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系統識別號 U0026-0401201322465500
論文名稱(中文) 多種處理速度訓練對提升老年人認知功能的效果探討
論文名稱(英文) The Effect of Multiple Processing Speed Training on the Cognitive Function of the Elderly
校院名稱 成功大學
系所名稱(中) 心理學系認知科學碩士班
系所名稱(英) MS in Cognitive Science
學年度 101
學期 1
出版年 102
研究生(中文) 陳恩佩
研究生(英文) En-Pei Chen
學號 U76981028
學位類別 碩士
語文別 中文
論文頁數 112頁
口試委員 指導教授-陳振宇
口試委員-曾進興
口試委員-成戎珠
中文關鍵字 處理速度  老年人  智力  認知退化  認知訓練  腦適能 
英文關鍵字 speed of processing  processing speed  the elderly  aging  fluid intelligence  cognitive training  brain fitness 
學科別分類
中文摘要 由於大腦具有神經可塑性,老年人認知功能的退化被認為是可以改善的,認知老化的處理速度障礙假說認為,處理速度的退化是老年人大腦各種認知功能(記憶、空間能力、邏輯)退化的最主要原因(Salthouse, 1996)。過去針對老人的處理速度能力的訓練,僅限於目檢時間(Inspection time)的訓練,訓練效果僅能改善與訓練內容非常相似的作業,訓練效果不能夠改善老年人的記憶、邏輯思考等能力。由於處理速度包含的認知歷程範圍甚廣,本研究認為過去的研究中使用的處理速度測驗難易度與複雜度不一,有些只涉及較簡單的知覺或動作反應,有些涉及較高階的中樞執行抑制能力。本研究於研究一探討處理速度作業可能的分類方式,並於研究二設計多種處理速度的訓練,其內容廣泛的包含知覺動作處理速度或中樞處理速度等層面,我們假設訓練效果能夠改善老年人知覺動作處理速度的退化,且訓練效果也能遷移到其他較高階認知功能(中樞處理速度)的退化。

研究一蒐集過去文獻中使用的15個處理速度測驗,徵召73名大學生參與這15項處理速度測驗,之後使用因素分析萃取處理速度測驗所包含的因子。因素分析結果得到八個因素,分別為視覺掃描、視覺注意力、手眼協調、記憶提取策略、動作反應協調、反應抑制、視覺區辨與抑制以及單位提取速度。最後將15項處理速度測驗分為兩類:知覺動作處理速度(簡單處理速度)與中樞處理速度(複雜處理速度)。
研究二的目的有二:一為探討老年人經過處理速度的訓練後是否進步,二為老年人參與知覺動作類與中樞類的處理速度訓練後,訓練成效是否能在知覺動作指標測驗或中樞指標測驗上顯示出來。將研究一所使用之15項測驗分類為知覺動作處理速度類(PMPS)與中樞處理速度類(CPS),各類再挑一部分做為訓練作業以及評量指標測驗。實驗設計為二因子混合設計(time x group),比較兩訓練組別的前後測以探討訓練效果。本研究徵召60-79歲受試者41名,通過中文版知能篩檢測驗CASI 2.0篩選得分87分以上,知覺動作組21人,中樞組20人。每位受試者共參與前後兩次的評量指標測驗以及八次的訓練,每次訓練約40分鐘,每週訓練兩次,實驗為期約一個月。評量指標測驗有抄寫、找部件測驗、圖型比較、數字比較、語言流暢度、Flanker作業及Stroop叫色作業。PMPS組訓練包含五項知覺動作處理速度訓練作業,國字比較、線段劃記、滑鼠與鍵盤按鍵、完成方塊及圖案判斷;CPS組訓練包含三項中樞處理速度訓練作業,Sternberg記憶提取、PASAT連續加法、倒述。研究二兩個訓練組在年齡、教育年數、性別比例以及CASI知能篩檢測驗分數上皆無顯著差異。在訓練前後期的平均表現,除了PMPS組國字比較作業之外,所有訓練作業均呈現顯著進步。檢視七項評量指標測驗的前後測差異發現,有四項測驗(抄寫測驗, 找部件測驗, 語言流暢度, 數字比較)的後測較前測有顯著進步,而組間所有的指標測驗均無顯著的差異。抄寫測驗和語言流暢度在time x group有顯著交互作用,顯示PMPS組在這兩項測驗的進步幅度較CPS組大。PMPS組的知覺動作處理速度標準分數(PM Score)在訓練後有顯著進步,效果量Cohen’s d達1.05。將研究一與研究二結果比較,檢視老年組與年輕組在各項作業的表現,在完成方塊、線段劃記、Sternberg記憶提取等三項作業中發現,老年組經訓練後,表現稍微優於年輕組。

本研究結論認為,老年人的處理速度表現可以在八次的訓練過程中獲得改善,老年人重複練習處理速度作業後的表現可與年輕人初次表現相當,且透過相對應的訓練,知覺動作處理速度較中樞處理速度容易改善。多種處理速度訓練,並不能顯著改善所有的處理速度作業表現,特別是高階中樞認知功能。本研究發現處理速度的訓練,並不能改善所有的認知功能,Salthouse的認知老化之廣泛性趨緩假說無法得到證實。研究者認為,老年人的速度緩慢是認知功能障礙的一種表像,而非認知障礙成因,處理速度作業可能更適合用於探討訓練效果的測量。
英文摘要 Background and Purpose
Cognitive aging is an important issue in aging research. It is supposed that declined processing speed is closely related to deficits in other cognitive functions such as fluid intelligence, reasoning, problem solving, and spatial ability. The processing-speed theory of cognitive aging proposed by Salthouse supposed that processing speed is the single mechanism which mediates cognitive aging (Salthouse , 1996). Some researches trained the processing speed ability (inspection time) of elderly. The training only results in improved ability which was closely related to the training program but no increased abilities in other cognitive domains.
We suppose that there are several types of processing speed rather than the former research restricted their training in inspection time. The transfer effects of their training seem restricted in the very-near and near tasks. If the processing speed theory of cognitive aging proposed by Salthouse is reliable, there might be some improvements in other cognitive functions after the speed training. Measurements of processing speed involve a spectrum of speed measures from very simple perceptual-motor response tasks to high level executive functions.

Hypothesis
We supposed multiple processing speed training derived from some modified speed measurements could broaden the training effects into a wide range of cognitive functions rather than restricted in very-near and near tasks.

Methods
In Study one, we want to categorize the traditional used speed measurements in order to design multiple processing speed training tasks into groups. We investigated the traditional used speed measurements to see the factors among these measurements. 73 college students were recruited. Each of them finished 15 speed measures including paper-pencil tasks and computerized tasks. Factor analysis was implemented.

In Study two, we implemented the processing speed training among the elderly. The experiment design is 2 factors time x group design. Two groups of processing speed training were designed according to the results of study one: perceptual-motor processing speed tasks (PMPS) and central processing speed tasks (CPS). 42 elderly over 60 years old were recruited from church, hospital volunteer team, and elderly schools in Tainan. Their cognitive function were tested by the Cognitive Abilities Screening Instrument 2.0 Chinese version and scored higher than 87. There are 7 criteria tasks. 4 of them are supposed to test PMPS (copying, finding As’, pattern comparison, number comparison), and the other 3 are testing CPS (verbal fluency, Flanker tasks and Stroop task). In PMPS group, the training programs are: Letter comparison, Line marking, Finger tapping, Identical pictures, and Box completion. In CPS group, the training are: Sternberg retrieval, word backward, and Paced Auditory Serial Addition Test (PASAT). The subjects were assigned into one of the groups and finished 2 sessions of assessments and 8 sessions of 40-mins training within one month. The training results were analyzed by paired T test or Wilcoxon rank sum test comparing the former and later stages of the training sessions with SPSS. The results of the pre-post criteria tests were individually analyzed by repeated-measures ANOVA. The results of criteria tests were also combined into 2 standardized scores, perceptual-motor score (PM Score) and central score (C Score), indicating general effects of training.

Results
In study one, we found 8 factors extracted from 15 measures, such as visual scanning, visual attention, eye-hand coordination, retrieval strategies, motor response, response inhibition, visual discrimination and retrieval rate. We categorize the 15 tasks into two groups: perceptual-motor processing speed tasks (PMPS) and central processing speed tasks (CPS).
In study two, there are no significant differences in education years, age, and gender proportion among these two groups. There are 21 and 20 subjects in the PMPS and CPS group.
In the training results, the variables in both groups were significantly (p <.05 or p <.001) improved in the later stage of training except the slope of Letter comparison. In the pre-post criteria test results, no significant difference was found between groups, but significant improvements were found under 4 tests (copying, finding As’, verbal fluency and number comparison) between time. There were also interactions of time x group were found under copying test and verbal fluency test, which means PMPS training group potentially improved more in these 2 tests than CPS group. Standardized perceptual-motor score (PM Score) was significantly improved in PMPS and the effect size (Cohen’s d) is 1.05 which means high training effect. Comparing the results of study one and study two, the elderly reached the performance level of young adults in some processing speed tasks.

Conclusions
1. The processing speed performance of the elderly could be improved to the average level of the young adults’ first performance after multiple processing speed training, and with corresponding training, PMPS abilities are easier to be improved than CPS abilities.
2. Multiple processing speed training couldn't improve all the performance of processing speed, especially high level cognitive function.
3. We suppose processing speed tasks are better used as criteria tasks for cognitive training rather than training tasks since slowing of speed is probably a behavioral evidence of cognitive deficit.

論文目次 第一章、前言 1
第二章、研究背景與研究問題 3
2.1人口老化現象及常見的因應策略 3
2.2 認知訓練及腦適能:概念、策略及其重要性 6
第三章、老年認知退化的現象及其理論上的解釋 9
3.1 老年認知退化的現象 9
3.2 「特定認知成份退化」假說 11
3.3 「廣泛性趨緩」假說 12
3.4 「處理速度」的理論意涵及操作性定義 14
第四章、「處理速度」訓練對提升老年認知功能的幫助 25
4.1 改良式UFOV處理速度訓練 25
4.2 改良式UFOV處理速度訓練研究結果 27
第五章、研究目的及研究假設 28
第六章、研究一:「處理速度」的心理計量 29
6.1研究目的 29
6.2研究假設 29
6.3 研究方法 29
6.4 研究工具 30
6.5 研究材料 31
6.5.1 動作處理速度測驗 31
6.5.2 知覺處理速度測驗 32
6.5.3 中樞處理速度測驗 34
6.6 測驗結果與計分 37
6.6.1 動作處理速度測驗計分 40
6.6.2 知覺處理速度測驗計分 40
6.6.3 中樞處理速度測驗計分 42
6.7 因素分析之方法與結果 44
6.8 討論 46
6.9 結論與應用 48
第七章、研究二:「處理速度」訓練 50
7.1 研究目的 50
7.2 研究方法 50
7.3 研究工具與材料 52
7.3.1 前後測指標作業 52
7.3.2 訓練作業 55
7.4 資料分析 60
7.5 結果 62
7.5.1 受試者分析結果 62
7.5.2 訓練結果 62
7.5.3 前後測驗結果 75
7.5.4 標準化指標分數結果 82
7.5.5 老年組訓練後表現與年輕組初次表現之比較 84
7.6 討論 86
第八章、綜合討論與結論 90
8.1 研究結果摘要 90
8.2 「處理速度」是一個有用的概念嗎? 90
8.3 對未來研究的建議 91
8.4 結論 92
第九章、參考文獻 93
附錄一、抄寫測驗 98
附錄二、線段畫記 102
附錄三、找口部件測驗 104
附錄四、國字倒述測驗題目 107
附錄五、國字比較測驗題目 108
附錄六、數字比較測驗題目(部分) 109
附錄六、數字比較測驗題目(部分) 109
附錄七、圖形比較測驗題目(部分) 110
附錄八、圖案判斷測驗題目(部分) 111
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