depression and the psychosis and agitation in dementia. Correlation
of behaviour with the anatomy of neurodegeneration in the different
dementias provides insights of potential use in therapy. T h e
penultimate chapter by Marson and Briggs provides an informative
review of competency and its neuropsychologic assessment in
dementia, citing their recent studies in this new field research.
Vo l i c e r’s chapter, perhaps unavoidably, last reviews issues in
management arising in the late stages of dementia. Few patients die
in a persistent vegetative state so that provision of meaningful
activities and sensory stimulation is a requirement for most patients.
Among medical, behavioural and caregiver issues, I found that his
discussion of tube feeding very informative.

Professionals interested in dementia will find something of
interest here in their own fields as well as enlightenment in the
related disciplines. Unlike other annual collections of reviews, this
one is well-indexed. I found some irritating redundancy in
exposition, suggesting a need for greater use of the red pencil by
senior authors and editors. Figures are well-reproduced (chapters 2
and 3), except that a blow up of medial temporal lobe images in
chapter 3 would have been helpful.

John R. Wher rett
Toronto, Ontario

BASAL GANGLIA AND THALAMUS IN HEALTH AND MOVEMENT
DI S O R D E R S. 2001. Edited by K. Kultas-Ilinsky, I.A. Ilinsky.
Published by Kluwer Academic/Plenum Publishers, New York. 378
pages. C$142.50 approx.

This text is notable for the authors selected. There is a “who’s
who” of movement disorders beginning with Anne Young, Jack
Penney and Mahlon DeLong and including the Toronto We s t e r n
Hospital group (including Jonathan Dostrovsky, William Hutchison,
Karen Davis and Andres Lozano). Do not be put off by the dry title.
There is vertical integration from basic science to clinical application.
For those who wondered how pallidotomy works in Parkinson’s
disease when the classic model of basal ganglia predicts chorea or
excessive movement, the answers are approached in these chapters. 

There is logical division of the formidable topic into Historical
Perspectives, Anatomical and Functional Org a n i z a t i o n ,
Neurotransmitters, Receptors and their Role in Motor Behavior,
Movement and Sleep Disorders, Plasticity in Movement Disorders,
Neuronal Activity in Movement Disorders, Mechanisms and
Efficiency of Novel Treatment for Movement Disorders. Each
section is further divided into chapters that touch upon every aspect
of basal ganglia and thalamic circuitry and their implications in
movement disorders. 

The chapter on microcircuits could benefit from more diagrams,
the text itself being quite dense. Whereas, the chapter on local and
efferent neurons has lavish histochemistry panels that add to its
comprehension. The editors’ chapter dealing with primate
organization and connection of the motor thalamus is well-organized
and well-written. The subject matter is key to understanding the
organization of the basal ganglia and thalamus. 

The sections on plasticity in movement disorders and neuronal
activity in movement disorders deal with primate and human studies.
These findings explain much of the paradox of the classic basal
ganglia model. Finally, there is a brief transcript of discussions from
the meeting on which this work is based. 

LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES

Volume 29, No. 2 – May 2002 197

reference for graduate students and postdocs beginning a research
career in this specific area, but feel it is probably too focused and
unbalanced to be of general interest to senior scientists and clinicians. 

Ian R.A. Mackenzie
Vancouver, British Columbia

ALZHEIMER’S DISEASE AND RELATED DISORDERS ANNUAL 2001.
Edited by Serge Gauthier and Jeffrey Cummings. Published by
Martin Dunitz. 216 pages. C$87.00 approx.

What is common to β-pleated sheets and PET therapy or to axial
FLAIR and the neuropsychology of the capacity to consent? Well, it is
all in a day for those specializing in dementia and for the editors of an
annual collection of reviews and essays in this field. This is the second
annual collection edited by Gauthier and Cummings (unfortunately,
contents of the first annual collection are not listed) and is as eclectic
as any deliberation in the field or indeed as in any field in medicine.
The untoward deterioration of manifold higher brain functions with
aging now has the attention of clinical professionals and researchers
from a remarkably wide range of disciplines that reflect the complexity
of both the etiology and pathogenesis and management. T h i s
management in wide measure needs to consider the social setting of the
a ffected individual. Early chapters address etiology and pathogenesis
and pharmacotherapy of particular interest to neurologists and
neuropathologists; three chapters address depression, behavioural
manifestations of interest to neuropsychiatrists and psychiatrists, and a
final chapter addresses geriatricians and family physicians caring for
patients in the later stages of debility. I first read chapter 3 by Scheltens
on neuroimaging, hoping for clarification of the indications in
diagnosis. Recent studies of mesial temporal atrophy, regional cortical
atrophy and white matter change have given conflicting results that
suggest that findings will mainly support what is clinically obvious.
Although research studies superimposing MRI and PET or SPECT
appear to give greater precision in detection of A l z h e i m e r’s disease,
guidelines of the American Academy of Neurology recommend against
use of metabolic imaging in daily practice. There is room for
considerable skepticism about the value of imaging of conditions
where multiple pathologic processes appear to intersect. One of these
processes that I suspect enters discussion in the memory clinic
i n f r e q u e n t l y, amyloid angiopathy, is thoughtfully reviewed by Vi n t e r s .
We learn that the amyloid does not form in the vessels of the white
matter although leukoencephalopathy is seen in some forms. We also
learn that 5% of patients dying with A l z h e i m e r’s disease will be found
to have cerebral hemorrhages.

The possibility that effective disease-modifying therapies are in
sight is reflected in two chapters. The first by Cole provides a
detailed discussion of mechanisms of amyloid formation and
disposal and the second by Peterson reviews “mild cognitive
impairment”, the term used to include subjects exhibiting the earliest
manifestations of Alzheimer’s disease and most likely to benefit
from these therapies. This latter syndrome is identified through
clinical judgement and the development of a definition suitable for
clinical studies will require some ingenuity. One of the editors,
Gauthier, reviews studies of cholinergic agonists that have been
overshadowed by the recent success with cholinesterase inhibitors.
It is too early to abandon this approach to symptomatic therapy. The
other editor, Cummings, contributes to one of three chapters
updating well-trod approaches to diagnosis and therapy of

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