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系統識別號 U0026-1108201120021600
論文名稱(中文) 阿茲海默型失智症患者執行注意功能缺損對生活執行功能表現之影響
論文名稱(英文) The Effects of Executive Attention Deficits on Daily Executive Functions in Demented Patients with Alzheimer’s Disease
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 99
學期 2
出版年 100
研究生(中文) 陳靖
研究生(英文) Ching Chen
電子信箱 tuku633@gmail.com
學號 s86994021
學位類別 碩士
語文別 中文
論文頁數 106頁
口試委員 口試委員-林克能
口試委員-葉宗烈
指導教授-郭乃文
中文關鍵字 阿茲海默型失智症  注意力  執行功能  日常生活功能 
英文關鍵字 Alzheimer’s disease  attention  executive function  daily function 
學科別分類
中文摘要 臨床觀察到執行注意力缺損會使阿茲海默性失智症患者專注困難且容易疲倦,進而增加跌倒或交通事故等意外危險。然而,阿茲海默型失智症患者隨病情的惡化不僅使認知功能障礙逐漸加重,也會導致生活執行功能下降,進而對生活品質造成影響。本研究想探究阿茲海默型失智症執行注意力缺損對生活執行功能之影響。想要探討的主題有(1)正常老年組、輕度與中度阿茲海默型失智症患者的執行注意力缺損表徵差異。(2)正常老年組、輕度與中度阿茲海默型失智症患者的生活執行功能障礙類型之異同。(3)執行注意力功能影響生活執行功能之因子探討。本研究受試者正常老年組29位、輕度與中度阿茲海默型失智症患者各30位與21位。每位受試者皆須接受基本資料與臨床評估,包括有認知功能、非語文注意力測驗、直接功能狀態評估、照護需求層級量表,日常執行功能行為量表。結果顯示(1)執行性注意力功能方面,失智組在高層次監督性注意力控制皆有顯著功能缺損現象,輕度失智組的低層次競爭程序化之注意力部件完整。有效反應時間分析,中度失智組的反應時間各項執行注意力分測驗表現皆有顯著遲緩,輕度失智組相較正常老年組,僅在基本注意力測驗表現有時間反應遲緩現象,但在抑制功能與抗拒分心等部件複雜測驗時間遲緩反應則不顯著。(2)生活執行功能方面:中度失智組在飲食基本能力與情緒監控因素無顯著障礙,其餘工具性生活功能、情緒認知、動機控制、計畫性等因素皆在輕度失智程度時即有顯著生活執行功能障礙。(3)預測因子:發現抗拒分心測驗總錯誤數對直接功能狀態評估總分、時間定向感、溝通能力、交通能力、財務與購物能力具有輕度到中度之預測力;抗拒分心測驗違反錯誤對照護需求層級量表之各項生活功能指標皆有中度預測力;抗拒分心測驗衝動錯誤對動機控制、計畫性、環境互動監控等因素具有輕度預測力。研究結果證實執行注意力功能指標對生活執行功能具有良好的預測力,因此期待透過本研究結果成果,能擬定未來認知復健計畫內容,加強進行有效認知復健因子訓練,進而提升或維持患者的生活獨立性。
英文摘要 Backgroud/Aims: In clinic, executive attention deficits make difficult concentrate and easily distracted in dementia with Alzheimer's type (DAT), thus leading to an increased risk of accidents such as falls or traffic accidents. However, the deterioration of DAT not only more severe cognitive impairment but also decline in executive function. Disease itself could impact on patient’s quality of life. This research tries to explore the implementation of executive attention deficit impact of daily executive function in DAT. Therefore, we wanted explore current subjects. (1) Normal, mild and moderate DAT characterized by differences in the executive attention deficits. (2) Normal, mild and moderate DAT characterized by differences in the daily executive functions. (3) The daily executive functions will be affected by executive attention,which most important factor was. Methods: Twenty-nine normal control elderly and fifty-one mild to moderate Alzheimer's dementia were recruited. Each subject completed cognitive function, comprehensive non-verbal attention test battery (CNAT), hierarchy of care rating (HCR), daily executive behaviors scale and direct assessment function status (DAFS) examinations. Results: (1) Dementia group show significant deficits of supervisory attentional control (SAC). Contention scheduling and routine attentional orienting would be unaffected in mild DAT. Response time of the executive attention subtests show significant slowly in moderate DAT. Compared with normal, mild DAT show significantly slow response time in basic attention tasks. However, Slow response time in go-no-go task and go- no- go with distracters task was not found in mild DAT. (2) Eating and emotional control were no significant impairment in moderate DAT. Decreased the daily executive functions included instrumental activities of daily living, cognitive and emotion, motivation control and planning were significant noted in mild DAT. (3) The executive attention is moderately predictive of daily executive functions. DAFS scores, time orientation, communication ,transportation skills, financial and sopping abilities were significantly predicted by total errors in go-no-go task with distracters.The independent function domains including total scores, activities of daily living(ADLs) , instrumental activities of daily living (IADLs) , cognitive and emotion(C&E) in HCR were significantly predicted by commission errors in go-no-go task with distracters. The factors of motivation control, planning and environment monitor in daily executive behaviors scale were significantly predicted by impulsive errors in go-no-go task with distracters. Conclusions: The findings provide evidence of a relationship between executive attention task performance and daily executive functions in DAT population. In the future, we can train DAT attention control ability to enhanced or maintain cognitive functions and patients’ independence in life.
論文目次 第壹章 緒 論...............................................1
第一節 研究背景與動機......................................1
第二節 阿茲海默型失智症的注意力功能缺損......................3
第三節 阿茲海默型失智症的生活執行功能探討...................16
第四節 研究目的與假設.....................................24
第貳章 研究方法............................................27
第一節 研究對象..........................................27
第二節 研究工具..........................................29
第三節 研究程序..........................................40
第四節 統計分析..........................................41
第參章 研究結果............................................42
第一節 執行注意力功能表現...................................42
第二節 生活執行功能表現.....................................48
第三節 執行注意力功能對生活執行功能之相關性探討...............52
第四節 執行注意力功能對生活執行功能之逐步複迴歸分析.............62
第肆章 討 論..............................................70
第一節 阿茲海默型失智症患者執行注意力功能缺損面貌...............70
第二節 阿茲海默型失智症患者生活執行功能缺損面貌................73
第三節 執行注意力對生活執行功能之預測.........................75
第四節 主觀評估工具與客觀評估工具優缺點探討....................78
第五節 研究限制............................................79
第六節 研究貢獻與未來方向....................................81
參考文獻...................................................82

附錄
附錄一 受試者同意書.....................................95
附錄二 基本資料問卷.....................................96
附錄三 二因素社經地位數運算表............................97
附錄四 直接功能狀態評估.................................99
附錄五 直接功能狀態評估修正同意函........................103
附錄六 照護需求層級量表................................104
附錄七 日常執行功能行為量表.............................105
附錄八 人體試驗委員會申請試驗同意書......................106
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