Parkinson's Disease and Parkinsonism in the Elderly.

Parkinson's Disease and Parkinsonism in the Elderly

Meara J, Koller WC, eds. New York, NY 10011-4211, Cambridge University Press, 2000, paperback, 260 pp, illus, ISBN: 0-521-62884-9, $49.95.

This book provides an overview of current information on the diagnosis, clinical features, medical management, and rehabilitation of geriatric patients with Parkinson disease or parkinsonism. It is written for health professionals who care for individuals diagnosed with these progressive neurological disorders. The editors have assembled a team of 17 authors from the United States, the United Kingdom, and Ireland to write the book's 14 chapters. The book begins with a useful glossary of terms, and subsequent chapters address the topics of differential diagnosis, the pathophysiology and clinical course of Parkinson disease, current drug treatments, epidemiology, and current rehabilitation issues. In addition, chapters on essential tremor and gait apraxia complement the primary topics of Parkinson disease and parkinsonism.

For the most part, the book is accurate, concise, and well written. Although there are some noticeable differences in writing style from one chapter to the next, these differences do not significantly interfere with the overall effectiveness of the book, and they are probably unavoidable given the number of authors. Each chapter is referenced (some more thoroughly than others), and there is a minimum of redundant information presented in different chapters. The figures and tables used by the authors are clear and helpful. Some of the authors successfully used case studies and specific clinical examples to illustrate a point of fact or to convey a principle.

The chapters on differential diagnosis and the clinical course of the diseases are especially in-depth, current, and readable and give the reader a good summary of the complicated nature of these disorders. The chapter on the drug treatment of Parkinson disease is probably best used as a reference because the number of drugs used to treat these disorders (and their associated side effects) is quite large. The sections on depression, psychosis, motor fluctuations, and the autonomic disturbances that are commonly encountered in these patients are especially important to rehabilitation providers.

The chapters that are probably of most interest to physical therapists and physical therapist assistants address rehabilitation issues in Parkinson disease and parkinsonism and the specific role of physical therapy in the care of these patients. The chapter on rehabilitation does an excellent job of discussing the issues of treatment, rehabilitation, and care of patients with chronic, progressive neurological diseases and offers a helpful model for the provision of rehabilitative services. Although the author of this chapter operates under the British health care system, his discussion of prevention, independence, and lifestyle and social environment issues is certainly relevant to the care of these patients in the United States.

The chapter that deals specifically with physical therapy intervention offers some guidelines on the assessment and treatment of the patient with Parkinson disease at the various stages of the disease. The authors also provide some particular treatment suggestions for specific motor deficits such as the gait disturbances and the loss of rotation, range of motion, and balance responses that characterize this patient population. The chapter ends with a section on the evidence for the effectiveness of physical therapy in the treatment of these patients. This section is short, indicating a relative lack of published reports that address this issue. However, a quick review of several recently published articles on various physical therapy interventions in this patient population indicate that the authors may have missed some relevant studies. Although the number of published studies that measure the effectiveness of physical therapy interventions for this patient population is very small, as noted by the authors, it is not as small as this chapter would indicate.

This book is well-suited for physical therapists, physical therapist assistants, and other health care providers who work in comprehensive, multidisciplinary, neurological rehabilitation settings and who care for elderly individuals with Parkinson disease and parkinsonism. It would also be a useful addition to the library of those therapists who treat significant numbers of patients with any chronic, progressive movement disorders.

Anthony E Kincaid, PT, PhD Creighton University Omaha, Neb

Dr Kincaid is Assistant Professor in the Department of Physical Therapy where he teaches histology and neuroscience and carries out research on the functional organization of the basal ganglia.