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Mental and behavioral dysfunction in movement disorders
  1. M Trimble

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    Marc-Andre Bedard, Yves Agid, Sylvain Chouinard, Stanley Fahn, Amos D Korczyn, Paul Lesperance. New Jersey: Humana Press 2003, pp 543, $185.00 (hardback). ISBN 1-58829-119-7

    It was not long ago that the basal ganglia were confidently asserted to have no influence on cognition, and to have only motor functions. This was the province of neurology, and the concept that they might be involved in disordered behaviour other than that referred to as movement disorders was an anathema to generations of neurologists.

    As Goetz notes, in the introduction to this nicely produced book, this view ignored over a 100 years’ of clinical observation, and much subsequent work, theoretical, clinical, neurochemical, and neuroanatomical, all of which underline the central role of the basal ganglia structures in regulating behaviour, in its widest sense, and hence the association between movement disorders and cognitive and behavioural dysfunction.

    The openers in this text are with neuroanatomy and neurochemistry, rightly so since the impact of the discovery of dopamine and the unveiling of the new neuroanatomy of the limbic forebrain, have fundamentally altered the way we think about the brain and its functions, and should profoundly influenced clinical thinking. A chapter on the cerebellum is also included in the opening section.

    The book then contains chapters on two main themes, cognition in movement disorders, including the long controversial area of links with dementia, and the neuropsychiatry of movement disorders. The main diseases discussed are the obvious eponymous ones of Parkinson’s, Huntington’s, and Gilles de la Tourette, as well as cortico-basal degeneration. There are some curious omissions, Wilson’s disease, Sydenham’s chorea, and supranuclear palsy, among others. The cognitive problems embrace such topics as speech disorders and apraxias, and include chapters on animal models as well as clinical research.

    The section on neuropsychiatric aspects is laid out rather differently and less systematically. A chapter on mood disorders and the pallidum, another on depression and the basal ganglia, another on psychosis and mood disorders in Huntington’s disease, some disease orientated, others anatomically based. Nevertheless, the individual chapters are, for the most part, well written, and included are contributions on REM sleep behaviour disorder, psychogenic movement disorders, and obsessive compulsive disorder. A separate section is devoted to quality of life studies.

    The book is a timely reminder of the growth of interest in and the clinical importance of neuropsychiatry, and quite some space in the text is given to treatment and management issues. No longer can the basal ganglia simply be viewed as structures subserving motor function, they represent drives and affects which are re-represented cortically and which propel our very being.