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Parkinson's Disease and Parkinsonism in the Elderly.

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    Parkinson's Disease and Parkinsonism in the Elderly. Edited by jolyon meara and william c koller (Pp251, £29.95). Published by Cambridge University Press, Cambridge, 2000. ISBN0-521-62884-9.

    This is a multiauthor book which aims to discuss Parkinson's disease and parkinsonism in the elderly. The chapters are on the whole well written and the overall style is very much one of a practical handbook which is relatively easy to dip in and out of. There is little overlap in information across chapters. Chapters which stand out for their useful content, particularly in relation to the older age group, are those on diagnosis (Rodnitsky), the overview chapter on Parkinson's disease and parkinsonism in the elderly (Meara and Bhowmick), and treatment (Zesiewicz and Hauser). However, the treatment presentation of the current use of COMT inhibitors could be improved: the section meticulously describes the clinical effects of tolcapone, its half life, the appropriate dose, and the side effects, and it is not until the last paragraph that the reader is alerted to the fact that the drug is no longer used in Europe and its usage in the United States is limited.

    The main failing of the book is in the selection of chapters. I have three criticisms. The chapters on ancillary areas such as nursing, physiotherapy, speech, and occupational therapy (of Parkinson's disease) and specific approaches to rehabilitation (in Parkinson's disease and parkinsonism), are brought nicely into the context of medical management. However, depending on the intended audience, too large a proportion of the book is dedicated to these areas (no fewer than five of the 14 chapters). As it stands the book will satisfy neither medical nor paramedical readers as each group will find a large portion of the book of limited practical relevance.

    Secondly, in view of the many changes that occur to the nervous system as part of the aging process (especially in relation to gait), and the controversy which still exists about the relation of Parkinson's disease to age related attrition of dopaminergic neurons, it would have been useful to include a chapter aimed at assisting the clinician to distinguish age related changes in motor function from Parkinsonian diseases. Thirdly, the book is far from comprehensive in the coverage of causes of parkinsonism other than Parkinson's disease. The various causes are mentioned briefly in the summary chapters at the beginning of the book. Subsequently, however, only three chapters are actually dedicated to other parkinsonian disorders—and the choice of these seems arbitrary—namely, gait apraxia and multi-infarct states; drug induced parkinsonism; and a chapter on essential tremor. The chapter on treatment deals only with Parkinson's disease. In view of the avowed subject matter of the book I would have liked to have seen at least one chapter dealing specifically with the diagnosis and management of other parkinsonism plus disorders, such as multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration.