of neuroimaging, since defects—or lack there-of—on various scans and tomographs do not always correlate well with degree of functional impairment.

This book’s 18 chapters are divided into 2 basic areas: The first covers assessment concepts and methodology, and the second, the impact of normal aging and neuropsychiatric disorders on everyday functionality. The first area is further subdivided into sections A and B. The 3 chapters that comprise A have to do with general approaches to evaluating cognition as it relates to everyday function. They include discussions about ergonomics and occupational therapy assessment. Section B includes 5 chapters, one devoted to instrumental activities, another to work abilities, a third to medication management, the fourth to assessment of driving, and the final one to cross-cultural considerations in functional assessment.

The second major area, impact of aging and specific disorders on cognition and functioning, is composed of 10 chapters which discuss general topics, such as quality of life and normal aging, as well as the effects of specific disorders, such as dementia, vascular dementia, mild cognitive impairment, concussion, traumatic brain injury, HIV-related disorders, multiple sclerosis, depression, and schizophrenia. Each chapter provides a thorough overview of its specific topic, indicating which tests may be useful, including an explanation and discussion of how they can be helpful and their potential weaknesses. Also included in many cases are appropriate definitions and, of course, issues of validity and reliability.

In essence, there is also a third area, including a nonnumbered chapter written by the editors that discusses future directions, although mention of such matters is scattered throughout the text. As one might imagine, neuropsychology is an area having multiple potential questions that need substantial additional work, despite the progress made through the years. References are listed at the conclusion of each chapter, and there is a comprehensive subject index at the end of the book.

Neuropsychology of Everyday Life is clearly written. Topics are discussed in detail and references for additional reading are included. This is a book that will be of interest to many psychologists. For those who are very familiar with the field of neuropsychology, there are chapters, such as the one on approaches to functional assessment in occupational therapy, which may offer new insights. For those new to the field, this book may serve as an excellent overview. Physicians and residents in the fields of neurology, neurosurgery, psychiatry, geriatrics, and even infectious disease (eg, HIV), could learn a great deal that may have clinical relevance to their patients’ functional abilities, from the discussion of both general theoretical and specific, practical matters. Social workers and marriage and family therapists, sometimes called upon to advise patients or families regarding functional concerns, could reference ideas for referrals or suggestions of resources to consider.