Book reviews

Brain (2003), 126, 15041506

PRINCIPLES OF FRONTAL LOBE FUNCTION By Donald T. Stuss and Robert T. Knight 2002. New York: Oxford University Press Inc. Price $120. pp. 630. ISBN 0-19-513497-4 Ever since Phineas Gage, the prefrontal cortex has occupied a disproportionate amount of neuropsychologists' time and effort and more recently that of functional neuroimagers too. This is entirely understandable, given the size, complexity and undoubted importance of the frontal lobes in the most interesting and unique capabilities of the human brain. However, spare a thought for the neglected parietal and temporal lobes; the latter hardly merit a mention here other than to be dismissed as "stupid" and contrasted with the "intelligent" frontal lobes (p205)! The research supremacy of the prefrontal cortex is emphasised by this comprehensive and authoritative volume. It provides an up to date summary of the current understanding of the functions and functioning of the prefrontal cortex (dened here as the frontal lobes anterior to the motor, premotor and supplementary motor areas; the anterior cingulate is excluded). The book has 34 chapters, with contributions from virtually anyone who is anyone in the prefrontal cortex. Although the predominant theme is neuropsychology, there are also chapters on development, biochemistry, physiology, anatomy, plasticity, lesions, rehabilitation and ageing. The book has many strengths. Most of the chapters stand alone well, and deserve to be read in their own right, providing a balanced introduction and extensive background reading to their chosen topic. It is invidious to pick out particular ones for praise, but several are worth noting. Diamond provides a valuable synthesis of the literature on the normal development in children of functions attributable to the prefrontal cortex; I have already tested my four year old (successfully) on several of the tasks. Arnsten and Robbins give an excellent review of the neurochemistry of the frontal lobes, dissecting out the relative roles of dopamine, noradrenaline, 5-HT and acetyl choline. Kolb and Gibb provide a useful summary of the literature (largely their own) on the plasticity of the frontal cortex at different ages and in response to different events. Mesulam's chapter is characteristically erudite and readable, despite its title, "The Human Frontal Lobes: Transcending the Default Mode through Contingent Encoding", the deciphering of which required several attempts and, presumably, considerable prefrontal activation. Equally, groups of chapters can be read in parallel in order to appreciate the points of agreement and disagreement between leading researchers. For example, the differences between Goldman-Rakic (chapter 5) Brain 126 Guarantors of Brain 2003; all rights reserved

and Passingham (chapter 14) regarding the relative contributions of areas 6, 8 and 46. A few areas would benet from greater attention in a second edition. Reecting my psychiatric bias, I would have like to have seen more about the ways in which psychiatric disorders (as a form of lesion) can illuminate the understanding of frontal lobe function. In particular, there is a large schizophrenia literature, inclusion of which would complement and extend the value of the sole psychiatric chapter (by Mayberg on depression). Psychopathy, borderline personality disorder and autism could also be fruitfully considered. The occurrence and signicance of frontal cortex lateralization merits greater coverage, perhaps as part of a broader discussion on evolution. A chapter on genetic and molecular aspects would also be of interest; for example, the recent evidence that allelic variation in the catechol-o-methyltransferase (COMT) gene affects the functioning, neurochemistry and pathophysiology of the prefrontal cortex (Biological Psychiatry, 2001; 50: 825847), and the ndings from twin studies that are beginning to elucidate the heritability of frontal lobe performance and structure. Extrinsic prefrontal connectivity is well covered by Petrides and Pandya, but consideration of the local circuits and synaptic organisation of the prefrontal cortex would complete the anatomical picture and integrate it with the neurochemistry and receptor pharmacology. Finally, the frontal lobes have surely got something important to do with consciousness, but consciousness is only mentioned during Tulving's description of chronaesthesia. Maybe the editors held back for want of empirical data, but if space permitted, a chapter by a neurophilosopher on consciousness and the frontal lobes would nicely round off the book. Such a chapter might also be an opportune place to discuss the role of metaphors, which all too often continue, as Mesulam notes, in place of explanation. A personal favourite is Baddeley's `central executive' and its `fractionation' (Chapter 16), which leads the reader to expect an exposition on NHS management. Moreover, it is surely only a matter of time (if it hasn't happened already) before an fMRI study completes the loop by showing that metaphors are generated and interpreted in the prefrontal cortex. These are minor quibbles; the book as it stands is highly recommended. It will be essential reading and a standard reference for researchers, teachers and students of the frontal lobes. Paul J. Harrison Department of Psychiatry, University of Oxford, Oxford, UK DOI: 10.1093/brain/awg121

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