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系統識別號 U0026-2101201605130000
論文名稱(中文) 慢性期複雜型輕度創傷性腦傷患者在前瞻性記憶表現之探究
論文名稱(英文) The Effects of Executive Functions on Prospective Memory in Chronic Complicated Mild Traumatic Brain Injury 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 104
學期 2
出版年 105
研究生(中文) 陳南君
研究生(英文) Nan-Chun Chen
學號 S86011077
學位類別 碩士
語文別 中文
論文頁數 80頁
口試委員 指導教授-郭乃文
口試委員-官大紳
口試委員-郭進榮
中文關鍵字 輕度創傷性腦傷  前瞻性記憶  執行功能 
英文關鍵字 mild traumatic brain injury  prospective memory  executive functions 
學科別分類
中文摘要 目的:輕度創傷性腦傷患者在受傷後持續有高比例的主觀記憶抱怨,影響其生活安適程度。研究發現在傷後三個月有前瞻性記憶 (prospective memory) 缺損,但未探討此缺損是否延續到慢性期。過去研究指出前瞻性記憶與執行功能(executive functions) 有很高的關聯性,尤其討論其與大腦系統受損間的關係。本研究探討慢性期複雜型輕度創傷性腦傷患者在前瞻性記憶與執行功能的表現,並分析執行功能部件對不同前瞻性記憶階段的影響,做為未來認知復健訓練(cognitive rehabilitation training) 計畫之參考。

方法:於南部某教學醫院使用病歷回溯方式,以國際診斷碼ICD-9,包括432.1;800-801.9;803-804.9;850-854.19;959.0-959.09;989.9;959.9篩選出民國101年至103上半年度期間受傷之複雜型輕度創傷性腦傷患者,經醫師與研究人員雙重確認後,以立意取樣方式邀請受試者參與評估,共納入62位受試者。執行功能部件包括以廣泛性非語文注意力測驗 (Comprehensive Nonverbal Attention Test Battery, CNAT)、廣泛性非語文記憶力測驗 (Comprehensive Nonverbal Memory Test Battery, CNMT)、Stroop叫色測驗 (Stroop Color-Word Interference)、倫敦塔 (Tower of London, ToL)、威斯康辛卡片分類測驗 (Wisconsin Card Sorting Test, WCST) 等工具,來評估注意力監控、工作記憶、抑制功能、計畫,以及認知彈性。前瞻性記憶分為他人規劃與自主規劃兩種情境,以自編階段性任務作業進行事件為基 (event-based) 與時間為基 (time-based) 之功能評估。分析執行功能部件對不同前瞻性記憶階段的影響。

結果:在不同情境中,執行功能部件對前瞻性記憶階段之預測程度並不相同。於他人規劃情境中,CNMT中順序提取的首次完成與CNAT中抗拒分心的反應時間可預測意圖保留的表現;CNMT中學習記憶的監控錯誤與順序提取的監控錯誤皆可預測事件為基的意圖起始。於自主規劃情境中,ToL的違反策略與CNAT的衝動錯誤可預測意圖形成表現;CNMT中順序提取的記憶鞏固可預測意圖保留與意圖起始的表現。

結論:具有:(1)注意力監控中的衝動監控與抗拒分心能力;(2)工作記憶中的順序提取完整性、記憶鞏固能力,以及少犯執續錯誤;以及(3)減少計畫中的違反錯誤,有利於前瞻性記憶表現。因此,於認知復健訓練中訓練前述執行功能部件,可改善慢性期複雜型輕度創傷性腦傷患者的前瞻性記憶表現。
英文摘要 There were study suggested that mild traumatic brain injury patients remained executive functions and prospective memory impairments post-injury, but it did not investigate whether these impairments persist to chronic stage. The objective of this study was to investigate the effects of executive functions to prospective memory in chronic complicated mild traumatic brain injury (MTBI) patients. Retrospective analysis of medical records in teaching hospital in south Taiwan to include suspected traumatic brain injury patients during January, 2012 to June 2014 and judgmental sampling was applied via telephone. Sixty-two subjects were included. Neuropsychological assessment of executive functions and prospective memory were conducted and analyzed. In different conditions, the effects of executive functions were different. In the given-planned condition, total trials to complete the retrieval of sequential working memory in CNMT and resistance distractions subtest in CNAT predicted the prospective in intention retention phase; monitoring errors in learning stage and monitoring errors in retrieval of sequential working memory in CNMT predicted the performance in event-based prospective memory in the intention initiation phase. In the self-planned condition, commission errors in ToL and impulsivity errors in CNAT predicted the intention formation phase; consolidation in the retrieval of sequential working memory in CNMT predicted the performances in the intention retention and intention initiation phases. This study recognized specific aspects of executive functions plays important roles in prospective memory, indicating that training specific aspect of executive functions can improve prospective memory performances in chronic complicated MTBI pateints.
論文目次 目錄
第一章 緒論 1
第一節 慢性期複雜型輕度創傷性腦傷 1
壹、創傷性腦傷之定義與概念 1
貳、輕度創傷性腦傷之後遺症 2
參、輕度創傷性腦傷患者的記憶困擾 4
第二節 創傷性腦傷患者之前瞻性記憶表現 6
壹、前瞻性記憶之定義與評估方式 6
貳、事件為基與時間為基的前瞻性記憶 8
參、創傷性腦傷患者在前瞻性記憶的表現 9
第三節 創傷性腦傷患者之執行功能表現 12
壹、執行功能之定義 12
貳、輕度創傷性腦傷患者的執行功能受損研究 13
參、前瞻性記憶與執行功能之關聯性 15
第四節 研究動機與問題假設 18
第二章 研究方法 21
第一節 研究架構 21
第二節 研究程序 22
第三節 研究對象 24
第四節 研究工具 25
第五節 統計分析 36
第三章 研究結果 37
第一節 受試者之基本人口學變項與受傷時神經學變項 37
第二節 執行功能部件與前瞻性記憶各階段表現之描述性分析 38
第三節 執行功能部件與前瞻性記憶階段之相關分析 46
第四節 執行功能部件與前瞻性記憶階段之迴歸分析 56
第四章 討論與結論 63
第一節 人口學變項與受傷時神經學變項 63
第二節 慢性期複雜型輕度創傷性腦傷患者的執行功能與前瞻性記憶表現 64
第三節 執行功能部件與前瞻性記憶各階段之關聯性 65
第四節 研究貢獻與限制 68
參考文獻 69
附件一 自主規劃情境意圖形成階段圖卡 79
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