1. Woods, Jennifer MSN CCNS CNRN

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Making the Connection Between Brain and Behavior, Coping With Parkinson's Disease

J. H. Friedman, New York: Demos Medical Publishing, 2008, 193 pages, $19.95, ISBN 13:978-1-932603-42-2.


Making the Connection Between Brain and Behavior, Coping With Parkinson's Disease is a thorough guide and explanation to the behavioral aspects associated with Parkinson's disease (PD). The forward, written by Lee Coleman Krapin, MD, and the preface suggest the intended audience is patients with PD and their caregivers; however, the technical terms and descriptions used in the text make the reading level highly advanced for the lay individual. Ideally, the book would be well suited to the physician, healthcare provider, or a highly educated individual.


The introduction highlights the finer points of PD, particularly motor dysfunction, but stresses the challenges of the behavioral aspects of the disease. Dr. Friedman comments that providers tend to focus more on the motor problems rather than on the behavioral issues in treating PD; however, current research trends toward the behavioral aspects. Chapter 1 provides an overview of the behavioral aspects, outlines the remaining chapters of the book, and also provides real-life vignettes to foster understanding.


Chapters 2-12 illustrate the specific behaviors associated with PD, including personality, fatigue, apathy, depression, anxiety, dementia, hallucinations, delusions, confusion and delirium, compulsive behavior, and sleep disorders. Each chapter provides detailed descriptions of the behaviors, diagnostic considerations, treatment modalities, and examples of real-life experiences.


The remaining chapters, 13-16, tackle the issues of surgical treatment options for PD, driving, caregivers, and trips to the emergency department. A brief historical summary outlines past and present surgical options with an emphasis on deep brain stimulation (DBS). Furthermore, the chapter provides a thorough explanation of the procedure as well as contraindications to the surgery and potential behavioral changes following DBS. Driving is a particularly sensitive topic because taking away driving privileges often ends independence; however, safety is of utmost concern as these individuals have difficulties with visual spatial perception.


Chapter 15 is devoted to the effects of PD, motor and behavior, on the patient's caregiver(s), the importance of familial involvement or lack thereof, and the challenges associated with treatment of not only the patient but also the caregiver(s). An interesting aspect of the care is the implied transcendence of symptoms for patient to caregiver; for example, when the patient is depressed, so too may be the caregiver(s).


The final chapter, 16, emphasizes why patient's with PD should not visit the emergency department when their symptoms worsen because most physicians do not know how to properly treat PD. As a result, the patient may be hospitalized for unnecessary testing; furthermore, medication schedules are disrupted, resulting in worsening of the problem for which the patient originally presented. Tips are provided for the patient who does require hospitalization either electively or acutely for illness other than PD.


Appendices illustrate the "what ifs" to the perfect treatment, such as DBS, of chronic illness; that is, the psychosocial aspects of patients being able to perform as they did prior to their illness. Additionally, the consequences of a learned behavior versus a chemical effect from medications are described, such as compulsive behaviors elicited from the dopamine agonists. For those individuals unfamiliar with medical terminology, a complete glossary of terms, with definitions, is provided, and an index allows for quick reference to highlighted points within the text.


Overall, the book provides insight into the behavioral aspects of PD and would be an excellent text for the healthcare provider unfamiliar with the disease. I would hesitate to recommend the text to my patients and their caregiver(s) given the complexity of terms; although, this is compensated for by the use of the case vignettes. For this reason, I might refer families to the book on a case-by-case basis.


Reviewed by Jennifer Woods, MSN CCNS CNRN, Clinical Nurse Specialist, Neurology & Neuroscience Associates, Akron, OH.