The eminent J.P. Mohr states in his Foreword to this text that its intention is to decrease the emphasis on “…seemingly compartmentalized cerebral functions…” in order to “…present methodology and data that support the use of neuropsychological techniques as a means of shedding light on cerebral localization, plasticity, and vascular pathophysiology”. Although some degree of emphasis on such disorders as aphasia, apraxia, and agnosia has, of course, been useful, as the oft-referenced quote from C. Miller Fischer notes that students learn neurology “stroke by stroke”. However, it has been nearly 20 years since Bornstein and Brown (Reference Bornstein and Brown1991) presented their excellent edited compilation describing the state of knowledge on cerebrovascular disorders and behavior. Festa and Lazar’s work is a timely effort to continue that effort to broaden and deepen our perspective on vascular disease as related to neuropsychological functioning.
Certainly, the focal stroke remains of interest and importance, but we have learned that such lesions occur within a broader medical context and that the visualized lesion itself is far from the whole story of the illness and its behavioral effects. Increasingly, neuropsychologists and clinicians from other medical and rehabilitative specialties are becoming aware of the complexities contributing to the clinical picture both prior to, and subsequent to, the identification of cerebrovascular lesions in a given patient. Perhaps most importantly this includes the identification of pathophysiological changes related to the presence of a developing dementia. Over the past 100 years, there have been shifting views on the relationship between cerebrovascular disease and dementia, especially in the absence of identifiable lesions. To the extent that much of neurovascular disease represents a range of both congenital and slowly developing vulnerabilities related to systemic disorders, Neurovascular Neuropsychology is designed to integrate knowledge related to causal mechanisms and underlying processes to enable a greater understanding of the problems.
This volume is a compilation of 19 chapters written by a remarkably international list of contributors with expertise at many levels in the field of vascular disease. While none of the reviews could be considered exhaustive, the chapters are clearly and concisely written and provide an excellent, broad-based introduction for each topic. For example, the initial historical perspective by Merino and Hachinski provides a brief summary of the pendulum shifts from the concept of arteriosclerotic dementia at the turn of the last century through the concept that impairment is directly linked to frank vascular events and lesions to the more recent recognition of vascular cognitive impairment, both with and without clearly defined stroke. Included is an appreciation of the possible relationships between cerebrovascular factors and Alzheimer-type processes. This is a very timely and important topic to which subsequent chapters return and enlarge upon.
In the second chapter, Lazar and Festa provide the necessary background and summary of neurovascular geography and a basic discussion of autoregulation and neurodiagnostic tools. From that point, while not broken into formal sections, the book provides a series of chapters covering the major types of neurovascular problems including ischemic and hemorrhagic stroke (Kirshner and Mark), aneurysm and subarachnoid hemorrhage (DeLuca and Prestigiacomo), and arteriovenous malformations (Lance and Lazar). Each of these chapters presents summaries of major findings and syndromes as well as basic descriptions of neurodiagnostic procedures.
Chapters 6–9 could be considered as directed toward small vessel and subcortical vascular diseases and to the issues of cortical perfusion as they are related to cognitive changes and dysfunction. These chapters include interesting, occasionally overlapping discussions regarding current perspectives on the development and progression of mild cognitive deficits through dementia related to vascular disease. In Chapter 6 (Libon et al.) and Chapter 7 (Kramer and Wetzel), there are considerations of recent research related to the association of vascular compromise from mild through marked impairment as well as discussion of the relationship between vascular disease and primary dementia. Chapter 8 (Benisty and Chabriat) provides definitions and research findings for the genetic disorders of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes (MELAS). In the last of these chapters, Chmayssani and Festa discuss large vessel occlusion with special attention to lowered cerebral perfusion and the effects of treatment through stenting and revascularization, although research in cognitive recovery is limited.
From the outset, the authors stress the complexities of neurovascular disease and the need for a broader understanding of process and causal mechanisms rather than simply describing stroke and the well-recognized vascular syndromes. Thus, the critical “support systems” of heart and lung and the common co-morbidities to cerebrovascular disease (diabetes, hypertension, and systemic/collagen vascular disorders) are the focus of ensuing Chapters 10–15. Chapter 10 (Lim and Alexander) discusses the neuropathology and outcomes associated with cardiac arrest. Zuccala et al. present the state of knowledge for congestive heart failure and heart transplant in Chapter 11, emphasizing the relatively preliminary nature of the data. A more lengthy history of research involving the natural history of neuropsychological consequences involved with cardiac surgery is updated in Chapter 12 by Selnes and Gottesman. Less widely reviewed research on pulmonary and lung transplant research is covered in Chapter 13 by Broshek et al. The following chapter on diabetes and hypertension (Launer and Wright) provides an overview of two primary precursors and contributors to cerebrovascular disease. They note that functional limitations may occur even in the absence of identified stroke or in association with or facilitation of other processes, most notably Alzheimer’s disease. Chapter 15 by Holliday and Brey presents a background and relevant neuropsychological research on neuropsychological and neuropsychiatric manifestations of systemic lupus erythematosus and antiphospholipid antibody syndrome. Although the information provided is consistently tied back into relationships specifically with cerebrovascular disease, these sections are in the tradition of earlier works in the area of medical neuropsychology (e.g., Tartar, Van Thiel, & Edwards, Reference Tartar, Van Thiel and Edwards1988; Tartar, Butters, & Beers, Reference Tartar, Butters and Beers2001; Waldstein & Elias, Reference Waldstein and Elias2001) .
Chapter 16 (Hacket and Anderson) provides an important discussion of neurovascular disease and mood disorders, considering underlying relationships and transmitter systems, diagnostic criteria, assessment, and natural history as well as the impact of depression on recovery. An appreciable amount of the focus of this chapter is on treatment for such depression, which represents a lead-in for the final three chapters of the book. This last section considers recovery from the perspectives of findings from functional imagery (Marshall), pharmacological treatment for cognitive disorders (Flanagan and Gordon), and neuropsychological rehabilitation (Eskes and Barrett).
Neurovascular Neuropsychology covers its territory in a thorough although not overly detailed manner. The reader is afforded useful summaries of topics written in a readily understandable manner. It is presented for neuropsychologists as its primary target audience, but less as a clinical or “how to” reference than as a foundational text providing overviews of critical research. As such, it could certainly be useful to others including physicians, clinical psychologists, and rehabilitation workers for whom background and research material would facilitate their efforts. Those who already have an in-depth knowledge in cerebrovascular disease and its complications may be a little disappointed with the brevity of a few sections, and others may find it surprising that so little is known in some areas. For example, the sections on heart and lung transplant and re-vascularization make it clear that considerably more research is needed. Research on pharmacological treatments for cognitive disorders is at very early stages. One of the strengths of this text and the presented reviews is that research to date is critically presented, with discussion of the problems in methodology, an awareness of the limited conclusions that are afforded in comparing the results of various studies, and clear directions and recommendations for future research.
