First off, this “little black book” is not little. It comes in at just under 1,000 pages and adds a hefty weight to any backpack or briefcase. The “little black book” part of the title is to explain that this is a comprehensive guide that covers most essential aspects of the practice of neuropsychology across the lifespan. It could be subtitled, “What every neuropsychologist needs to (or should) know.” There is no other book in the field that covers the scope of material that is inside this comprehensive text. The work might be best summed up as being a clinical neuropsychology postdoctoral residency in a book, with the most up to date information available, so that it is also an indispensible book for practicing neuropsychologists in addition to students and residents. The content ranges from presenting the practical framework for conducting neuropsychological evaluations and reliability and validity issues, similar to that covered in the initial chapters of Lezak's Neuropsychological Assessment to the major neurobehavioral syndromes found in Heilman and Valenstein's Clinical Neuropsychology to covering the diseases and conditions that are detailed in Morgan and Ricker's Textbook of Clinical Neuropsychology.
Because of its unusually wide-ranging coverage, the book is equally well suited to be either a reference work that clinicians consult as needed or read cover to cover as a textbook. Every chapter begins with an abstract of the essential chapter elements, and all chapters are supplemented with highlighted textboxes containing the basic “Key Points” and “Rules of Thumb” in straightforward language. The two editors are authors on the majority of chapters so the book does not suffer from the chapter quality inconsistency so common among edited books. There are also contributions from neurologists and neurosurgeons, which add an important medical perspective of a great value to the issues discussed, especially medical therapies. An easy-to-follow organizational structure flows through the chapters. The book may be conceptualized as falling into four broad sections: (1) the foundations of neuropsychology (clinical report writing, understanding medical charts, neuroanatomy, and neurophysiology); (2) how to conceptualize and assess the primary presenting clinical symptoms neuropsychologists typically face (e.g., memory complaints, acute confusion, language problems); (3) all major neurobehavioral syndromes and conditions (e.g., aphasia, dementia, and mild cognitive impairment, TBI, stroke, brain tumors, epilepsy, MS, neurotoxicity, psychiatric disorders); and (4) practical review of psychometrics and interviewing techniques.
The first section deals with some important fundamentals including how to write and interpret a neuropsychological report and how to interpret inpatient and outpatient medical records, with an emphasis on neurological medical data but includes lists of common medical abbreviations and tables of normal blood and urine laboratory values. This first section concludes with one of the best fundamental overviews of neuroanatomy available. It covers all of the important neuroanatomical and neurophysiological topics succinctly and is richly supplemented with explanatory diagrams.
The second section contains six chapters covering the most common presenting clinical symptoms in the following areas: arousal, attention, language, memory, visual-spatial abilities, and executive functions. Each chapter begins with an excellent concise overview of what constitutes normal functioning in each cognitive domain, then goes on to explain how to plan an assessment, reviews the deficit patterns that patients typically display, and concludes with specific instructions for interpreting commonly encountered cognitive test results. One of the unique strengths of this section is it gives explicit instructions about how to evaluate these cognitive problems across the spectrum of disease severity (from untestable inpatients to subacute, recovering patients to those with chronic conditions who have reached maximum recovery) and how to interpret various performance patterns to arrive at neurobehavioral diagnoses. As an example, the authors provide a guide on how to interpret seven different memory deficit performance patterns based upon encoding, delayed recall, and recognition which includes the patterns typically seen in bilateral mesial temporal lobe dysfunction, diencephalic lesions, vascular dementia, frontal lobe lesions, severe depression or anxiety, and non-neurologic memory impairment. The overview of language disorders and assessment is excellent (including bedside assessment of acute aphasia), and this chapter includes an appendix with an acute bedside assessment of language and prosody which is an outstanding, much needed replacement for the antiquated Aphasia Screening Test from the Halstead–Reitan battery.
The third section covers most of the major diseases and conditions that neuropsychologists will typically be asked to evaluate (e.g., cerebrovascular disease, TBI, movement disorders, brain tumors, epilepsy, somatoform disorders, neurotoxicity, multiple sclerosis) as well a host of rare disorders that many of us will never see (e.g., genetic metabolic disorders, neuronal lipofuscinosis disorders, aminoacidopathies). The emphasis is on adults but several chapters, and portions of chapters, cover children as well. The text is abundantly intermingled with tables, figures, and diagrams, which greatly enhance the understanding of the material. An example of this is the impressive table in the chapter on stroke which displays all the major cerebral artery syndromes that include schematic drawings of the brain lesions, MRI scans, and descriptions of sensorimotor and higher cortical impairments for each of the hemispheres. Vast amounts of information have also been compressed into useful tables for quick reference. A good example is the table in the dementia chapter that provides an outstanding overview of the history, cardinal features, behavioral observations, and all major cognitive domain findings (e.g., attention, memory, language, spatial, executive) in Alzheimer's disease, frontotemporal dementia, dementia with Lewy's bodies, vascular dementia, Parkinson's disease dementia, progressive supranuclear palsy, corticobasal ganglionic degeneration, and depression.
The amount of material in this book is encyclopedic; it covers just about everything that a clinical neuropsychologist is expected to know. Because of this breath of coverage, the book cannot get into the more academic details of areas of controversy and of necessity is not filled with many primary references. In other words, the book covers the top of the iceberg brilliantly but rarely delves into the iceberg's depths. Although all the chapters in the third section cover the important basics well, the chapters on epilepsy and movement disorders are particularly strong. Besides providing the most up to date information on the diagnosis and treatment of these conditions, there are extensive tables of reliable change indices on the most important neuropsychological tests, and the neurosurgical interventions discussed are state of the art. Most of the important details that many neuropsychologists refer to Mendez and Cummings' Dementia: A Clinical Approach may be found in the chapters on dementia, MCI, and movement disorders. Although they do their job adequately, by far the weakest chapters are on TBI and neurotoxicity. There are five chapters on TBI that cover the essentials of mild, moderate/severe, sports-related concussion, pediatric TBI, and the postconcussive syndrome. There is nothing particularly different or new in these chapters from what is found in most other chapters and books on the subject.
The middle sections overflow with practical advice as well as memory aids to assist the neuropsychologist in remembering neuroanatomy and clinical neurology signs and symptoms. Some examples of memory aids include: OPAAM for the arteries originating from the internal carotid artery (ophthalmic, PCom, anterior choroidal, ACA, and MCA), the mnemonic for symptoms associated with anticholinergic neurotoxicity, the mnemonic for the medical conditions that cause delirium (I WATCH DEATH), and the 3 Ws (whacky, wobbly, and wet) for the confusion/dementia, gait instability, and urinary incontinence seen in normal pressure hydrocephalus. The text is also interspersed generously with helpful pearls of clinical wisdom. For instance, one way to terminate pseudobulbar affect is to ask the patient a neutral question, such as “What color are your shoes?” while the patient is laughing or crying.
The final section of the book includes a chapter on counseling patients who are non-compliant with medical therapy, an excellent review on test reliability and validity, and ends with two chapters on the psychometric foundations of test interpretation including discussion about norms, ceiling/floor effects, variability across tests and test batteries, the value of reliable change indices, and the limitations of using various score cut-off levels for inferring impairment. These are all very important considerations that are (hopefully) universally taught during a postdoctoral residency, but are rarely explicitly written about in books or journal articles. There is really no book like this available today. It skillfully brings together the most important foundations of clinical neuropsychology with the “nuts and bolts” of every facet of assessment. It also reminds the more weathered neuropsychologists among us of the essential value of neuropsychological assessment; that even when it is known that a patient has a particular disease, so that lesion location and diagnosis are not in question, the impact of the disease on the patient's cognitive functioning and behavior may only be objectively quantified through a neuropsychological assessment.