Neurodegenerative Diseases: Neurobiology, Pathogenesis and Therapeutics

Edited by M. Flint Beal, Anthony E. Lang, and Albert Ludolph. Cambridge, UK: Cambridge University Press; 2005, $324.

In the disorders resulting in cerebral neurodegenerative disease, neuroimaging assumes a key role; and because imaging has evolved to more than pattern recognition on routine MR imaging (or CT), a basic understanding of the pathophysiologic processes involved in degenerative disease is a requisite. This 985-page book, edited by Drs. Beal, Lang, and Ludolph with 122 contributors, serves to broaden our understanding of these diseases because neuroradiologists will be increasingly asked to analyze, for example, tract morphology on diffusion tensor imaging (DTI) or biochemical alterations on chemical shift imaging, or areas of diminished cerebral perfusion on perfusion-weighted imaging (PWI) in these abnormalities.

The book is divided into 10 parts, encompassing 62 chapters. The parts are the following: “Basic Aspects of Neurodegeneration,” “Neuroimaging in Neurodegeneration,” “Therapeutic Approaches in Neurodegeneration,” “Normal Aging,” “Alzheimer Disease,” “Other Dementias,” Parkinson’s and Related Movement Disorders,” “Cerebellar Degenerations,” “Motor Neuron Diseases,” and “Other Neurodegenerative Diseases.”

Surprisingly (and to this reviewer somewhat disheartening), the chapter, “Structural and Functional Magnetic Resonance Imaging in Neurodegenerative Diseases,” has 2 authors, neither of whom is a neuroradiologist. Most images shown in this chapter came not from the authors’ own experience but from other clinicians’ files or previously published material. Although this feature is not, by itself, a major problem, one always likes to read chapters in which the authors present their own material, not material from others. As for the chapter itself, the authors say that it focuses on “nonroutine structural MR imaging,” then other than some functional MR imaging (fMRI) images, they proceed to show virtually all routine MR imaging. One wonders where DTI, blood volume maps, and PWI are if this chapter covers nonroutine MR imaging? The authors mention MR microscopy as having “very high spatial resolution,” but they do not tell the reader how they define high spatial resolution. Information on DWI, tractography, and DTI is so scant that it is not valuable, and to top it off, no representative images of the latter are shown. Findings are mentioned under many of the diseases (eg, under extrapyramidal disease) but are not illustrated, adding to the problems with the material in this chapter. A valuable item would have been a chart that lists individually the various dementias, extrapyramidal disorders, motor system disorders, and ataxias, enumerating the imaging findings in each. A more complete section of the chapter is one that deals with fMRI in neurodegenerative disease, in which the basic concepts of cortical activation are described and are accompanied by a few illustrations. In summary, this chapter is disappointing and would not be the recommended source for learning the imaging characteristics of neurodegenerative disease. If a new edition of the book is planned, the authors and coauthors of the structural MR imaging chapter should include a neuroradiologist.

The remaining 2 chapters in part 2 of the book, “Neuroimaging in Neurodegeneration,” deal with single-photon emisson CT/PET and MR spectroscopy of neurodegenerative illnesses and are basic and adequate. What the clinical role is or ever will be for spectroscopy in neurodegenerative disease is questionable, particularly phosphorus and carbon spectroscopy, on which the authors spend some time. The other part of the book that could have been of interest to the radiologist is the section, “Normal Aging.” Here the 2 chapters describe the clinical aspects and neuropathology of normal aging. Although there is mention and 1 T1-weighted MR imaging example of a healthy older patient, the lack of a separate chapter on the imaging of aging with appropriate examples is a drawback of this part of the book.

For the neuroradiologist then, how would this book fit into his or her collection or a departmental library? It would be for those with a particular interest in the various clinical syndromes and diseases in neurodegeneration. For example, as would be expected, considerable space is devoted to Alzheimer disease (neuropathology genetics and the role of beta amyloid), prion diseases, Parkinson disease/Parkinsonism and related movement disorders, and motor neuron disease. A lack of adequate imaging and a failure to integrate imaging in an important way in all of these chapters diminishes the potential interest of the book to neuroradiologists. Nonetheless, for those interested in a deeper clinical and neuropathologic understanding of these degenerative diseases, this book will be useful.