Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health
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Neuroepidemiology: From Principles to Practice
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115
Edited by Lorene M. Nelson, Caroline M. Tanner, Stephen K. Van Den Eeden, and Valerie M. McGuire
ISBN 0-19-513379-X, Oxford University Press, New York, New York (Telephone: 800-445-9714, Fax: 919-677-1303, E-mail: custserv.us{at}oup.com, World Wide Web: http://www.oup.com), 2004, 461 pp. (hardcover)
Epidemiologists interested in neurologic disorders may rely on excellent books devoted to specific conditions, such as multiple sclerosis or Parkinson’s disease, but they have a relatively limited choice of texts that cover the entire field. Neuroepidemiology ameliorates this problem by providing a comprehensive overview of the epidemiology of neurologic diseases with an eye on methodological issues.
The book is structured in three parts. The first part contains an introduction to epidemiologic methods (chapters 1–3) and to genetic epidemiology (chapter 4) from a neuroepidemiologic perspective. The first three chapters are concerned with study design, effect measures, bias, and analytic methods. The second part, chapters 5–15, is a set of reviews of the epidemiology of the following neurologic disorders: Alz-heimer’s disease and vascular dementia, movement disorders, amyotrophic lateral sclerosis, multiple sclerosis, stroke, brain and spinal cord injury, peripheral neuropathy, epilepsy, migraine and tension-type headache, intracranial neoplasms, and neurodevelopmental disabilities. The last part, chapters 16–19, is dedicated to the clinical epidemiology of neurologic disorders. This part introduces prognostic studies, clinical trials, health services research, and evidence-based medicine for neurologic diseases.
The editors set an ambitious goal for themselves in the first part of the book. The first paragraph of chapter 1 reads, "We hope to be equally useful to epidemiologists who are not familiar with neurologic disease and neurologists who are not familiar with epidemiologic approaches." While targeting such a broad audience is a laudable goal, it is also a difficult one: The initial 84-page summary of epidemiologic methods is probably insufficient for neurologists with no prior epidemiologic experience, who will need to resort to a general epidemiology textbook anyway, and it is largely unnecessary for epidemiologists, who will still need to read it carefully to identify common methodological challenges in the study of neurologic diseases. Some of the common challenges described in the book are the variability of diagnostic criteria, uncertainty about time of onset, and the study of rare diseases. (An exception to the rare disease problem is the study of dementia, which can have a prevalence as high as 30–40 percent in the oldest age groups of the general population.)
Determination of the onset of a neurologic disease can be extremely difficult when, as often happens, the interval between clinical onset and diagnosis is long. As a result, the categories of prevalent and incident cases are frequently blurred in neuroepidemiologic studies, even if one is willing to assume that the true onset of the disease coincides with the appearance of its first symptoms. In the book, the critical concept of an "incident case" is sometimes interchangeable with that of a "newly diagnosed case." It is also noticeable that the description of some methodological topics (e.g., the definition of confounding, the case-control design, the role of the rare disease assumption) is not entirely consistent with modern epidemiology texts. Closer attention to these issues, both theoretically and operationally, is needed in future neuroepidemiologic research. The chapter on genetic epidemiology of neurologic disease that closes the first part of the book is an excellent introduction to the field; we only missed a brief description of the main Web-based resources available for genetic research.
The second part is the core, and the main strength, of the book. Each chapter reviews a major neurologic disorder, and most chapters are written by world leaders in the corresponding research area. Although occasionally the authors of a chapter may promote a controversial point of view or omit an important reference, the reviews are generally balanced, comprehensive, and up to date. This part of the book arguably provides the broadest and most complete snapshot of the state of neuroepidemiologic research that is currently available. Reviews of mild cognitive impairment and other neurodegenerative dementias, the subjects of active epidemiologic research over the past decade, were not included but probably would have been of interest. The methodological thread of the book is clearly visible throughout these reviews in the form of selected examples that illustrate practical problems, and sometimes their solutions, in real neuroepidemiologic studies.
The third part of the book is focused on the prognosis and treatment of neurologic disorders, rather than on their etiology. These last four chapters include methodological descriptions written in nontechnical language and will surely be attractive to both clinicians and epidemiologists who wish to explore research in clinical neurology. The difficulty of dating the onset of many neurologic diseases reappears as an important methodological challenge, though not one stressed by the authors, in natural history studies. For example, use of the date of first symptoms versus the date of diagnosis can lead to different conclusions about the prognosis of neurologic diseases. As in the rest of the book, the last section of each chapter ("Future directions and conclusions") provides recommendations for future research that may be especially helpful for new investigators.
In summary, this text is an indispensable reference for any investigator who intends to conduct neuroepidemiologic research. With its rich supply of information, Neuroepidemiology is likely to become a landmark in the epidemiologic literature. On the other hand, for those seeking a text that integrates epidemiology with basic neuroscience, Neuroepidemiology will not offer much help. However, this should be viewed not as a limitation of the book but as a reflection of the current stage of development of neuroepidemiologic research.
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