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系統識別號 U0026-1502201611272000
論文名稱(中文) 台版認知刺激治療對失智症患者的認知、情緒、焦躁行為及生活品質之成效探討
論文名稱(英文) Effects of Cognitive Stimulation Therapy-Taiwan version on Cognition, Mood, Agitation Behavior and Quality of Life in Patient with Neurocognitive Disorder
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 104
學期 1
出版年 105
研究生(中文) 趙慧珍
研究生(英文) Hui-Chen Chao
學號 TA8981055
學位類別 博士
語文別 中文
論文頁數 139頁
口試委員 指導教授-王靜枝
口試委員-馬慧英
召集委員-傅中玲
口試委員-張玲慧
口試委員-謝秀芳
中文關鍵字 認知狀態  憂鬱情緒  焦躁行為  生活品質  認知刺激治療 
英文關鍵字 cognition status  depression status  Agitation Behavior  quality of life  Cognitive stimulation therapy 
學科別分類
中文摘要 背景:失智症多為無法治癒、慢性且腦部神經病變而產生的一種退化性疾病,其發生機率隨著年齡的增長而增加。失智症患者的腦神經認知行為精神症狀與情緒症狀若未有合宜的處置,嚴重影響患者與照顧者的生活品質。而非藥物輔助治療被認為應於使用藥物治療前,其角色值得探討。
目的:本研究目的為探討一項非藥物輔助治療-認知刺激治療方案對失智症者的認知狀態、憂鬱情緒、焦躁行為及生活品質之成效。
研究方法:本研究採雙組重複量數混合設計,遴選南部地區長期照護機構,包括護理之家及養護機構等共8機構罹患失智症長者,依其多單位隨機分派分為實驗組與對照組,實驗組進行為期10週,每週一次、每次45-50分鐘之認知次刺激治療,而對照組則維持原有之日常生活活動。兩組皆以簡短心智量表、中文版康乃爾失智憂鬱量表、中文版焦躁量表及阿茲海默氏症生活品質量表作為評估工具,分別於研究介入前一周及介入結束後第一週與第三個月進行檢測。
資料分析:研究結果以SPSS 17.0英文版套裝軟體進行資料建檔與統計分析,針對一般人口學變項作一詳盡描述性統計及推論性統計。認知狀態、憂鬱情緒、焦躁行為、及生活品質等方面之成效測量則以廣義估計方程式進行分析,進行檢定10週認知刺激介入措施之成效。
結果:期經過認知刺激治療訓練後,實驗組個案在生活品質於介入結束後第一周即產生立即效益(p< 0.01)且持續至12周(p< 0.01);焦躁行為方面則持續改善並於追蹤後測最明顯(p<0 .01)。至於認知狀態及憂鬱情緒方面,實驗組結果雖未達統計上顯著差異,但可證實認知刺激治療對於個案認知狀態及憂鬱情緒是具有穩定效益。控制組方面未參與認知刺激治療之個案於認知狀態及生活品質則有持續下降傾向且達統計上顯著差異(p< 0.01)。
結論:參與認知刺激治療之失智老人之焦躁行為及生活品質有顯著之改善,對於認知及憂鬱情緒雖有改善,其仍需更多資料進行佐證。故,本研究結果可提供臨床人員在失智症非藥物照護措施之之指引。
英文摘要 Background: Neurocognitive Disorder (NCD) is often an incurable, chronic, and progressive neurodegenerative disease. Without appropriate management for neuropsychiatric symptoms and mood status, quality of life may be influenced severely both for patients and their caregivers. Non-pharmacological interventions are believed to be administered before pharmacological treatment and it is worthy studied.
Purpose: The purpose of this research was to evaluate the effects of one of the non-pharmacological interventions- Cognitive stimulation therapy (CST) intervention on cognition status, depression status, agitation behavior and quality of life in patient with neurocognitive disorder.
Method: A two-group, the CST group and the control group and repeated measures design will be conducted. A random assignment method will be used to select subjects residing in long-term care including nursing home and assisted living facilities. The Cognitive stimulation group will receive a 45-50-minute session per week for continuous 10 weeks program. Measurement instruments include the Mini-Mental State Examination, Cornell Scale for Depression in Dementia Chinese version, Cohen-Mansfield Agitation Inventory and Quality of life-Alzheimer’s disease scale. Repeated Measures will be assessed at baseline, one week and 3 months following the CST intervention.
Analysis: The SPSS 17.0 for windows was be used to analyze the data. Descriptive analysis was being performed for demographic data and inferential analysis was being performed to analyze cognitive status, depression, agitation behavior, and quality of life through Mixed Linear Modelapproach.
Result: The findings indicated that AD-QoL had improved significantly over the baseline by either the posttest and follow test (p <0 .01). CMAI had improved significantly in follow test (p <0 .01).However, MMSE and CSDD showed no significant improvement in the posttest and follow test survey (p > 0.05).
Conclusion: This study showed that the cognitive stimulation therapy improves agitation and quality of life in patient with dementia.However; cognition status and depression were feeping stable.Findings of this study may serve as references for healthcare providers when planning for non-pharmacological care.
論文目次 中文摘要................ I
英文摘要.............. II
目錄............... VI
表目錄............... VI
圖目錄................VII
第一章 緒論..............1
第一節 研究動機及重要性..........1
第二節研究目的............6
第三節研究假設............7
第四節 名詞解釋............8
第二章 文獻查證..............11
第一節 認識認知刺激治療..........12
第二節 失智患者認狀態與認知刺激治療於認知狀態之成效文獻....14
第三節 失智患者憂鬱狀態與認知刺激治療於憂鬱狀態之成效文獻....17
第四節失智患者焦躁行為與認知刺激治療於焦躁行為之成效文獻.. ..18
第五節失智患者生活品質與認知刺激治療於生活品質之成效文獻....20
第六節研究架構............22
第三章 研究方法..............25 第一節 研究設計............25
第二節 收案地點及選樣............26 第三節 研究工具信效度檢定..........28
第四節 介入措施............31 第五節 研究收案過程............34
第六節 倫理考量............36 第七節 資料分析............37
第四章 研究結果..........................39
第一節 研究對象人口學基本資料描述...............39
第二節 認知刺激組與對照組於台版認知刺激治療前之比較.......43
第三節 認知刺激治療對失智症者於測量指標之成效...........45
第五章 討論與結論..........................56
第一節 研究對象屬性.........................56
第二節台版認知刺激治療對於失智症長者認知狀態之影響.........58
第三節台版認知刺激治療對於失智症長者憂鬱狀態之影響.... ....60
第四節台版認知刺激治療對於失智症長者焦躁行為之影響..........61
第五節台版認知刺激治療對於失智症長者生活品質之影響............62
第六節結論.............................63
第七節研究限制...........................64
第八節未來研究應用與發展方向......................67
參考文獻...............69
附錄................89
附件一 認知刺激治療授權信件.....................89
附件二 認知刺激治療受訓證明.....................90
附件三同意人體研究證明書..........92
附件四認知刺激治療方案..........93
附件五認知刺激治療活動參與記錄單........116
附件六研究同意書............117
附件七個案社會人口學屬性資料........119
VIII
附件八簡易式智能評估中文版...................120
附件九中文版康乃爾失智憂鬱量表..................121
附件十中文版焦躁量表.....................123
附件十一失智症生活品質量表.......................124
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