2.疗效评价[19,20]:在乙酰胆碱酯酶抑制剂特可林(tacrine)、velnacrine 、毒扁豆碱(physostigmine)、多奈哌齐(donepezil)和rivastigmine治疗轻-中度AD的大样本、多中心、随机、双盲、安慰剂对照临床试验中,疗效评价均采用MMSE、ADAS-cog分测验和临床晤谈总体印象量表。Arrieta等[20]总结1981~1997年公开发表的49篇特可林治疗AD的论文,应用的评定工具为:MMSE 16篇,ADAS 4篇,3MS、CASI、AVLT等均有报道。
六、几点说明
1. 上述量表对于确定痴呆的病因即鉴别诊断方面作用有限。
2. 从55或60岁开始纵向随访认知功能十分重要,尤其是教育程度比较高的老人。
3. 认知评定只能作为AD诊断的辅助工具,临床诊断必须结合日常活动能力量表、非认知行为问卷、总体严重度量表、照料者负担量表及脑影像学、电生理学、生化学检查结果,最后确诊依赖于随访和病理检查。
4. 躯体状况不佳、情绪障碍、意识不清、受试者不配合等都可以影响认知检查结果。
5. 时代在发展,人口的年龄结构和老人素质处在变化之中,对认知功能的认识也在深化,故评定工具也需要不断修订以适应新的要求。由于知识产权等原因,上述大部分测验没有引进。我们介绍这些评定方法,供国内同道在量表编制与使用时参考。
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