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Neuroimaging and the Psychiatry of Late Life.
  1. CLARE GALTON

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    Neuroimaging and the Psychiatry of Late Life.Edited by david ames and edmond chiu. (Pp242). Published, by Cambridge University Press, Cambridge, 1997. ISBN 0-521 49505 9.

    The continuing rapid expansion of neuroradiology, with new technologies and improvements in more well established techniques, have sharpened the tools with which to examine neurological and psychiatric diseases of old age. Investigation of, for example, the MRI findings in vascular dementia and depression, measurements of medial temporal lobe structures in Alzheimer’s disease, and functional imaging studies of schizophrenia, have led to new insights into the diagnosis, prognosis, and symptomatology of these ill understood diseases. However, there are two obstacles in the understanding of this expanding area of research for the interested neurologist and psychiatrist—namely, understanding of the basis of the technology and relating the research findings to best clinical practice. The remit of this text covers both these deficiencies.

    For the non-physicist getting to grips with the basic principles and methodologies of neuroimaging can be daunting. The first section of this book explains the basic principles behind the hardware of the imaging department and this is aided by many excellent diagrams. The general clinical indications and safety issues of structural (CT and MRI) and functional (PET, SPECT and EEG) imaging techniques are well reviewed and illustrated.

    The second section of the text explores the research questions and summarises the answers so far in the field of old age psychiatry. Interpretation of imaging research in abnormal elderly patients, with regard to subject selection, imaging technique and the relation to normal aging, is one of the main dilemmas in this field. This is fully discussed in the admirable chapter on normal aging, which commences this review of the research. Other chapters on Alzheimer’s disease, vascular dementia, other dementias, delirum, affective disorders, and schizophrenia of late onset continue this well referenced text. Besides presenting the data for the clinican, this comprehensive review will also be appreciated by researchers in this field.

    The third part of this book returns to the application of these results to clinical practice. Both an American and European perspective on the clinical interpretations of the above data are presented and the conclusion can be quoted “Our ability to image the brain, however, has in some cases outpaced our ability to understand the clinical implications of the structural and functional findings seen using modern imaging techniques”. In other words this interesting research which has been so excellently summarised here has yet to make an real impact on routine clinical practice.

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