2．療效評(píng)價(jià)［19,20］：在乙酰膽堿酯酶抑制劑特可林（tacrine）、velnacrine 、毒扁豆堿（physostigmine）、多奈哌齊（donepezil）和rivastigmine治療輕-中度AD的大樣本、多中心、隨機(jī)、雙盲、安慰劑對(duì)照臨床試驗(yàn)中，療效評(píng)價(jià)均采用MMSE、ADAS-cog分測(cè)驗(yàn)和臨床晤談總體印象量表。Arrieta等［20］總結(jié)1981～1997年公開(kāi)發(fā)表的49篇特可林治療AD的論文，應(yīng)用的評(píng)定工具為：MMSE 16篇，ADAS 4篇，3MS、CASI、AVLT等均有報(bào)道。

　　　　六、幾點(diǎn)說(shuō)明

　　　　1． 上述量表對(duì)于確定癡呆的病因即鑒別診斷方面作用有限。

　　2． 從55或60歲開(kāi)始縱向隨訪(fǎng)認(rèn)知功能十分重要，尤其是教育程度比較高的老人。

　　3． 認(rèn)知評(píng)定只能作為AD診斷的輔助工具，臨床診斷必須結(jié)合日�；顒�(dòng)能力量表、非認(rèn)知行為問(wèn)卷、總體嚴(yán)重度量表、照料者負(fù)擔(dān)量表及腦影像學(xué)、電生理學(xué)、生化學(xué)檢查結(jié)果，最后確診依賴(lài)于隨訪(fǎng)和病理檢查。

　　4. 軀體狀況不佳、情緒障礙、意識(shí)不清、受試者不配合等都可以影響認(rèn)知檢查結(jié)果。

　　5. 時(shí)代在發(fā)展，人口的年齡結(jié)構(gòu)和老人素質(zhì)處在變化之中，對(duì)認(rèn)知功能的認(rèn)識(shí)也在深化，故評(píng)定工具也需要不斷修訂以適應(yīng)新的要求。由于知識(shí)產(chǎn)權(quán)等原因，上述大部分測(cè)驗(yàn)沒(méi)有引進(jìn)。我們介紹這些評(píng)定方法，供國(guó)內(nèi)同道在量表編制與使用時(shí)參考。

　　參考文獻(xiàn)
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