Wesnes Keith A, Harrison John E
Cognitive Drug Research Ltd, Reading, UK; Human Cognitive Neuroscience Unit, Northumbria University, Newcastle upon Tyne, UK.
Dialogues Clin Neurosci. 2003 Mar;5(1):77-88. doi: 10.31887/DCNS.2003.5.1/kwesnes.
Impairment of cognitive function is the central feature of dementia. Although, clinically, the cognitive deficit most often manifests itself as memory problems, a number of other areas of cognition are affected, and memory is but one of the cognitive skills compromised in dementia. Dementia with Lewy bodies, for example, accounts for 15% to 25% of all dementias and does not have memory deficits as a core feature. Our cognitive facilities underlie our abilities to engage successfully in the activities of daily living (ADL) and it follows thai enhancement of cognitive function will facilitate performance of ADL The assessment and understanding of these impairments are crucial to any treatment of the disorder. Unfortunately, the principal instrument used to assess cognitive function in most of the major clinical trials of Alzheimer's disease in recent years, the Alzheimer's Disease Assessment Scale-Cognitive Subsection (ADAS-COG), primarily assesses aspects of memory, which has resulted in other important cognitive deficits in dementia being overlooked. Automated cognitive tests are now available that can identify an earlier onset of improvements in dementia in smaller samples than the ADAS, Regulatory authorities should encourage - or even require - the use of automated procedures alongside the ADAS in pivotal trials to help determine the relative utility of the instruments in the fairest way possible. Whatever the outcome, this will be of long-term benefit to patients, carers, drug developers, clinicians, and regulators in this important area.
认知功能损害是痴呆症的核心特征。虽然在临床上，认知缺陷最常表现为记忆问题，但认知的其他一些领域也会受到影响，记忆只是痴呆症中受损的认知技能之一。例如，路易体痴呆占所有痴呆症的15%至25%，其核心特征并非记忆缺陷。我们的认知能力是我们成功参与日常生活活动（ADL）的基础，因此认知功能的增强将有助于ADL的表现。对这些损害的评估和理解对于该疾病的任何治疗都至关重要。不幸的是，近年来在大多数阿尔茨海默病主要临床试验中用于评估认知功能的主要工具，即阿尔茨海默病评估量表-认知部分（ADAS-COG），主要评估记忆方面，这导致痴呆症中其他重要的认知缺陷被忽视。现在有了自动化认知测试，与ADAS相比，它可以在更小的样本中识别出痴呆症改善的更早发作。监管机构应鼓励甚至要求在关键试验中同时使用自动化程序和ADAS，以尽可能公平的方式帮助确定这些工具的相对效用。无论结果如何，这将对该重要领域的患者、护理人员、药物研发人员、临床医生和监管机构产生长期益处。
