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Book Forum: Neuropsychology, Neuroscience, and Psychiatry   |    
Neuropsychological Assessment, 4th ed.
Am J Psychiatry 2005;162:1237-1237. doi:10.1176/appi.ajp.162.6.1237
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Albuquerque, N.Mex.

By Muriel Deutsch Lezak, Diane B. Howleson, and David W. Loring, with H. Julia Hannay and Jill S. Fischer. New York, Oxford University Press, 2004, 1,016 pp., $89.50.

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Neuroscientists have witnessed exponential growth in brain-behavior research during the last century, culminating in the "decade of the brain" (Presidential Proclamation 6158). Since its inception in 1976, Neuropsychological Assessment has chronicled the growth of behavioral measures available to both neuroscientists and clinical practitioners, expanding from a mere 220 pages in its first edition to more than 1,000 pages in the current fourth edition. However, this text was never intended simply as an accounting of behavioral measures but, rather, as a road map to understanding brain functioning through a detailed inquiry of its output: the behaviors that allow us to perceive our world, to interact with other beings, and to express our individuality through reason. This is a daunting task, representing an amalgam of several "neuro" disciplines, which Lezak has taken up repeatedly and currently with her characteristic dry wit, keen attention to detail, and unwavering regard for scientific support as the underpinning of neuropsychological inquiry.

For the clinical practitioner, Lezak and her co-authors provide a succinct yet comprehensive primer on the myriad aspects of human behavior, the rationale underlying deficit measurement, and neuropsychological examination procedures and interpretation. They successfully introduce a brief and "necessarily superficial" account of neuroanatomy and neuropathology, directing readers to more exhaustive reviews of each. "Imaging is not enough," a quote by Mortimer Mishkin, frames this discussion and serves as a recurring touchstone throughout the book. Indeed, through careful interrogation of skills and deficits within an individual patient, which Lezak exemplifies through numerous detailed case presentations, one may glean information about brain functioning that "even the most sensitive laboratory analyses" fail to spot. Indeed, the neuropsychologist is a detective, of sorts, objectively linking bits of information together from the patient’s history, medical record, imaging data, and behavioral presentation to form a coherent narrative leading to a diagnosis, treatment recommendations, and answers to research or forensic inquiries.

The reliability and validity of one’s measures will always limit the inferences made from behavior to brain function. This is where Lezak and her colleagues truly shine, for the remainder of the book is devoted to a detailed compendium of tests and techniques to measure brain function and emotional status. Each test is briefly described in terms of historical development, content, and cognitive domain assessed. A section titled Test Characteristics summarizes the development of normative data and any age, gender, racial, or practice effects that have been found. Finally, the Neuropsychological Findings section highlights brain correlates, obtained from the research literature, of each test in its application to various individuals with brain disorders. Lezak expends languorous passages on measures that have accumulated substantial experimental support: measures with little or no such support are met with an arid combination of wry humor and a clipped narrative style. Thus, Neuropsychological Assessment is the emblematic work of a true scientist and a practitioner of neuropsychology and remains a vital component of any complete library of the behavioral neurosciences.




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