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In Context
www.thelancet.com/neurology Vol 8 March 2009 233
BooksiGenerationAs the subtitle suggests, this book is an American self-help text, written for those whom the authors call Digital Immigrants, a reference to us unfortunate oldies who need a 6-year-old child to programme our washing machines or send a text message. The youngsters, born into the digital age and who have an iPod wired into their brains from infancy, are apparently Digital Natives. Gary Small is a neuroscientist, Ms Vorgan a professional writer, and iBrain is the latest in a series of popular books about the brain that they have co-authored. iBrain has one basic (but misleading) idea; that Your Brain is evolving Right Now (their emphases) to meet the digital challenge. This notion is misleading because evolution in the Darwinian sense does not occur within a generation but through variation and selection across generations.
As a species we are indeed evolving in response to the new selection pressures resulting in part from our own technological ingenuity. What Small and Vorgan mean to draw attention to is the extreme plasticity of the brain, particularly during development, which causes continual modifi cation of synapses and pathways as a result of experience. The skills of keyboard dexterity learned at an early age, which children growing up in a digital world acquire (watch even 2-year-olds pressing buttons on mock telephones), will be refl ected in changes in the wiring pattern of their motor cortices. Such
plasticity persists through adulthood, although diminishes as we age; we older dogs fi nd it harder to learn new tricks. The molecular and cellular processes that underlie this plasticity are hot research areas, studied at all levels from genetics to brain imaging. Some of these details are discussed in passing, with a brief review of basic brain mechanisms.
However, description of this plasticity is not the book’s main goal. We are all familiar with the kids who get hooked on their computer games and the email junkies who can’t let go of their Blackberries. Through a series of boxed vignettes typical of this type of self-help book, the authors describe domestic and work-place encounters between Digital Immigrants and Digital Natives. Each vignette prefaces a chapter full of tips on how to survive in this digital age. The book’s cover suggests the contents will “manage techno-brain burnout”—whatever that might mean. It is diffi cult not to conclude that Small and Vorgan were running out of ideas in writing what is little more than a pot-boiler. However, now that the art of text messaging is beginning to become a serious fi eld of study for literary theorists, the appendix of text-message abbreviations and “emoticons” might prove useful to novices.
Steven [email protected]
iBrain: surviving the technological alteration of the modern mindBy Gary Small and Gigi Vorgan HarperCollins Publishers, 2008. Pp 240. $24.95ISBN 978-0-061-34033-8
Neurocognition in neurologyThis book is a concisely written reference text for neurologists, old-age psychiatrists and geriatricians, general physicians, specialists in endocrine, metabolic, vascular, or infective disorders, and practitioners of professions allied to medicine who have contact with patients with cognitive impairments.
Larner outlines that in some neurological disorders, such as dementias, to look for neurocognitive impairment is obvious; however, we should also think of dementia more often in other disorders, which he describes in detail in the book. He points out that the standard neurological examination is mainly focussed on the function of the parietal and occipital lobes, and frontal and temporal functions are relatively untested. Adequate neurocognitive testing is, however, essential for the diagnosis of dementia, and might help in the diff erential diagnosis of other neurological and general medical disorders and in case management. Alleviation of neurocognitive impairment can also be used as a sign of therapeutic effi cacy. Because of the limited time the clinical practitioner has to test neurocognitive function, Larner takes a pragmatic approach in his book, with a modest excursion into examination tools. Neuropsychiatric features of neurological disorders are left aside because the author felt they were well
covered by others; however, they are referenced for any reader with a special interest. Likewise, depression-related cognitive dysfunction is referred to only briefl y.
The book starts with a concise description of neurocognitive domains and so-called “bedside tests” that take about only 10 to 30 min to complete . Larner points out that because these tests are brief, they might have shortcomings, and a particular raw score is not necessarily diagnostic, although it can increase the likelihood of a particular diagnosis. He also stresses the importance of obtaining collateral history from relatives, friends, or carers of the patient. He then reviews the defi cits found across the spectrum of other neurological disorders.
Overall, Larner has put together an intelligent discussion of the evidence for the profi les of neurocognitive impairment found in neurological and general medical conditions and the diffi culties of assessing these functions. The book is well suited as a reference text, with tables that review the profi les of defi cits typical of a specifi c disorder and detailed references for readers with a deeper interest in the topic.
Andrea [email protected]
Neuropsychological Neurology: The Neurocognitive Impairments of Neurological Disorders by A J Larner. Cambridge University Press, 2008. Pp 248. £38. ISBN 9780521717922
