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系統識別號 U0026-2708201305235700
論文名稱(中文) 認知障礙相關因素之初探
論文名稱(英文) Preliminary Study of the Factors of Cognitive Impairment
校院名稱 成功大學
系所名稱(中) 政治經濟學研究所專班
系所名稱(英) Graduate Institute of Political Economy
學年度 101
學期 2
出版年 102
研究生(中文) 蔡欣霓
研究生(英文) Shin-Ni Tsai
學號 U17951024
學位類別 碩士
語文別 中文
論文頁數 62頁
口試委員 指導教授-謝文真
口試委員-劉亞明
口試委員-張家銘
中文關鍵字 輕度認知障礙  階層線性模型  TLSA 
英文關鍵字 Mild cognitive impairment  Hierarchical linear model  TLSA 
學科別分類
中文摘要 過去幾十年,人類變得更長壽而且更健康,然而,非接觸傳染性疾病卻增加了,像是失智症(Dementia)。根據世界衛生組織(World Health Organization, WHO)與國際失智症協會(Alzheimer’s Disease Internationl, ADI)估計全世界目前至少有3,560萬的人口罹患失智症,到了2030年將倍數增加,2050年則增加至三倍。這樣的疾病影響的不僅是個人的健康,並且對家人造成相當大的負擔,患者需要長期的照顧,人力與經濟的負擔將會相當可觀,因此WHO呼籲各國政府應該重視失智症,並視之為優先的公共健康議題,規劃相關政策。
輕度認知障礙(mild cognitive impairment, MCI)是一種腦部功能減弱的情況,與同齡,同等教育程度的成人相較,出現認知能力降低,但尚未嚴重影響到日常活動的情況。根據不同的研究資料顯示,65歲以上的成年人,輕微認知障礙的盛行率約有3%~19%。部份發生認知障礙的成年人隨著時間的流逝會保持穩定狀態或恢復常態,但約有一半的人會在五年內發展為失智症。因而我們可以將輕度認知障礙視為發生失智的風險狀態,可能進一步發展為失智症。本研究選取了「台灣地區中老年身心社會生活狀況長期追蹤調查」(Taiwan Longitudinal Study on Aging,簡稱TLSA)的長期追蹤資料中1999年、2003年及2007年的三波資料,選取在1999年時,達65歲以上的樣本,使用階層線性模型(Hierarchical linear modeling, HLM)進行計量分析,以探討影響輕度認知障礙發生的環境風險因子。
實證結果發現隨著年齡的增加,認知能力惡化的狀態存在個體間的差異,進一步探究發現,教育年數與憂鬱狀態,此兩項解釋變數達到統計上的顯著,教育年數愈長愈不容易發生輕微認知障礙,而憂鬱症狀則與輕微認知障礙的發生呈現正相關。性別、婚姻狀態、族群、健康行為以及家人支持並未達到顯著水準。對於輕微認知障礙的發生原因,我們所知仍然很少,WHO建議,政府必須持續進行調查研究、監控與宣導,以建立有效的預防系統。
2014年,九年國民義務教育將延長為十二年,教育年數的增加,對於降低輕微認知障礙的發生,有正向的助益。除此之外,政府應提倡建立終身學習社會。持續的學習除了有效鍛錬腦力之外,並且能夠建立自我價值,減少憂鬱的發生。推動中老年人力資源的再利用,培養良好生活習慣有助於降低憂鬱的傾向,亦可減緩輕微認知障礙的發生。高齡化社會的來臨,勢必面臨極大的挑戰,多一分準備,少一分衝擊。
英文摘要 Improvements in health care over the past decades have contributed to longer life expectancy and better health of mankind. However, non-contagious diseases, such as dementia, have increased. According to World Health Organization and Alzheimer’s Disease International, people suffering with dementia worldwide have reached 35.6 million. The magnitudes will become doubled by 2030 and tripled by 2050. Dementia does not only seriously restrict people’s capacity of function or activity but also places quite burden on their families and caregivers, and thereby the patients need long-term economy. Hence, WHO appeals to governments to prioritize dementia as a major public health issue, and to formulate supporting policies to meet the challenges of dementia in the ageing societies.
Mild cognitive impairment is a syndrome defined as a greater cognitive decline than the elderly of the same age and education level though their daily lives are not being notably interfered. Prevalence, in population-based epidemiological studies, ranges from 3% to 19% among the elderly age 65 and over. Some people with mild cognitive impairment seem to remain stable or return to normal over time, but more than half have deteriorated to dementia within five years. Mild cognitive impairment can thus be regarded as a risk state of developing dementia, further as progression to dementia. The thesis aims to make further exploration into the environmental risk factors of mild cognitive impairment, adopting the longitudinal data of three surveys in 1999, 2003 and 2007 from "Taiwan Longitudinal Study on Aging" published by National Health Board. Hierarchical linear model is applied to analyze samples from Taiwan Longitudinal Study on Aging (TLSA) with the elderly aged 65 and over in 1999.
Based on the empirical results, cognitive function worsening differs among individuals, and increases with age. The estimated coefficients of independent variables of depressive symptoms show statistically positively significance but educational attainment show the opposite direction, whereas gender, marital status, ethnic, health behavior, and family support are not significant. What we known is limited for the cause of mild cognitive impairment. World Health Organization recommends that the Government must continue to conduct research, monitoring and advocacy, in order to establish an effective prevention system.
In 2014, the Government will extend current nine-year compulsory education to 12 years. Increasing in the number of years of education attainment could reduce the incidence of mild cognitive impairment. There is a positive aid. In addition, the Government should promote to establish a lifelong learning society. Continuing learning will effective excise brainpower, build self-esteem and reduce the incidence of depression. The human resources of the elderly should be reused. Cultivating good lifestyle can help reduce the tendency of depression may also slow the occurrence of mild cognitive impairment. It’s a great challenge to face an ageing society. A little more prepared, curbing shocks.
論文目次 目 錄
第一章 緒論...... 1
第一節 研究動機... 1
第二節 研究目的... 5
第三節 研究流程與架構...... 7
第二章 理論與文獻回顧...... 9
第一節 失智症的定義與診斷... 9
第二節 失智症盛行率........ 12
第三節 輕度認知障礙........ 16
第四節 社會經濟因子........ 19
第三章 研究方法........... 23
第一節 理論模型介紹與推演... 23
第二節 資料來源與變數說明... 28
第四章 實證分析與結果...... 38
第一節 敘述統計... 38
第二節 階層線性模型分析結果....44
第五章 結論...... 50
第一節 政策建議... 51
第二節 研究限制... 54
參考文獻......... 56
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