Rockwood Kenneth
Division of Geriatric Medicine, Dalhousie University, and Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada.
Int Psychogeriatr. 2007 Jun;19(3):467-82. doi: 10.1017/S1041610207004966. Epub 2007 Mar 15.
Dementia is defined as global cognitive impairment that interferes with function; however, function has been less well measured than cognition in anti-dementia drug trials. In the modern era of anti-dementia clinical trials, measurement of function has improved by differentiating between the aspects of function that have been impaired--for example, impaired initiative versus ineffective performance, as is evaluated by the Disability Assessment for Dementia. Obstacles remain, including how best to distinguish the concepts of functional impairment and disability, how broad to make the range of functional impairment (e.g. whether it should include impaired performance of hobbies, or withdrawal from leisure activities) to individualize assessment, and to distinguish cognitive from non-cognitive causes of impaired function. Even though it appears that improved function is commonly related to improved executive function, and that the latter, more than other aspects of improved cognition, is the effect most prized by patients, families and physicians, functional assessment measures are often less sensitive to change than other outcome measures. How best to improve sensitivity to change of functional measurements is controversial, but it is necessary to do so in order to evaluate the full effects of treatment.
痴呆症被定义为妨碍功能的全面认知障碍；然而，在抗痴呆药物试验中，对功能的测量不如对认知的测量完善。在抗痴呆临床试验的现代阶段，通过区分已受损的功能方面，功能测量得到了改进，例如，主动性受损与表现无效，这是通过痴呆症残疾评估来评估的。障碍仍然存在，包括如何最好地区分功能障碍和残疾的概念，使功能障碍的范围（例如，是否应包括爱好表现受损或退出休闲活动）有多宽泛以实现个性化评估，以及区分功能受损的认知和非认知原因。尽管改善功能似乎通常与改善执行功能相关，而且与认知改善的其他方面相比，后者是患者、家庭和医生最看重的效果，但功能评估措施往往比其他结局指标对变化的敏感性更低。如何最好地提高功能测量对变化的敏感性存在争议，但为了评估治疗的全面效果，这样做是必要的。
