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系統識別號 U0026-3008201818124800
論文名稱(中文) 用於失智症篩檢的遊戲型認知功能評估應用程式之研究
論文名稱(英文) A Study of Game-Based Cognitive Assessment APP for Dementia Screening
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 106
學期 2
出版年 107
研究生(中文) 吳佳芸
研究生(英文) Jia-Yun Wu
學號 P86054145
學位類別 碩士
語文別 英文
論文頁數 44頁
口試委員 指導教授-鄭國順
口試委員-孫永年
口試委員-李宗南
口試委員-柯乃熒
口試委員-黃敏偉
口試委員-施東河
中文關鍵字 失智症篩檢  認知能力評估  遊戲  應用程式  認知障礙症 
英文關鍵字 Dementia screening  Cognitive assessment  Game  APP  Neurocognitive disorder 
學科別分類
中文摘要 失智症盛行率隨著年紀增長而逐年增加,失智症篩檢已成為老年化社會的重要議題,其中輕度認知功能衰退(MCI)族群相較於正常老化者,較有可能轉變為失智症(每年約10-15%)。從醫療成本方面,台灣輕度失智症患者每月平均花費約兩萬元,對於普通收入的家庭有一定的經濟壓力,而隨著病情惡化,花費則以1.4倍增長。若能及早發現疾病及早治療,不僅能夠延緩病情惡化,同時也可以維持患者的生活品質,為減少後續照護人力及成本的關鍵。目前雖然有多種評估認知功能的工具如簡易心智量表(MMSE)、臨床失智評估量表(CDR)、認知功能障礙篩檢量表(CASI)、蒙特利爾認知評估量表(MoCA)等可供臨床應用,但是根據統計我國失智症患者的就診率仍然偏低。現代生活中,智慧型手機與平板電腦等電子產品應用相當普遍,因此本論文主要以平板電腦為基礎在Android與Window平台研發,用以早期失智症篩檢的遊戲型認知功能評估應用程式,其內容包含取得使用者背景資訊以及測試五個認知領域(視覺空間概念、注意力、語言能力、記憶力及執行功能) 共13關卡;關卡設計是參考臨床上常用評估量表,遊戲元素則以台灣文化為主,加入較貼近台灣日常生活的故事。本研究實驗共收集103筆有效的個案資料,包括正常組50位、輕微認知衰退組 14位及失智症組39位。資料內容包含CDR、CASI、MMSE量表分數,和使用本研究所研發之應用程式所測得分數與問卷調查。研究結果顯示本應用程式分別與CASI(r=0.93)和MMSE(r=0.91)有高度的線性相關性。三組在CASI、MMSE與本應用程式的結果亦有明顯差異,尤其是視覺空間概念、記憶力及執行功能的表現差異最為明顯。根據實驗結果,使用本應用程式所測得的平均分數對於正常組為90.2分,輕微認知衰退組為76.5分,失智組為47.3分。基於分析比較之結果,本應用程式深具潛力發展為早期失智症篩檢工具,可以運用於一般普及化初步篩檢。
英文摘要 Due to the prevalence of dementia as increasing with age, the dementia screening becomes an important issue in aging or aged society. Compared to general elders, the groups of Mild Cognitive Impairment (MCI) is shown to have higher ratio about 10-15% being changed into dementia annually. From the aspect of healthcare cost, about NT$20,000 in average is spent for a mild dementia patient per month. The cost is increasing with disease severity and puts heavy burden on their family. If the patients can be diagnosed and treated earlier, not only disease progression can be slowed down but also the quality of life may be maintained. In addition, it may save more labors and cost on caregiving. There are several cognitive assessments for clinical application, such as Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Cognitive Abilities Screening Instrument (CASI), Montreal Cognitive Assessment (MoCA), etc., however, according to statistics, the clinical OPD following-up rate of dementia patients is still low. Nowadays, smart phones and tablet are easily available and become a part of daily life. Therefore, in this study, Game-Based Cognitive Assessment (GBCA) is proposed and developed for early screening of cognitive impairment. GBCA is a type of an interactive game APP implemented on Android and Windows platforms. It includes the user background information acquisition and 13 test games in 5 main cognitive domains (visuospatial perception, attention, language, memory and executive functioning). The testing contents are designed by taking the general assessments in clinic as reference. The game theme and elements are based on Taiwanese culture, so it would go with daily life experience. In this study, 103 valid data (NC=50, MCI=14, Dementia=39) have been collected, including scores of CDR, CASI, MMSE, the proposed GBCA and a questionnaire. The results show the highly linear correlation between GBCA and CASI (r=0.93) as well as between the APP and MMSE (r=0.91). From the results of GBCA, the average score for the groups of NC, MCI, and dementia are 90.2, 76.5, and 47.3, respectively. Based on the comparison analysis, the proposed APP is demonstrated to be a potential tool for dementia screening.
論文目次 中文摘要 I
ABSTRACT II
致謝 III
CONTENT IV
LIST OF FIGURES VI
LIST OF TABLES VII
Chapter 1 Introduction 1
1.1 Background 1
1.1.1 Global dementia overview 1
1.1.2 Status in Taiwan 1
1.2 Research Purpose 4
1.3 Research Area 4
Chapter 2 Literature Review 5
2.1 Dementia 5
2.1.1 Definition and symptoms 5
2.1.2 Classification 5
2.1.3 Mild cognitive impairment 6
2.2 Cognitive assessments 8
2.2.1 Mini-Mental State Examination 8
2.2.2 Montreal Cognitive Assessment 8
2.2.3 Cognitive Abilities Screening Instrument 9
2.2.4 Clinical Dementia Rating 9
2.2.5 Comparison of different clinical cognitive assessments 10
2.3 Computerization 11
2.4 Gamification and Serious game 11
Chapter 3 Material and Methods 13
3.1 Structure of Experiment 13
3.2 Subject 13
3.3 Game-Based Cognitive Assessment APP 14
3.3.1 Concept of design 14
3.3.2 Interaction design 15
3.3.3 Design of User interface 16
3.3.4 Scoring criteria 22
3.3 Questionnaire of user experience 23
3.4 Data collection procedure 24
Chapter 4 Results and Discussion 25
4.1 Results 25
4.1.1 Results of Game-Based Cognitive Assessment 25
4.1.2 Correlation analysis 29
4.1.3 Results of Questionnaire 29
4.2 Discussion 31
4.2.1 Discussion of Game-Based Cognitive Assessment APP 31
4.2.2 User experience 31
4.2.3 User scenario 32
4.2.4 Limitation 32
Chapter 5 Conclusion and Prospects 33
References 35
Appendix A Questionnaire of Game-Based Cognitive Assessment (GBCA) APP 38
Appendix B Interface of Game-Based Cognitive Assessment (GBCA) APP 41
Registration 41
Repeat the number and Reverse the number 41
Recognize the number 42
Repeat after me 43
Ten fruits 44
Overlapped pentagons drawing test 44
Tower of London test 44

參考文獻 [1] M. J. Prince, A. Wimo, M. M. Guerchet, G. C. Ali, Y.-T. Wu, and M. Prina, “World Alzheimer Report 2015 - The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends,” Aug. 2015.
[2] A. Wimo et al., “The worldwide costs of dementia 2015 and comparisons with 2010,” Alzheimers Dement, vol. 13, no. 1, pp. 1–7, Jan. 2017.
[3] Taiwan Alzheimer Disease Association, “關於失智症.” [Online]. Available: http://www.tada2002.org.tw/About/IsntDementia. [Accessed: 22-Jun-2018].
[4] F. E. Matthews et al., “A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II,” Lancet, vol. 382, no. 9902, pp. 1405–1412, Oct. 2013.
[5] “內政部統計處.” [Online]. Available: https://www.moi.gov.tw/chi/chi_site/stat/chart.aspx. [Accessed: 18-Jul-2018].
[6] “WHO | Dementia: a public health priority,” WHO. [Online]. Available: http://www.who.int/mental_health/publications/dementia_report_2012/en/. [Accessed: 25-Apr-2018].
[7] L.-J. E. Ku, M.-C. Pai, and P.-Y. Shih, “Economic Impact of Dementia by Disease Severity: Exploring the Relationship between Stage of Dementia and Cost of Care in Taiwan,” PLOS ONE, vol. 11, no. 2, p. e0148779, Feb. 2016.
[8] “2018 ICD-10-CM Diagnosis Code F03.9: Unspecified dementia.” [Online]. Available: http://www.icd10data.com/ICD10CM/Codes/F01-F99/F01-F09/F03-/F03.9. [Accessed: 25-Apr-2018].
[9] M. Prince, D. R. Bryce, and D. C. Ferri, “World Alzheimer Report 2011: The benefits of early diagnosis and intervention,” p. 72, Sep. 2011.
[10] National Development Council(ROC), “Educational attainment over 15 - by region and age.” [Online]. Available: http://statis.moi.gov.tw/micst/stmain.jsp?sys=100&kind=10&type=1&funid=c01104&rdm=lheeJ7py. [Accessed: 24-Jan-2018].
[11] “Dementia – Signs, Symptoms, Causes, Tests, Treatment, Care | alz.org.” [Online]. Available: https://www.alz.org/what-is-dementia.asp. [Accessed: 25-Apr-2018].
[12] “WHO | Dementia,” 18-Mar-2015. [Online]. Available: https://web.archive.org/web/20150318030901/http://www.who.int/mediacentre/factsheets/fs362/en. [Accessed: 25-Apr-2018].
[13] American Psychiatric Association, Ed., Diagnostic and statistical manual of mental disorders: DSM-IV, 4. ed. Washington, DC, 1994.
[14] H. Chertkow, “Diagnosis and treatment of dementia: Introduction. Introducing a series based on the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia,” CMAJ, vol. 178, no. 3, pp. 316–321, Jan. 2008.
[15] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013.
[16] “Alzheimer’s disease: Symptoms, stages, causes, and treatment,” Medical News Today. [Online]. Available: https://www.medicalnewstoday.com/articles/159442.php. [Accessed: 25-Jun-2018].
[17] “Common and Rare Types of Dementia.” .
[18] “Lewy body dementia - Symptoms and causes,” Mayo Clinic. [Online]. Available: http://www.mayoclinic.org/diseases-conditions/lewy-body-dementia/symptoms-causes/syc-20352025. [Accessed: 25-Jun-2018].
[19] “Frontotemporal Dementia | Signs, Symptoms, & Diagnosis,” Dementia. [Online]. Available: //www.alz.org/dementia/fronto-temporal-dementia-ftd-symptoms.asp. [Accessed: 25-Jun-2018].
[20] “Lewy Body Dementias,” Memory and Aging Center. [Online]. Available: https://memory.ucsf.edu/lewy-body-dementias. [Accessed: 31-Jul-2018].
[21] “Vascular Dementia | Signs, Symptoms, & Diagnosis,” Dementia. [Online]. Available: //www.alz.org/dementia/vascular-dementia-symptoms.asp. [Accessed: 25-Jun-2018].
[22] “Mixed Dementia,” Alzheimer’s Disease and Dementia. [Online]. Available: https://alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/mixed-dementia. [Accessed: 31-Jul-2018].
[23] S. Gauthier et al., “Mild cognitive impairment,” Lancet, vol. 367, no. 9518, pp. 1262–1270, Apr. 2006.
[24] N. T. Aggarwal, R. C. Shah, and D. A. Bennett, “Alzheimer’s disease: Unique markers for diagnosis & new treatment modalities,” Indian Journal of Medical Research, vol. 142, no. 4, p. 369, Jan. 2015.
[25] R. C. Petersen et al., “Current concepts in mild cognitive impairment,” Arch. Neurol., vol. 58, no. 12, pp. 1985–1992, Dec. 2001.
[26] R. C. Petersen and J. C. Morris, “Mild Cognitive Impairment as a Clinical Entity and Treatment Target,” Arch Neurol, vol. 62, no. 7, pp. 1160–1163, Jul. 2005.
[27] K. Schmidtke and S. Hermeneit, “High rate of conversion to Alzheimer’s disease in a cohort of amnestic MCI patients,” Int Psychogeriatr, vol. 20, no. 1, pp. 96–108, Feb. 2008.
[28] M. Bruscoli and S. Lovestone, “Is MCI really just early dementia? A systematic review of conversion studies,” Int Psychogeriatr, vol. 16, no. 2, pp. 129–140, Jun. 2004.
[29] P. A. Boyle, R. S. Wilson, N. T. Aggarwal, Y. Tang, and D. A. Bennett, “Mild cognitive impairment: risk of Alzheimer disease and rate of cognitive decline,” Neurology, vol. 67, no. 3, pp. 441–445, Aug. 2006.
[30] S. T. Farias, D. Mungas, B. R. Reed, D. Harvey, D. Cahn-Weiner, and C. DeCarli, “MCI is Associated With Deficits in Everyday Functioning,” Alzheimer Dis Assoc Disord, vol. 20, no. 4, pp. 217–223, 2006.
[31] O. V. Forlenza, B. S. Diniz, F. Stella, A. L. Teixeira, and W. F. Gattaz, “Mild cognitive impairment (part 1): clinical characteristics and predictors of dementia,” Revista Brasileira de Psiquiatria, vol. 35, no. 2, pp. 178–185, 2013.
[32] M. F. Folstein, S. E. Folstein, and P. R. McHugh, “‘Mini-mental state’: A practical method for grading the cognitive state of patients for the clinician,” Journal of Psychiatric Research, vol. 12, no. 3, pp. 189–198, Nov. 1975.
[33] B. Ridha and M. Rossor, “The mini mental state examination,” Practical Neurology, vol. 5, no. 5, pp. 298–303, 2005.
[34] N.-W. Guo et al., “Chinese Version and Norms of the Mini-Mental State Examination 「簡短式智能評估」之中文施測與常模建立,” 中華民國復健醫學會雜誌, no. 16, pp. 52–59, Dec. 1988.
[35] Z. S. Nasreddine et al., “The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment,” J Am Geriatr Soc, vol. 53, no. 4, pp. 695–699, Apr. 2005.
[36] T. Smith, N. Gildeh, and C. Holmes, “The Montreal Cognitive Assessment: validity and utility in a memory clinic setting,” Can J Psychiatry, vol. 52, no. 5, pp. 329–332, May 2007.
[37] P.-Y. Wang, “Cognitive Function and Subjective Memory Complaints on Cognitive Activity in Older Adults,” National Pingtung University, 2016.
[38] E. L. Teng et al., “The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia,” Int Psychogeriatr, vol. 6, no. 1, pp. 45–58; discussion 62, 1994.
[39] K.-N. Lin, P.-N. Wang, H.-C. Liu, and E. L. Teng, “[Cognitive Abilities Screening Instrument, Chinese Version 2.0 (CASI C-2.0): administration and clinical application],” Acta Neurol Taiwan, vol. 21, no. 4, pp. 180–189, Dec. 2012.
[40] C. P. Hughes, L. Berg, W. Danziger, L. A. Coben, and R. L. Martin, “A New Clinical Scale for the Staging of Dementia,” The British Journal of Psychiatry, vol. 140, no. 6, pp. 566–572, Jun. 1982.
[41] K.-N. Lin and H.-C. Liu, “Clinical Dementia Rating (CDR), Chinese Version,” Acta Neurologica Taiwanica, vol. 12, no. 3, pp. 154–165, 01 2003.
[42] “107年長照給付及支付基準,及相關推動事宜.” Ministry of Health and Welfare, 08-Jan-2018.
[43] M. Montaño, M. B. M, and L. R. Ramos, “Validity of the Portuguese version of Clinical Dementia Rating,” Revista de Saúde Pública, vol. 39, no. 6, pp. 912–917, Dec. 2005.
[44] G. Groth-Marnat, “Visions of clinical assessment: then, now, and a brief history of the future,” J Clin Psychol, vol. 56, no. 3, pp. 349–365, Mar. 2000.
[45] G. Groth-Marnat, Handbook of Psychological Assessment. John Wiley & Sons, 2003.
[46] M. S. Finger and D. S. Ones, “Psychometric equivalence of the computer and booklet forms of the MMPI: A meta-analysis.,” Psychological Assessment, vol. 11, no. 1, pp. 58–66, 1999.
[47] T. Tong, M. Chignell, M. C. Tierney, and J. Lee, “A Serious Game for Clinical Assessment of Cognitive Status: Validation Study,” JMIR Serious Games, vol. 4, no. 1, May 2016.
[48] S. McCallum, “Gamification and serious games for personalized health,” Stud Health Technol Inform, vol. 177, pp. 85–96, 2012.
[49] S. McCallum and C. Boletsis, “Dementia Games: A Literature Review of Dementia-Related Serious Games,” in Serious Games Development and Applications, 2013, pp. 15–27.
[50] J. A. Anguera et al., “Video game training enhances cognitive control in older adults,” Nature, vol. 501, no. 7465, pp. 97–101, Sep. 2013.
[51] A. C. Oei and M. D. Patterson, “Enhancing Cognition with Video Games: A Multiple Game Training Study,” PLOS ONE, vol. 8, no. 3, p. e58546, Mar. 2013.
[52] “Sea Hero Quest - Gaming to Help Study Dementia.” [Online]. Available: http://www.seaheroquest.com/site/en. [Accessed: 27-Jan-2018].
[53] V. Vallejo et al., “Evaluation of a novel Serious Game based assessment tool for patients with Alzheimer’s disease,” PLoS One, vol. 12, no. 5, May 2017.
[54] G. Duque et al., “Effects of balance training using a virtual-reality system in older fallers,” Clin Interv Aging, vol. 8, pp. 257–263, 2013.
[55] S. M. LaValle, “Virtual Reality - LaValle.” [Online]. Available: http://vr.cs.uiuc.edu/node405.html. [Accessed: 25-Jun-2018].
[56] A. Wong, C.-H. Fong, V. C.-T. Mok, K.-T. Leung, and R. K.-Y. Tong, “Computerized Cognitive Screen (CoCoSc): A Self-Administered Computerized Test for Screening for Cognitive Impairment in Community Social Centers,” J. Alzheimers Dis., vol. 59, no. 4, pp. 1299–1306, 2017.
[57] S. Chen, “Design of tablet-based dementia examination system,” National Taipei University of Technology, Taipei, Taiwan, 2017.
[58] J. M. Morris, “User interface design for older adults,” Interacting with Computers, vol. 6, no. 4, pp. 373–393, Dec. 1994.
[59] E. M. Chilufya, “HCI: Design Guidelines of Mobile Device Games for the Elderly,” p. 56.
[60] V. L. Claypoole, B. L. Schroeder, and A. D. Mishler, “Keeping in Touch: Tactile Interface Design for Older Users,” Ergonomics in Design: The Quarterly of Human Factors Applications, vol. 24, no. 1, pp. 18–24, Jan. 2016.
[61] B. Agrell and O. Dehlin, “The clock-drawing test,” Age Ageing, vol. 27, no. 3, pp. 399–403, May 1998.
[62] T. Sunderland et al., “Clock drawing in Alzheimer’s disease. A novel measure of dementia severity,” J Am Geriatr Soc, vol. 37, no. 8, pp. 725–729, Aug. 1989.
[63] R. Krikorian, J. Bartok, and N. Gay, “Tower of London procedure: a standard method and developmental data,” J Clin Exp Neuropsychol, vol. 16, no. 6, pp. 840–850, Dec. 1994.

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