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系統識別號 U0026-1507201822364500
論文名稱(中文) 性別影響複雜型輕度創傷性腦傷患者在主觀記憶抱怨和記憶測驗表現之間的一致性
論文名稱(英文) Gender Effects on the Consistency between Subjective Memory Complaints and Memory Test Performance in Patients with Complicated Mild Traumatic Brain Injury
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 106
學期 2
出版年 107
研究生(中文) 樂晏均
研究生(英文) Yen-Chun Yueh
學號 S86041064
學位類別 碩士
語文別 中文
論文頁數 72頁
口試委員 指導教授-郭乃文
口試委員-郭進榮
口試委員-官大紳
中文關鍵字 主觀記憶抱怨  性別  記憶測驗表現  複雜型輕度創傷性腦傷 
英文關鍵字 Complicated mild traumatic brain injury  Gender  Memory test performance  Subjective memory complaint 
學科別分類
中文摘要 目的:複雜型輕度創傷性腦傷(mTBI)患者除了在傷後存有各種神經心理功能(如:記憶力、處理速度、注意力)缺損,亦出現多種主觀抱怨,其中記憶為患者之主觀抱怨,且影響其後續生活適應。mTBI患者的功能缺損情形僅能解釋部分的主觀抱怨項目,且性別更會顯著影響患者的預後和抱怨情形。本研究欲探討性別影響複雜型mTBI患者在主觀記憶抱怨和記憶測驗表現之間的一致性。
方法:採臨床樣本之立意取樣,於南部某醫學中心民國101至104年符合頭部損傷診斷碼之病歷進行篩選共1200人,經醫師與研究人員確認病歷後納入478人,進行電話訪問並邀請參與神經心理衡鑑。其中有373人完成電訪,81人同意參與神經心理衡鑑,最後完成衡鑑者共74人。研究工具包含評估主觀記憶抱怨的身心健康狀況量表;評估記憶測驗表現的郭氏語文記憶量表(GVM)、日常生活工作記憶量表(SIVWM-DL),以及廣泛性非語文記憶力測驗(CNMT)。採用獨立樣本t檢定進行檢驗分析。
結果:共74位受試者完成衡鑑,含42位男性和32位女性,平均年齡為31.09±12.39歲,平均教育年數為13.57±2.99年。主觀記憶抱怨部分,有91%的受試者在傷後回報有不同程度的主觀記憶抱怨,女性比男性有較高的主觀記憶抱怨。記憶測驗表現部分,所有受試者的記憶功能皆為正常範圍,男性和女性受試者的記憶測驗表現並無顯著差異。男性之高抱怨和低抱怨組在記憶測驗表現有顯著差異,達顯著的記憶測驗指標包括郭氏語文記憶測驗的成功提取總和與成功儲存總和;日常生活工作記憶量表的量表總分與和視覺次量表分數;廣泛性非語文記憶力測驗的學習記憶階段的首次學習(圖形)分數、學習記憶階段的首次學習(全)分數、學習記憶的有效記憶項(圖形)、學習記憶階段的執續錯誤數、學習記憶階段的跳躍錯誤數、執續錯誤總和。達顯著的指標和急診時嘔吐、急診時頭痛、受傷時蜘蛛膜下腔出血(Subarachnoid hemorrhage, SAH)、硬腦膜下血腫(Subdural hematoma, SDH)、住院時進行腦部手術、門診時嘔吐的神經生理變項有關。女性之高、低抱怨組在記憶測驗表現在學習記憶階段的跳躍錯誤數有顯著差異,達顯著的指標和急診時暈眩與受傷時SAH的神經生理變項有關。年齡和教育程度部分,青年組之高、低抱怨組在郭氏語文記憶測驗的成功提取總和與成功儲存總和、廣泛性非語文記憶力測驗中的學習記憶階段的記憶鞏固(圖形)分數和順序記憶階段的跳躍錯誤數有顯著差異,達顯著的指標和住院時是否進行腦部手術的神經生理變項有關。大專畢業組之高、低抱怨組在廣泛性非語文記憶力測驗中順序記憶階段的跳躍錯誤數有顯著差異,達顯著的指標和門診時是否暈眩的神經生理變項有關。
討論:(1)大部分的受試者在主觀記憶抱怨和記憶測驗表現之間皆出現不一致的情形。(2)男性患者的記憶表現與受傷時的神經生理變項較一致。(3)女性受試者有較高程度的主觀記憶抱怨,且主觀記憶抱怨與測驗表現之一致性較低。(4)比起年齡和教育程度,性別對主觀記憶抱怨和記憶測驗表現的一致性有較大影響。
英文摘要 Patients with complicated mild traumatic brain injury (mTBI) suffer from neuropsychological deficits and complaints. Gender affects patient complaints. This study sought to investigate gender effects on the consistency between subjective memory complaints and memory test performance in patients with complicated mTBI. This study taking a sample of the clinical samples, 478 of the head-damage diagnosis codes were included in a medical center in the southern country from 101 to 104 years. Of these, 81 agreed to participate in the neuropsychological assessment. Research tools included Physical and Mental Health Status Scale for assessing subjective memory complaints and the Guo's Verbal Memory Scale (GVM), the Scale of Instrumental Verbal Working Memory of Daily Life (SIVWM-DL), and Comprehensive Non-verbal Memory Test Battery (CNMT) for assessing memory function. A total of 74 subjects completed the study, 91% of the subjects had different levels of memory complaints. All subjects are in a normal memory range. In our study, most of the subjects had inconsistencies between subjective memory complaints and memory test performance. The consistency between memory complaining and test performance was lower for female than for male. The memory performance of male patients is more consistent with the neurophysiological variables at the time of injury than female. Female subjects have a higher degree of subjective memory complaints, and subjective memory complaints are less consistent with test performance.
論文目次 目 錄
第壹章、緒論 1
第一節 複雜型輕度創傷性腦傷 1
一、創傷性腦傷之定義 1
二、創傷性腦傷之類型 1
第二節 輕度創傷性腦傷患者之功能缺損和主觀抱怨 4
一、輕度創傷性腦傷之功能缺損與適應問題 4
二、輕度創傷性腦傷之主觀抱怨 5
三、輕度創傷性腦傷的功能缺損和主觀抱怨之不一致性 5
第三節 輕度創傷性腦傷的記憶功能缺損和主觀記憶抱怨 7
一、輕度創傷性腦傷的記憶功能缺損 7
二、輕度創傷性腦傷的主觀記憶抱怨 7
第四節 性別影響輕度創傷性腦傷患者的預後 9
第五節 研究目的與假設 10
一、研究目的 10
二、研究假設 10
第貳章、研究方法 11
第一節 研究架構 11
第二節 研究流程 13
一、研究倫理審查 14
二、收案流程 14
第三節 研究對象 15
一、納入條款 15
二、排除條款 15
三、篩選過程 15
第四節 研究工具 18
一、主觀記憶抱怨測量 18
二、記憶測驗表現測量 18
第五節 資料分析 24
第參章、結果 25
第一節 受試者人口學變項與受傷時神經生理變項之描述性分析 26
第二節 性別影響主觀記憶抱怨和記憶測驗表現之間一致性的分析 34
第三節 年齡影響主觀記憶抱怨和記憶測驗表現之間一致性的分析 41
第四節 教育程度影響主觀記憶抱怨和記憶測驗表現之間一致性的分析 47
第肆章、討論 52
第一節 複雜型mTBI患者之主觀記憶抱怨和記憶測驗表現之不一致性 53
第二節 性別影響腦傷患者之主觀記憶抱怨情形 54
第三節 年齡和教育程度影響腦傷患者之主觀記憶抱怨情形 56
第四節 研究貢獻與限制 58
一、研究貢獻 58
二、研究限制 58
參考文獻 60
中文部分 60
英文部分 62
附 錄 70
附錄一、身心健康狀況量表 70
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