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系統識別號 U0026-1302201914565800
論文名稱(中文) 中文簡短式智能評估與盧-尼神經心理測驗組篩檢測驗於創傷性腦傷患者之適用性探討
論文名稱(英文) An evaluation of Mini-Mental Status Examination-Chinese and Screening Test for the Luria-Nebraska Neuropsychological Battery for traumatic brain injured patients
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 107
學期 1
出版年 108
研究生(中文) 王士榮
研究生(英文) Shih-Jung Wang
學號 S86024046
學位類別 碩士
語文別 中文
論文頁數 47頁
口試委員 指導教授-郭乃文
口試委員-官大紳
口試委員-蘇倍儀
中文關鍵字 中文簡短式智能評估  盧-尼神經心理測驗組篩檢測驗  神經心理衡鑑  創傷性腦傷 
英文關鍵字 MMSE-C  ST-LNNB  Neuropsychological Assessment  Traumatic Brain Injury 
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)疾患常伴隨之症狀,臨床上常用的篩檢神經認知功能缺損的測驗為中文簡短式智能評估(Mini-Mental Status Examination-Chinese, MMSE-C)與盧-尼神經心理測驗組篩檢測驗(Luria-Nebraska Neuropsychological Battery-Screening test, ST-LNNB)。本研究討論此兩種測驗之:(1)檢視MMSE-C與ST-LNNB於TBI患者之檢出率。(2)MMSE-C檢出結果之後續分析。(3)多次施測之結果分析。(4) ST-LNNB陽性者之病患當中,MMSE-C為陽性者與陰性者之比較。

方法:
本研究使用病歷進行回溯性研究,資料來自南部某醫學中心復健科2005至2014年之TBI患者,篩檢條件為確診僅具TBI診斷且因臨床需求完成MMSE-C與ST-LNNB之病患共152人(男109人、女43人,平均年齡38.6 ± 16.9歲,平均教育年數12.0 ± 3.1年),此152人共計提供180筆資料。以描述統計、相關分析、單因子變異數分析、t檢定分析之。

結果:
資料顯示(1)55.3%(84人)於MMSE-C與ST-LNNB均呈現陽性,16.4%(25人)均呈現陰性,28.3%(43人)兩測驗呈現篩檢不一致之結果。卡方檢定顯示MMSE-C與ST-LNNB篩檢性之間其差異達顯著(X2(1)=30.35, p<.001),ST-LNNB篩檢能力較佳 (2) ST-LNNB未檢出,但MMES-C檢出的可能原因為MMSE-C中定向感題目的失分而導致MMSE-C呈陽性反應。(3)多次施測分析顯示,ST-LNNB相較於MMSE-C較為敏感,且研究結果指出其在篩檢性穩定地持續較佳。(4)針對ST-LNNB篩檢出陽性人數共124人,其中MMSE-C為陽性組有84人,MMSE-C為陰性組有40人,兩組的比較分析顯示:在MMSE與ST-LNNB的測驗表現上,兩組之間也均具有統計上的顯著差別。

結論:
MMSE-C對於TBI患者之檢出率較低,建議使用ST-LNNB可提高神經認知功能缺損之檢出率。在多次施測的情境中,ST-LNNB也相對保持於MMSE-C敏感。ST-LNNB顯示為陽性者,但MMSE-C同時也為陽性的患者其認知功能有更嚴重受損的傾向。建議可以選用ST-LNNB之中更具鑑別力的子題目作為更精簡的篩檢性測驗。

關鍵詞:中文簡短式智能評估(MMSE-C)、盧-尼神經心理測驗組篩檢測驗(ST-LNNB)、神經心理衡鑑(neuropsychological assessment)、創傷性腦傷(Traumatic Brain Injury , TBI)
英文摘要 SUMMARY
The data showed that (1) 55.3% (84 persons) were positive in both MMSE-C and ST-LNNB, 16.4% (25 persons) were both negative, and 28.3% (43 persons) showed inconsistent results. The chi-square test showed that the difference between MMSE-C and ST-LNNB was significant (X2(1)=30.35, p<.001), which suggests that ST-LNNB had better screening ability. (2) the possible reason for the detection of MMES-C while ST-LNNB was not detected, was that the patients performed poorly in MMSE-C. (3) Multiple measurements showed that ST-LNNB was more sensitive than MMSE-C, and the results indicated that it was more stable in screening performance. (4) 124 patients were positive for ST-LNNB screening, of which 84 were positive and 40 more negative in MMSE-C. A comparative analysis of the two groups showed that statistically significant difference exists between the two groups in the test performance of MMSE and ST-LNNB.

Key words: MMSE-C, ST-LNNB, Neuropsychological Assessment, Traumatic Brain Injury

INTRODUCTION

The Mini-Mental Status Examination-Chinese (MMSE-C) and the Luria-Nebraska Neuropsychological Battery-Screening test (ST-LNNB) are widely used for TBI patients with cognitive impairment. The purposes of this study are as follows: (1) to examine the detection rate of MMSE-C and ST-LNNB in patients with TBI; (2) to analyze subsequent MMSE-C detection results; (3) the different results of multiple measurement; (4) to analyze the differences between positive and negative results by MMSE-C in patients with ST-LNNB positive result.

MATERIALS AND METHODS
This study is a retrospective research. The medical records are from TBI patients, during 2005 to 2014, of a rehabilitation department in a medical center in southern Taiwan. The screening conditions are for patients diagnosed with TBI only and who have completed MMSE-C and ST-LNNB due to clinical needs. 152 people (109 males and 43 females, with an average age of 38.6 ± 16.9 years, and an average number of years of education 12.0 ± 3.1 years) supplied 180 data analyzed by ANOVA, t-test and correlation test.

RESULTS AND DISCUSSION

The data showed that (1) 55.3% (84 persons) were positive in both MMSE-C and ST-LNNB, 16.4% (25 persons) were both negative, and 28.3% (43 persons) showed inconsistent results. The chi-square test showed that the difference between MMSE-C and ST-LNNB was significant (X2(1)=30.35, p<.001), which suggests that ST-LNNB had better screening ability. (2) the possible reason for the detection of MMES-C while ST-LNNB was not detected, was that the patients performed poorly in MMSE-C. (3) Multiple measurements showed that ST-LNNB was more sensitive than MMSE-C, and the results indicated that it was more stable in screening performance. (4) 124 patients were positive for ST-LNNB screening, of which 84 were positive and 40 more negative in MMSE-C. A comparative analysis of the two groups showed that statistically significant difference exists between the two groups in the test performance of MMSE and ST-LNNB.

CONCLUSION

MMSE-C has a lower detection rate for patients with TBI. The results suggest that ST-LNNB can improve the detection rate of neurocognitive deficits. ST-LNNB is more sensitive in the context of multiple measurements than MMSE-C. Patients positive both in ST-LNNB and MMSE-C have more severe impairment in their cognitive function. The author recommends to use some of the more discriminating sub-tests of ST-LNNB as a more streamlined screening test.

論文目次 壹、緒論 1
第一節、 神經心理衡鑑的目的、內涵與臨床應用 1
一、 神經心理衡鑑目的與內容 1
二、 神經心理篩檢工具內涵 6
三、 復健領域運用神經心理衡鑑 10
第二節、 創傷性腦傷與神經功能缺損 12
一、 創傷性腦傷之定義與概念 12
二、 創傷性腦傷導致之神經認知功能缺損 14
第三節、 篩檢性測驗於創傷性腦傷疾患之應用 15
一、 簡短式智能評估之發展與應用 15
二、 簡短式智能評估於篩檢創傷性腦傷疾患之侷限 17
三、 盧-尼神經心理測驗組篩檢測驗之發展與應用 19
第四節、 研究動機與假設 21
貳、研究方法 23
第一節、 研究設計與流程 23
第二節、 研究對象 23
第三節、 研究工具 24
第四節、 統計分析方法 25
參、研究結果 26
第一節、 人口學統計資料分析 26
第二節、 MMSE-C與ST-LNNB檢出結果分析 27
第三節、 MMSE-C陽性、ST-LNNB陰性組之測驗結果分析 28
第四節、 多次施測之測驗結果分析 29
第五節、 ST-LNNB陽性者之MMSE-C、ST-LNNB測驗結果分析 32
肆、討論 35
第一節、 ST-LNNB與MMSE-C之檢出率探討 35
第二節、 MMSE-C陽性、ST-LNNB陰性組之測驗結果分析探討 35
第三節、 多次施測之研究結果探討 36
第四節、 ST-LNNB之研究結果探討 36
第五節、 研究限制 38
第六節、 結論 38
參考文獻 40
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