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系統識別號 U0026-0812200915373663
論文名稱(中文) 艾倫認知篩檢測驗於阿茲海默氏症老人適用性之信效度檢驗
論文名稱(英文) Validation of the Allen Cognitive Level Test in the Elderly with and without Alzheimer’s Disease
校院名稱 成功大學
系所名稱(中) 職能治療學系碩博士班
系所名稱(英) Department of Occupational Therapy
學年度 97
學期 2
出版年 98
研究生(中文) 吳思慧
研究生(英文) Szu-Hui Wu
電子信箱 t7696102@mail.ncku.edu.tw
學號 t7696102
學位類別 碩士
語文別 中文
論文頁數 71頁
口試委員 口試委員-蘇純瑩
口試委員-王靜枝
指導教授-汪翠瀅
指導教授-白明奇
中文關鍵字 區辨性  聚斂效度  同時效度  再測信度  阿茲海默氏症  放大版艾倫認知篩檢測驗 
英文關鍵字 test-retest reliability  Alzheimer’s disease  concurrent validity  convergent validity  discriminant analysis  ROC curve  Large Allen Cognitive Level Test 
學科別分類
中文摘要 研究背景與目的:

多重認知損傷是阿茲海默氏症最主要的特徵,臨床上多以神經心理評估來診斷其認知缺損情況,但此方式對於職能治療介入提供的線索並不明確。艾倫針對認知功能損傷提出一完整的模式,包含各個認知層級的功能表現及介入建議,放大版艾倫認知篩檢測驗(LACL)為此模式中適用於認知失能老人之評估工具,對於認知功能改變具敏感性,ACL廣泛用於精神病患者的認知功能評估,但卻少有研究將ACL或LACL作為失智症患者的篩檢或評估之工具。因此,本研究的主要目的為艾倫認知篩檢測驗於阿茲海默氏症老人適用性之信效度檢驗,包括再測信度、效標關聯效度、建構效度,能否顯示一般老人與阿茲海默氏症老人之差異以及能否區辨老人有無阿茲海默氏症。藉由工具信效度的建立,期望未來能進一步提供相關研究使用,進而作為職能治療評估與介入的參考。


研究方法:

以臨床失智評量表(CDR)作為篩檢與分組的工具,從南台灣某教學醫院共招募57位60歲以上阿茲海默氏症患者為實驗組,另招募21位正常老人為控制組,經同意參與研究並填寫同意書後,進行完整施測(CASI、LACL、digit span、Trail Making Test A & B、IADL、Barthel Index),並於兩週的間隔時間後進行再測。


結果與討論:

三組在配對上,性別方面無顯著差異,而年齡、教育程度皆達顯著差異,且老人憂鬱量表亦達顯著差異,因此考量將年齡、教育程度與老人憂鬱量表分數皆列為控制變項進行共變數分析(ANCOVA);LACL間隔兩週的再測信度在正常組老人與阿茲海默氏症組之組內相關係數(ICC)值分別為 .951與 .858 (p<.001),而測量誤差值(SEM)與最小真實改變量(SRD)之百分比在兩組分別為1.67%與4.22%,以及4.63%與11.71%,皆顯示LACL於兩族群皆有良好的再測信度;同時效度部分,LACL與CDR(r=-.827, p<.001)、MMSE(r=.879, p<.001)與CASI(r=.871, p<.001)分數皆達顯著高度相關;建構效度部份,LACL與注意力(DS_f, r=.665, p<.001)、執行功能(TMT_B, r=-.540, p<.001)及日常生活功能(BI, r=.383, p<.01; IADL, r=.805, p<.001)皆達顯著中度到高度相關,進一步以逐步迴歸分析探討認知功能向度對LACL解釋變異程度,結果發現可解釋最大變異量之因子為DS_f,而DS_f與TMT_B共可解釋45.4%的變異量(p < .001);比較正常組、輕度AD與中度AD之LACL,發現的確達顯著差異。以LACL進行區辨分析,顯示以LACL區辨有無AD之正確區辨率為89.7%,若區辨有無AD之LACL切點分數為4.7時,敏感度為 .857,特異度為 .912,而LACL區辨正常組、輕度AD與中度AD之正確區辨率為82.1%,結果顯示不論是以LACL區辨有無AD,或是不同嚴重度之AD,皆有良好的正確區辨率,且皆優於MMSE與CASI之正確區辨率。


結論:

本研究發現LACL不論是再測信度、同時效度、聚斂效度或區辨性,皆有良好的結果,顯示LACL可作為AD之篩檢、評估與介入的臨床實務參考。
英文摘要 Background and purposes:

The multi-cognitive impairment is obvious in the patients with Alzheimer’s disease (AD). In clinical practice, the neuropsychological assessments used to evaluate AD, do not provide further information for the care of the patients. The Large Allen Cognitive Level Test (LACL) based on the cognitive disability model (CDM) is a screening for the cognitive function and the required assistance for the cognitive impaired. However there is little research about the applicability of LACL for the patients with AD. The purpose of this study was to examine the reliability and validity of LACL, including the test-retest reliability, concurrent and convergent validity, as well as the discriminant validity for the individuals with and without AD.


Methods:

Fifty-seven patients with mild to moderate AD diagnosed by NINCDS-ADRDA criteria were recruited as the patient group and 21 community volunteers without cognitive impairments participated as the control group. The cognitive functions were evaluated by LACL, Mini-Mental Status Exam (MMSE), Cognitive Ability Screening Instrument (CASI), Clinical Dementia Rating scale (CDR), Digit Span forward (DS_f), Trail Making Test-A & B (TMT A & B), Barthel Index (BI), and Lawton’s Instrumental Activities of Daily Living (IADL). The interval between the pre- and post-LACL test was two weeks. All participants gave written informed consent prior to their participation.


Results:

The results showed that the test-retest reliability of LACL were excellent in control and AD group (ICC= .951 & .858, ps <.001; SEM%=1.67% & 4.22%; SRD%= 4.63% & 11.71%, respectivelys). There were significant differences in age, education, and GDS among the three groups. After controlling for these variables, the LACL score highly correlated with the CDR (r =- .827, p<.001), MMSE(r=.879, p<.001) and CASI (r = .871, p<.001), and moderately to highly correlated to other cognitive and functional assessments (DS_f, r = .665, p<.001; TMT_B, r = -.540, p<.001; BI, r = .383, p < .01; IADL, r = .805, p < .001). There were significant group differences in LACL by ANCOVA (F = 71.26, p<.001). With discriminant analysis, the percentage of LACL scores correctly classified 89.7% of the subjects into their original groups. Using receiver operating characteristic (ROC) curve analysis, a cut off point at 4.7 provided the optimised sensitivity ( .857) and specificity ( .912) for LACL to differentiate participants with or without AD.


Conclusions:

The findings support that LACL is a reliable and valid instrument, and is useful for the screening of AD. Further application and investigation with LACL and the CDM guidelines are warranted for clinical practice.
論文目次 目錄
中文摘要 I
ABSTRACT III
誌謝 V
目錄 VII
表目錄 IX
圖目錄 X
附錄目錄 XI
第一章、 前言 1
第一節、 動機與重要性 1
第二節、 研究目的 3
第二章、 文獻回顧 4
第一節、 阿茲海默氏症認知特徵與功能表現 4
第二節、 艾倫(ALLEN)的認知模式 15
第三節、 艾論認知失能模式(CDM)於阿茲海默氏症的應用 23
第三章、 研究方法 26
第一節、 研究對象 26
第二節、 研究流程 27
第三節、 研究工具 29
第四節、 資料分析 33
第四章、 研究結果 34
第一節、 基本資料 34
第二節、 艾倫認知篩檢測驗(LACL)之再測信度分析 36
第三節、 艾倫認知篩檢測驗(LACL)之效度分析 37
第四節、 LACL於一般老人與阿茲海默症老人之表現及區辨性 40
第五章、 討論 44
第一節、 組間人口學變項與測驗表現之關係 44
第二節、 艾倫認知篩檢測驗(LACL)之再測信度探討 46
第三節、 艾倫認知篩檢測驗(LACL)之效度探討 48
第四節、 LACL於一般老人與阿茲海默症老人之表現及區辨性探討 51
第六章、 結論與建議 54
參考文獻 55
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