Telephone interview for cognitive status.
Telephone interview for cognitive status.
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DOI：
10.1159/000264678
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发表时间：
2010-01-01
影响因子：
5.7
通讯作者：
Kuller, Lewis H
中科院分区：
文献类型：
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作者：
Lopez, Oscar L;Kuller, Lewis H
洛佩斯/库勒神经流行病学2010; 34：63-64 64调谐，情况并没有那么简单。很有可能的是，“治疗”不仅对痴呆症的潜在发病率有影响，而且对痴呆症的诊断存活的可能性也有影响。例如，如果一个人正在进行一项抗高血压药物治疗预防痴呆症的试验，那么抗高血压药物治疗不仅可以降低痴呆症的发病率，而且还可以通过改变与高血压相关的死亡或严重残疾（即肾功能衰竭，充血性心力衰竭，中风等）的风险。- 增加痴呆症患者的预期寿命或寿命，使他们更有可能通过TICS-m筛查被识别出来（即随着他们变得更加残疾，他们的TICS-m评分变得更低，他们达到了进一步评估的临界点）。另一方面，在未接受降压药物治疗的对照组中，痴呆诊断后的死亡率可能远高于治疗组，并且痴呆的早期病例可能在严重发病之前不太可能被确定，即具有致残性中风，严重肾衰竭等，这使得在继发事件发生之前诊断痴呆非常困难。因此，试验结果可能表明，抗高血压药物治疗实际上不是非常有效，而实际上它可能非常有效，但也可能导致其他高血压相关发病率的降低和痴呆病例持续时间的延长，因此，在研究中根据TICS-m或类似工具的筛选临界点确定它们。因此，在临床试验中使用筛选临界点时必须格外谨慎，尤其是在死亡率和合并症较高的老年人中。TICS-m等筛查工具的另一个基本问题是，痴呆症甚至AD显然不是一种疾病。TICS-m可以提供认知下降的估计，但可能会错过其他各种认知领域（例如视觉空间功能，视觉记忆）中发生的重要变化，这些变化可能与风险因素，特别是与临床试验中的治疗相关。同样，以抗高血压药物治疗为例，这种治疗可能优先影响与执行功能相关的额叶变化，而不是最近的记忆。使用TICS-m作为初始筛选设备来识别个体以在临床试验中进行进一步测试可能会错过关于特定认知领域变化的重要信息，这些信息是重要的并且与特定治疗相关。最后，重要的是要考虑诸如TICS-m的此类筛选工具在现代痴呆诊断中的作用，这些诊断越来越多地基于成像技术，因此，在人群样本的进一步评估中，评估MRI或PET扫描等异常的特定TICS-m切割点可能是有用的。例如，具有相似的TICS-m评分或TICS-m评分变化，但随后通过进一步研究被分类为痴呆、MCI或
Lopez/Kuller Neuroepidemiology 2010; 34: 63–64 64 tunately, the situation is not that simple. It is very possible that the ‘therapy’has an effect not only on the potential incidence of dementia, but also on the likelihood of survival given the diagnosis of incident dementia. For example, if one was doing a trial of antihypertensive drug therapies for the prevention of dementia, then antihypertensive drug therapy may not only have an effect on reducing the incidence of dementia, but also–by modifying the risk of death or severe disability associated with hypertension (ie renal failure, congestive heart failure, stroke, etc.)–increase the life expectancy or the longevity of the incident dementia cases, so that they are more likely to be identified through the screening TICS-m (ie as they become more disabled, their TICS-m scores get lower and they reach the cut point for further evaluation). In the control group, on the other hand, that is not receiving the antihypertensive drug therapy, the mortality following the diagnosis of dementia may be much higher than in the treatment arm, and the early cases of dementia may be less likely to be ascertained prior to severe morbidity, ie having a disabling stroke, severe renal failure, etc., which makes the diagnosis of dementia prior to the onset of the secondary event very difficult. The results of the trial may therefore suggest that the antihypertensive drug therapy is actually not very effective, when in truth it might be highly effective but may also result in the decrease in other hypertensive-related morbidity and prolong the duration of the dementia cases, so that they are ascertained in the study based on the screening cut points from the TICS-m or similar instruments. Therefore, one has to be extraordinarily cautious in using a screening cut point in a clinical trial, especially in older individuals with high mortality and comorbidities. Another basic problem with screening instruments such as the TICS-m is that dementia, or even AD, is clearly not one disease. The TICS-m could provide an estimate of cognitive decline, but probably misses important changes which occur in other various cognitive domains (eg visuospatial functions, visual memory) that may be related both to risk factors and especially to treatment in clinical trials. Again, taking the example of antihypertensive drug therapy, it is possible that the therapy preferentially effects frontal lobe changes related to executive function, for example, rather than recent memory. Using the TICS-m as an initial screening device to identify individuals for further testing within the clinical trial may miss important information regarding changes in specific domains of cognition which are important and are related to the specific therapies.Finally, it is important to consider the role of such screening instruments such as the TICS-m in the modern era of dementia diagnoses, which are increasingly being based on imaging techniques, spinal fluid examinations, etc. Therefore, it might be useful in further evaluations in a population sample to evaluate the specific TICS-m cut points with abnormalities on MRI or PET scanning, etc. For example, do individuals who have similar TICS-m scores or changes in TICS-m scores, but are subsequently classified by further investigation as being dementia, MCI or