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Handbook of Neuropsychology and Aging
CRITICAL ISSUES IN NEUROPSYCHOLOGY
Series Editors
Antonio E. Puente University of North Carolina, Wilmington
Current Volumes in this Series
Cecil R. Reynolds Texas A&M University
BEHAVIORAL INTERVENTIONS WITH BRAIN-INJURED CHILDREN A. MacNeill Horton, Jr.
CLINICAL NEUROPSYCHOLOGICAL ASSESSMENT: A Cognitive Approach Edited by Robert L. Mapou and Jack Spector
CONTEMPORARY APPROACHES TO NEUROPSYCHOLOGICAL ASSESSMENT Edited by Gerald Goldstein and Theresa M. Incagnoli
FAMILY SUPPORT PROGRAMS AND REHABILITATION: A Cognitive-Behavioral Approach to Traumatic Brain Injury Louise Margaret Smith and Hamish P. D. Godfrey
HANDBOOK OF CLINICAL CHILD NEUROPSYCHOLOGY, Second Edition Edited by Cecil R. Reynolds and Elaine Fletcher-Janzen
HANDBOOK OF NEUROPSYCHOLOGY AND AGING Edited by Paul David Nussbaum
NEUROPSYCHOLOGICAL EXPLORATIONS OF MEMORY AND COGNITION: Essays in Honor of Nelson Butters Edited by Laird S. Cermak
NEUROPSYCHOLOGICAL TOXICOLOGY: Identification and Assessment of Human Neurotoxic Syndromes, Second Edition David E. Hartman
THE PRACTICE OF FORENSIC NEUROPSYCHOLOGY: Meeting Challenges in the Courtroom Edited by Robert J. McCaffrey, Arthur D. Williams, Jerid M. Fisher, and Linda C. Laing
PRACTITIONER'S GUIDE TO CLINICAL NEUROPSYCHOLOGY Robert M. Anderson, Jr.
A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.
Handbook of Neuropsychology and Aging
Edited by
Paul David Nussbaum Lutheran Affiliated Services Aging Research and Education Center Mars. Pennsylvania
Springer Science+Business Media, LLC
Library of Congress Cataloglng-ln-Publ1cat1on Data
Handbook of neuropsychology and aging / edite d by Paul David Nussbaum. p. cm. — ( C r i t i c a l i s s u e s in neuropsychology)
Includes b i b l i o g r a p h i c a l r e f e r e n c e s and index. 1. G e r i a t r i c neuropsychiatry. 2. G e r i a t r i c neurology.
3. C l i n i c a l neuropsychology. I. Nussbaum, Paul David. I I . S e r i e s . RC451.4.A5H39 1997 618.97'68—dc21 97-12001
CIP
ISBN 978-1-4899-1859-8 ISBN 978-1-4899-1857-4 (eBook) DOI 10.1007/978-1-4899-1857-4
© Springer Science+Business Media New York 1997 Originally published by Plenum Press, New York in 1997 Softcover reprint of the hardcover 1st edition 1997
http://www.plenum.com
1 0 9 8 7 6 5 4 3 2 1
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher
To Ryan Paul
Contributors
Daniel N. Allen • Psychology Service, Highland Drive Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15206
Kathryn A. Bayles • National Center for Neurogenic Communication Disorders, University of Arizona, Tucson, Arizona 85721
James T. Becker • Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
Pelagie M. Beeson • National Center for Neurogenic Communication Disorders, University of Arizona, Tucson, Arizona 85721
David A. Bennett • Rush Institute on Aging, Rush Alzheimer's Disease Center, and Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
Julie Berkey • Allegheny General Hospital! Allegheny Neuropsychiatric Institute, Pittsburgh, Pennsylvania 15212
Erin D. Bigler • Department of Psychology, Brigham Young University, Provo, Utah 84602; and LDS Hospital, Salt Lake City, Utah 84103
Mark W. Bondi • Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, California 92093-0948; and San Diego Department of Veterans Affairs Medical Center, San Diego, California 92161
Jennifer J. Bortz • Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496
Jon Brillman • Allegheny General Hospital, Pittsburgh, Pennsylvania 15212
Meryl A. Butters • Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
Frederick W. Bylsma • Department of Psychiatry and Behavioral Sciences, Division of Medical Psychology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
Jeffrey L. Cummings • Department of Neurology, University of California, Los Angeles, School of Medicine, Los Angeles, California 90024; and West Los Angeles Veterans Affairs Medical Center, Los Angeles, California 90095-1769
Louis F. Damis • Private Practice, Clinical and Health Psychology, Orlando, Florida 32803
Richard C. Delaney • Neuropsychology Section, Psychology Service, Veterans Affairs Medical Center, West Haven, Connecticut 06516
Denise L. Evert • Laboratory of Neuropsychology, Division of Psychiatry, and Department of Neurology, Boston University School of Medicine, Boston, Massachusetts 02118; and Psychology Research Service, Department of Veterans Affairs Medical Center, Boston, Massachusetts 02130
Robert B. Fields • Department of Psychiatry, Allegheny General Hospital, and Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania 15212
vii
viii CONTRIBUTORS
Gerald Goldstein • Highland Drive Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15206; and Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
Anthony J. Goreczny • Department of Behavioral Sciences, University of Indianapolis, Indianapolis, Indiana 46227
George Grossberg • Division of Geriatric Psychiatry, Department of Psychiatry and Human Behavior, St. Louis University, St. Louis, Missouri 63104
Alfred W. Kaszniak • Department of Psy-chology, University of Arizona, Tucson, Arizona
Harold G. Koenig • Duke University Medi-cal Center, Durham, North Carolina 27710
Daniel A. Krauss • Department of Psychology, University of Arizona, Tucson, Arizona 85721
Rhonda K. B. Landis Behavioral Health Services, DuBois Regional Medical Center, DuBois, Pennsylvania 15801
Asenath La Rue • Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico 87131; and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90024-1759
Mark R. Lovell • Division of Neuropsychology, Henry Ford Hospital, Detroit, Michigan 48202
David C. Martin • Division of Geriatric Medicine, Shadyside Hospital, Pittsburgh, Pennsylvania 15232; and Departments of Medicine, Psychiatry, and Health Services Administration, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
Harry W. McConnell • tology, Maudsley Hospital, England
Institute of EpilepLondon SE5 8AZ,
Michael McCue • Center for Applied Neu-ropsychology, Pittsburgh, Pennsylvania 15222
Susan E. McPherson • Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine, Los Angeles, California 90024; and Cedars Sinai Alzheimer's Disease Research and Treatment Center, Los Angeles, California 90024
Benoit H. Mulsant • Western Psychiatric Institute and Clinic and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
Jodi D. Nadler • Medical Psychology Section, Florida Hospital Health Center, Orlando, Florida 32803
Paul David Nussbaum • Aging Research and Education Center, Lutheran Affiliated Services, Mars, Pennsylvania 16046; and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261
Kevin P. O'Brien • Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496
Marlene Oscar-Berman • Laboratory of Neuropsychology, Division of Psychiatry, and Department of Neurology, Boston University School of Medicine, Boston, Massachusetts 02118; and Psychology Research Service, Department of Veterans Affairs Medical Center, Boston, Massachusetts 02130
Linda Peterson • Department of Psychology, Barry University, Miami Shores, Florida 33161
Lisa D. Ravdin • Department of Neurology and Neuroscience, The New York Hospital-Cornell Medical Center, New York, New York 10021
Emily D. Richardson • Yale University School of Medicine, Adler Geriatric Center, YaleNew Haven Hospital, New Haven, Connecticut 06504
Linda S. Rockey • Geriatric Care Services, Lutheran Affiliated Services, Mars, Pennsylvania 16046-0928
Fred H. Rubin • Department of Medicine, Shadyside Hospital, Pittsburgh, Pennsylvania 15232; and Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
Bruce D. Sales • Department of Psychology , University of Arizona, Tucson, Arizona 85721
David P. Salmon • Department of Neurosciences, School of Medicine, University of California, San Diego, La Jolla, California 92093-0948
Carol J. Schramke • Psychology Service, Highland Drive Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15206; and Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
Gregory T. Slomka • Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213
Stanley S. Smith • Department of Psychiatry, Medical College of Pennsylvania and Hahnemann University-Allegheny Campus, Pittsburgh, Pennsylvania 15212
Bonnie Lynn Snyder • School of Social Work Graduate Program, University of Pittsburgh, Pittsburgh, Pennsylvania
PeterJ.Snyder • Department of Neurology, Medical College of Pennsylvania and Hahnemann University-Allegheny Campus, Pittsburgh, Pennsylvania 15212
Elizabeth Soety • Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
Christopher Starratt • Department of Psychology, Barry University, Miami Shores, Florida 33161
CONTRIBUTORS ix
Rex Swanda • Veterans Affairs Medical Center, Albuquerque, New Mexico 87108
Andrea Swartzendruber • Rush Institute on Aging, Rush Alzheimer's Disease Center, and Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
John A. Sweeney • Western Psychiatric Institute and Clinic and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
Alexander I. 'frOster • Department of Neurology, University of Kansas Medical Center, Kansas City, Missouri 66160-7314
Mahmood A. Usman • The Alzheimer Cen-ter of Pittsburgh, Pittsburgh, Pennsylvania 15205
James Valeriano • Department of Neurology, Medical College of Pennsylvania and Hahnemann University-Allegheny Campus, Pittsburgh, Pennsylvania 15212
Sharon M. Wallsten • Duke University School of Nursing, Duke University Medical Center, Durham, North Carolina 27710
Robert S. Wilson • Rush Institute on Aging, Rush Alzheimer's Disease Center, and Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
Ben Zimmer • Geriatric Psychiatry Program, Department of Psychiatry, and Allegheny Neuropsychiatric Institute, Medical College of Pennsylvania and Hahnemann University-Allegheny Campus, Pittsburgh, Pennsylvania 15212
Foreword
As larger numbers of persons survive into older age, biobehavioral scientists and health care professionals have become more aware of the unique needs of older adults. This awareness is reflected in a dramatic increase in the publication of both basic and applied research concerned with aging and agerelated disorders. Nowhere has this been more true than within those various disciplines that contribute to our understanding of the neuropsychology of aging. Disorders of the central nervous system in older age are a cause of considerable disability and suffering, and there is widespread recognition of the need to better understand the psychological consequences of these disorders. Similarly, there is increasing recognition of the contributions to both diagnosis and intervention being made by clinical neuropsychologists with expertise in aging. For example, neuropsychological consultation now plays a critical role in the early identification of progressive dementia, contributes to differential neurologic and neuropsychiatric diagnosis of the many possible causes of dementia, and aids in the treatment and clinical management of dementing illness. Similar contributions are being made in regard to a variety of other (e.g., focal cerebrovascular) neurobehavioral syndromes that are prevalent among older adults.
Particular challenges face the clinician or investigator who wishes to become better informed about research and clinical application in this area. The neuropsychology of aging is a fundamentally interdisciplinary field of study, with neuropsychology, behavioral neurology, neuropsychiatry, speech and language science, and various other neurobehavioral and neurobiological disciplines playing necessary roles. Complex interactions exist between fundamental changes in the aging brain, neurological and systemic illnesses, age-related changes in pharmacokinetics and pharmacodynamics, and a
variety of psychological and social factors that influence the occurrence and nature of both cognitive and affective symptoms in older adults. It is not surprising therefore to find that relevant research and clinical scholarship are published across a wide range of journals and books. For both neophyte and seasoned clinician or investigator, there is a need for authoritative reference sources that critically review, summarize, integrate, and abstract the most important clinical applications of this increasingly large body of work.
Over the past decade, a small number of excellent books have been published that partially fill this need by providing integrative overviews of the clinical neuropsychology of aging (e.g., Albert & Moss, 1988; La Rue, 1992) or by focusing on particular problems in the neuropsychological assessment of older adults (e.g., Poon, 1986; Storandt & VandenBos, 1994). However, none of these previous volumes has provided the scope or depth of this handbook. Dr. Nussbaum has brought together an outstanding multidisciplinary group of authors, many of whom are recognized as the nation's leading researchers and clinicians in neuropsychological aspects of aging. The topics covered by these authorities represent the scope of knowledge that is critical to fully understanding this field. The range of neuropsychological and psychiatric disorders most frequently seen among elderly persons is given comprehensive review. It is noteworthy that chapters are included that review areas of newly emerging research (e.g., frontal lobe dementias, neuropsychological aspects of late-life depression), as well as those clinical problems that typically are given insufficient consideration (e.g., seizure disorders, head injury, mental retardation) in other sources. An adequate understanding of the psychological consequences of these disorders is, of course, not
xi
xii FOREWORD
possible without an appreciation of the neuroanatomical, neurophysiological, cognitive, personality, and psychosocial aspects of normal aging, and this volume covers these areas in good detail. In reviewing assessment procedures that contribute to the clinical evaluation of older persons with known or suspected neuropsychological disorder, the volume makes a significant contribution by bringing together in one place discussions of neurological, brain imaging, electrophysiological, neuropsychological, and functional approaches. The breadth of approaches described again underscores the inherently multidisciplinary nature of clinical assessment in this area.
A quite unique, aspect of this handbook, among other volumes concerned with neuropsychological aspects of aging, is its comprehensive review of clinical intervention. The neuropsychology of aging has recently moved beyond an exclusive focus on descriptive and diagnostic efforts in its clinical application, and the handbook reflects this current status. Developments in psychotherapeutic, behavioral, psychopharmacologic, and electroconvulsive interventions are described and critically evaluated, as are those in the new and growing area of cognitive rehabilitation. In addition, consideration is given to clinically critical issues concerning both guardianship and caregiving.
Dr. Nussbaum and the authors he has gathered together have made a major contribution to this area of growing clinical and research importance. This Handbook of Neuropsychology and Aging will serve as an indispensable resource as new clinicians and investigators from various disciplines become attracted to the neuropsychology of aging and as experienced professionals look to expand and update their expertise.
References
Alfred W. Kaszniak University of Arizona
Albert, M.S., & Moss, M. B. (Eds.). (1988). Geriatric neuropsychology. New York: Guilford Press.
La Rue, A. (1992). Aging and neuropsychological assessment. New York: Plenum Press.
Poon, L. W. (Ed.). (1986). Handbook for the clinical memory assessment of older adults. Washington, DC: American Psychological Association.
Storandt, M., & VandenBos, G. R. (Eds.). (1994). Neuropsychological assessment of dementia and depression in older adults: A clinician's guide. Washington, DC: American Psychological Association.
Preface
The ongoing demographic revolution in the United States represents a tremendous opportunity and responsibility for the health care system. Indeed, by the year 2010, the baby boom generation, estimated to number 75 million, will begin to tum 65 years of age. Clinicians and researchers interested in the field of aging need to prepare for this growth. Specific agendas might include development of a vision of health care and research in aging, education of society about the facts of aging, and creation of new models of training and clinical philosophy. Indeed, a progressive model of health care, based on wellness and prevention rather than the current diseasebased approach, might be a starting point worthy of critical analysis. There is clear need to highlight the many positive attributes of aging, emphasizing the later years of life to be a productive and natural part of the life span. Finally, there is a tremendous need for well-trained geriatricians and allied health professionals to meet the growing medical, psychological, and social needs of the older adult population.
Within this context, clinical neuropsychology can contribute significantly, both from a clinical and scientific perspective. There is a need to establish specialized training in geriatric neuropsychology with consideration for board certification status. Continued illumination of brain-behavior relations with advancing age remains a high priority of research, particularly with models of normal aging. Clinical neuropsychology can advance the study of preclinical markers for progressive dementias such as Alzheimer's disease. The clinical neuropsychologist can also contribute significantly to our understanding of why some older adults thrive while others isolate. These and many other areas of study in aging require continued investigation and development. Clinical neuropsychology can be a leader in this regard, helping to map the frontiers of
clinical care and research of aging into the 21st century.
This volume does not provide answers to all of the critical issues raised here. However, it attempts to provide a comprehensive text on aging that can be used by both the clinician and scientist. The handbook is meant to build upon the excellent works of La Rue (1992) and Albert and Moss (1988), who initiated the discussion on integrating neuropsychology and gerontology. A main purpose of the handbook is to provide an overview of neuropsychology and aging that will accentuate the importance of geriatric neuropsychology and serve as a comprehensive reference.
The volume follows a scientist-practitioner model and is divided into five broad parts: Normal Aging, Psychiatric Disorders of Late Life, Neuropsychological Disorders of Late Life, Assessment Procedures and the Older Patient, and Treatment Interventions and the Older Patient. Normal aging is the first part because, in the opinion of the editor, it is the most important area of study for neuropsychology and gerontology and deserves increased attention. The other parts are significant in that they are meant to provide a review of current knowledge as well as direction for future clinical investigation. Some of the chapters, such as those covering epilepsy, head injury, legal issues, and personality, highlight areas that have not received much attention in the literature and, as such, may not be readily familiar to clinicians who examine and treat older adults.
This handbook is written for all students and professionals interested in the aging process. It is meant to serve as a useful reference source and teaching guide that promotes progressive ideas regarding the attitudes and care of aging individuals in our society. The knowledge presented in each
xiii
xiv PREFACE
chapter is not meant to be conclusive, but a catalyst for continued investigation and question.
Paul David Nussbaum
ACKNOWLEDGMENTS
This volume reflects the hard work of many individuals, including Melinda Gatesman, Connie Peterson, and Tammy Sherrick. Mary Butler, in particular, proved herself invaluable with many hours of excellent proofreading. Thanks also go to Eliot Werner and Mariclaire Cloutier, Senior Edi-
tors; their professionalism and advice made my work much easier. As with any of my small professional successes, none is achieved without the guidance of my primary mentor Alfred W. Kaszniak and secondary mentor Gerald Goldstein. Much appreciation and gratitude is also directed to Michael Hendrickson and Grady Hunter for their vision and leadership and for giving me the opportunity to succeed. I wish to thank the many students whom I have had the pleasure of teaching; their enthusiasm and critical questions have provided fuel for my own investigative efforts. Finally, special thanks to Kim.
Contents
1. Introduction ................................................................ 1 PAUL DAVID NUSSBAUM
I. Normal Aging
2. Age-Related Change in Cognitive Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ROBERT S. WILSON, DAVID A. BENNETT, AND ANDREA SWARTZENDRUBER
3. Personality and Normal Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 CHRISTOPHER STARRATT AND LINDA PETERSON
4. Anatomy and Physiology of the Aging Human Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 DAVID C. MARTIN AND FRED H. RUSIN
5. Psychosocial Aspects of Aging ................................................. 44 JODI D. NADLER, LOUIS F. DAMIS, AND EMILY D. RICHARDSON
II. Psychiatric Disorders of Late Life
6. Mood Disorders 63 HAROLD G. KOENIG
7. Anxiety Disorders ........................................................... 80 CAROL J. SCHRAMKE
8. Psychotic Disorders in Late Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 GERALD GOLDSTEIN
9. Substance Abuse in Elderly Individuals .......................................... 111 DANIEL N. ALLEN AND RHONDA K. B. LANDIS
III. Neuropsychological Disorders of Late Life
10. The Neuropsychology of Alzheimer's Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 DAVID P. SALMON AND MARK W. BONDI
xv
xvi CONTENTS
11. Frontotemporal Dementias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 MAHMOOD A. USMAN
12. Vascular Dementia: Clinical Assessment, Neuropsychological Features, and Treatment. . . . 177 SUSAN E. MCPHERSON AND JEFFREY L. CUMMINGS
13. Neuropsychological Evaluation of Subcortical Dementia MARK R. LOVELL AND STANLEY S. SMITH
189
14. Alcoholic Korsakoff's Syndrome ............................................... 201 MARLENE OSCAR-BERMAN AND DENISE L. EVERT
15. Parkinson's Disease: Neurobehavioral Consequences of Basal Ganglia Dysfunction 216 MARK W. BONDI AND ALEXANDER I. TROSTER
16. Huntington's Disease ......................................................... 246 FREDERICK W. BYLSMA
17. Late-Life Depression: A Neuropsychological Perspective. . . . . . . . . . . . . . . . . . . . . . . . . . .. 260 PAUL DAVID NUSSBAUM
18. Neuropsychological Aspects of Epilepsy in the Elderly PETER J. SNYDER AND HARRY W. MCCONNELL
271
19. Geriatric Head Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 280 ROBERT B. FIELDS
20. Aphasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 298 PELAGIE M. BEESON AND KATHRYN A. BAYLES
21. The Neuropsychology of Stroke ................................................ 315 RICHARD C. DELANEY AND LISA D. RAVDIN
22. Aging and Mental Retardation ................................................. 331 GREGORY T. SLOMKA AND JULIE BERKEY
IV. Assessment Procedures and the Older Patient
23. Neurological Evaluation in the Elderly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351 JON BRILLMAN
24. Neuropsychological Assessment ................................................ 360 ASENATH LA RUE AND REx SWANDA
25. Memory Assessment of the Older Adult LINDA S. ROCKEY
385
CONTENTS xvii
26. The Relationship between Neuropsychology and Functional Assessment in the Elderly 394 MICHAEL MCCUE
27. Neuroimaging in Normal Aging and Dementia ERIN D. BIGLER
409
28. Electroencephalography in the Elderly ........................................... 422 HARRY W. MCCONNELL, PETER J. SNYDER, AND JAMES VALERIANO
v. Treatment Interventions and the Older Patient
29. Psychotherapy with Older Adults: Theoretical Issues, Empirical Findings, and Clinical Applications ..................................................... 431 JENNIFER J. BORTZ AND KEVIN P. O'BRIEN
30. Behavior Modification of Older Adults ANTHONyJ.GORECZNY
31. Elderly Caregivers and Care Receivers: Facts and Gaps in the Literature SHARON M. WALLSTEN
32. Geriatric Psychopharmacology: An Update and Review BEN ZIMMER AND GEORGE GROSSBERG
452
467
483
33. Electroconvulsive Therapy .................................................... 508 BENOIT H. MULSANT AND JOHN A. SWEENEY
34. Memory Rehabilitation ....................................................... 515 MERYL A. BUTTERS, ELIZABETH SOETY, AND JAMES T. BECKER
35. Guardianship and the Elderly .................................................. 528 DANIEL A. KRAUSS AND BRUCE D. SALES
36. Conclusion ................................................................. 541 PAUL DAVID NUSSBAUM
Index ......................................................................... 543
Handbook of Neuropsychology and Aging