Bracket, Goring-on-Thames, UK; Department of Psychology, Northumbria University, Newcastle, UK; Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia.
Formerly Bracket, Goring-on-Thames, UK.
Curr Opin Pharmacol. 2014 Feb;14:62-73. doi: 10.1016/j.coph.2013.12.001. Epub 2013 Dec 22.
Cognitive dysfunction characterizes all the various forms of dementia. Evidence is accumulating that all of the progressive neurodegenerative dementias, such as Alzheimer's disease (AD), are preceded by years, if not decades, of pathological cognitive decline. The limited effectiveness of the four current medications registered for AD together with the failure of dozens of programmes over the last decade has influenced the decision to evaluate treatment at earlier stages of the disease; even before any cognitive symptoms have appeared. However, it has to be acknowledged that treating mild cognitive impairment (MCI) as a prodrome for AD has also had very limited success. Nonetheless a more important problem in MCI research, and dementia in general, has to be laid at the door of the limited effectiveness of the cognitive tests employed. This problem will become even more severe for the latest research direction of treating preclinical AD because such individuals will have levels of cognitive abilities which are in the normal range; and thus many of the scales currently used in dementia research will not be sufficiently demanding to identify change over time. This paper reviews and discusses the methodology and instruments available for research and clinical practice in this major area; with a focus on the challenges involved in test selection and evaluation.
认知功能障碍是所有类型痴呆的特征。有证据表明，所有进行性神经退行性痴呆，如阿尔茨海默病（AD），在出现病理认知下降的数年甚至数十年前就已经存在。目前用于 AD 的四种药物的疗效有限，以及过去十年数十个项目的失败，影响了在疾病早期阶段评估治疗的决定；甚至在出现任何认知症状之前。然而，必须承认，将轻度认知障碍（MCI）视为 AD 的前驱期，也取得了非常有限的成功。尽管如此，在 MCI 研究中，甚至在一般痴呆症研究中，一个更重要的问题必须归咎于所使用的认知测试的有限效果。对于治疗临床前 AD 的最新研究方向来说，这个问题将变得更加严重，因为这些个体的认知能力水平处于正常范围内；因此，目前用于痴呆症研究的许多量表在识别随时间变化方面的要求不够高。本文回顾和讨论了这一主要领域的研究和临床实践中可用的方法和工具；重点讨论了测试选择和评估所涉及的挑战。
