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系統識別號 U0026-0407202022405500
論文名稱(中文) 社區型心智篩檢測驗、中文簡短式智能評估及盧-尼神經心理測驗組篩檢測驗於創傷性腦傷患者之篩檢適用性比較
論文名稱(英文) Comparing the application of Screening Tests in Patients with Traumatic Brain Injury: CMSE, MMSE-C and ST-LNNB
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 108
學期 2
出版年 109
研究生(中文) 蘇靖雯
研究生(英文) Ching-Wen Su
學號 S86064038
學位類別 碩士
語文別 中文
論文頁數 97頁
口試委員 指導教授-郭乃文
共同指導教授-楊延光
口試委員-蘇純瑩
中文關鍵字 社區型心智篩檢測驗  中文簡短式智能評估  盧-尼神經心理測驗組篩檢測驗  篩檢測驗  創傷性腦傷 
英文關鍵字 Community Mental Status Examination(CMSE)  Mini-Mental Status Examination-Chinese(MMSE-C)  Screening Test for Luria-Nebraska Neuropsychological Battery(ST-LNNB)  Screening test  traumatic brain injury(TBI) 
學科別分類
中文摘要 目的:認知功能缺損為創傷性腦傷(traumatic brain injury, TBI)患者常出現的後遺症,採用能識別特定認知功能缺損的篩檢測驗有利於提升臨床決策之效率。目前臨床上常用的認知功能篩檢測驗包含社區型心智篩檢測驗(CMSE)、中文簡短式智能評估(MMSE-C)及盧-尼神經心理測驗組篩檢測驗(ST-LNNB),其中CMSE為台灣本土發展的神經心理衡鑑篩檢工具,建構目標為用於檢測主要的大腦功能缺損。本研究目的為比較CMSE、MMSE-C及ST-LNNB於TBI患者之篩檢適用性。
方法:本研究為回溯性研究,病歷資料來自南部某醫學中心復健科自2010至2019年,確診僅具TBI診斷且因臨床需求完成CMSE、MMSE-C及ST-LNNB之患者共80人,男性佔65.28%,平均年齡為39.81歲,教育程度國中以上佔65.28%,平均受傷時腦傷嚴重度屬重度佔70.83%,平均傷後時間5.98個月。受試者於篩檢測驗之缺損判定是依據不同年齡與教育程度常模之切截分數(cut-off point)。並以t檢定、卡方檢定、邏輯式迴歸及高特曼量表方法分析之。
結果:僅53.52%被MMSE-C判定缺損,69.01%被ST-LNNB判定缺損,95.77%被CMSE判定缺損。被MMSE-C判定缺損者,同時皆可被CMSE檢出;被CMSE判定缺損者,僅有57.97%同時被MMSE-C檢出。以CMSE的後葉、語文分量表及理解和回憶題型就可以有效預測患者在MMSE-C缺損結果。相較於CMSE,MMSE-C傾向找出腦傷較嚴重的患者。被ST-LNNB判定缺損者,同時皆可被CMSE檢出;被CMSE判定缺損者,有70.42%同時被ST-LNNB檢出。以CMSE的後葉、非語文分量表及理解題型就可以有效預測患者在ST-LNNB缺損結果。功能表現較差時,才能同時被三項篩檢測驗篩出。以高特曼量表(guttman scale)分析三項篩檢測驗缺損結果之複製係數(CR)為0.99。
結論:考慮年齡與教育程度後,MMSE-C與ST-LNNB對創傷性腦傷患者認知功能缺損之篩檢能力較CMSE差,MMSE-C傾向篩檢不出前葉功能與非語文功能缺損者,ST-LNNB傾向篩檢不出前葉功能與語文功能缺損。MMSE-C、ST-LNNB及CMSE三個認知功能篩檢測驗呈現一階層性之難度差異,其中,CMSE可以篩檢出MMSE-C與ST-LNNB所能偵測之TBI患者,若臨床工作時間有限,建議直接以CMSE替代MMSE-C與ST-LNNB以評估TBI患者之認知功能表現。
英文摘要 Patients with traumatic brain injury(TBI) suffer from cognitive impairment, thus, an effective screening test should be developed. There are few studies on the applicability of cognitive screening tests in Taiwan. In the present study, we compare the application of CMSE, MMSE-C and ST-LNNB in patients with TBI. This study is a retrospective study. Medical records from the 2010–2019 period for patients with TBI at the division of rehabilitation at a medical center in Southern Taiwan were used. A total of 80 patients diagnosed with TBI and completed CMSE, MMSE-C and ST-LNNB due to clinical needs were enrolled in this study. Their mean age was 40.17 years old and average post-injury time was 6.15 months. Only 53.52% were determined to be impaired by MMSE-C, 69.01% were determined to be impaired by ST-LNNB, and 95.77% were determined to be impaired by CMSE. The posterior lobe subscale, verbal subscale, comprehension item and recall item of CMSE could effectively predict the patient's impairment in MMSE-C. Compared with CMSE, MMSE-C tended to find patients with severe brain injury The posterior lobe subscale, nonverbal subscale and comprehension item of CMSE could effectively predict the patient's impairment in ST-LNNB. When the cognitive performance was poor, it screened out by three screening tests at the same time. Using Guttman scale to analyze the application of the three-screen test, the coefficient of reproducibility was 0.99. For patients with TBI, clinical recommendation is to give priority to screening for cognitive impairment with CMSE.
論文目次 摘要-----------------------------------------------------------------------------------I
誌謝---------------------------------------------------------------------------------VI
表目錄------------------------------------------------------------------------------IX
圖目錄-----------------------------------------------------------------------------XII
第壹章、緒論 1
第一節、認知功能篩檢測驗----------------------------------------------------1
第二節、創傷性腦傷-------------------------------------------------------------6
第三節、MMSE-C與ST-LNNB在創傷性腦傷之應用--------------------12
第四節、CMSE之介紹--------------------------------------------------------16
第五節、研究目的與假設-----------------------------------------------------18
第貳章、研究方法 19
第一節、研究設計與流程-----------------------------------------------------19
第二節、研究對象--------------------------------------------------------------20
第三節、研究工具--------------------------------------------------------------22
第四節、研究變項--------------------------------------------------------------24
第五節、資料分析--------------------------------------------------------------26
第參章、研究結果 27
第一節、CMSE與MMSE-C篩檢適用性之比較------------------------29
第二節、CMSE與ST-LNNB篩檢適用性之比較-----------------------43
第三節、CMSE、MMSE-C及ST-LNNB篩檢適用性之比較--------57
第肆章、討論 75
第一節、探討高特曼量表結果-----------------------------------------------75
第二節、探討CMSE與MMSE-C之篩檢能力-----------------------------77
第三節、探討CMSE與ST-LNNB之篩檢能力----------------------------79
第四節、考慮腦傷嚴重度之討論--------------------------------------------80
第五節、研究限制--------------------------------------------------------------81
第六節、結論--------------------------------------------------------------------82
參考文獻--------------------------------------------------------------------------83
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