臺灣博碩士論文加值系統

本研究針對認知功能障礙之長者來探討一次性給予每日建議量之礦物質鎂對血流及對認知方面的影響。本研究邀請過去參加「腦血管硬化與血流動力學對認知功能影響」計畫中，簡易心智量表(MMSE)分數小於等於26分的受試者參與。受試者分別被隨機分派到鎂介入組及安慰劑組，在雙盲（施測者及受試者）情況下進行頸動脈超音波及脈波傳播速率之檢測、認知功能評估、工作記憶測試、尿液收集，以及營養補充劑介入和飲食頻率問卷。

試驗共招募了50位（21位男性及29位女性）60歲以上 MMSE及蒙特利爾認知評估(MoCA)皆≤ 26分之長者（安慰劑組：75.0± 7.4歲，鎂補充組：75.3± 7.6歲），兩組受試者的身體質量指數(BMI)、教育程度、疾病史（高血壓、心血管疾病、第二型糖尿病及高血脂症）每日飲食鎂攝入量分佈皆沒有達到顯著差異。在基線時，尿鎂含量（安慰劑組：5.4 ± 2.4 mg/dL，鎂補充組：6.5 ± 5.2 mg/dL）、尿肌肝酸（安慰劑組：70.7 ± 40.2 mg/dL，鎂補充組：88.7 ± 52.8 mg/dL）及尿鎂/肌肝酸（安慰劑組：0.088 ± 0.032，鎂補充組：0.076 ± 0.036）皆未達到顯著差異。而對於MoCA分數，相較於鎂補充組，控制組的MoCA總分有較高的現象（安慰劑組：20.6 ±4.0 分，鎂補充組：18.0 ± 6.2 分，P值為0.0896）。試驗在鎂補充組介入300mg檸檬酸鎂2小時候後進行後測。此試驗結果顯示僅在後測的MoCA 總分（安慰劑組：23.8 ± 4.0分，鎂補充組：20.1 ± 6.6 分，P值為0.0226）及左總頸動脈平均流速的前後測差異（安慰劑組：-1.57 ± 6.40 cm/s，鎂補充組： -5.11 ± 5.35 cm/s，P值為0.0381）中達到在兩組之間的顯著差異。而在後測的尿液檢測結果中，尿鎂含量（安慰劑組：4.5 ± 2.3 mg/dL，鎂補充組：6.6 ± 4.4 mg/dL）及尿肌肝酸含量（安慰劑組：57.5 ±34.5 mg/dL，鎂補充組：87.8 ±63.0 mg/dL），相較於安慰劑組，鎂補充組有傾向較高的現象但未達到統計顯著差異。而尿鎂/肌肝酸，相較於介入前，介入後安慰劑組增加了0.0023 ± 0.0288而鎂補充組增加了0.0089 ± 0.03（安慰劑組：0.090 ±0.038，鎂補充組：0.085 ± 0.035），但未達到統計上的顯著差異。

由此可見，一次性的鎂介入在3小時內不能幫助認知功能及血管流速的改善，長期介入鎂或許能更有效的發揮鎂的益處。

關鍵字：鎂、雙盲、長者、認知功能、一次性

This study intended to evaluate the short-term effect of magnesium supplement at a Daily Recommended Index (DRI) level on cognitive function and on certain hemodynamic parameters. This study aimed to recruit cognitively impaired participants aged 60 and over who determined cognitive scores ≤ 26 using Mini-Mental State Examination (MMSE). Using a double-blind randomized placebo-controlled intervention trial design, participants were divided into magnesium intervention group and placebo group. Both groups were evaluated by Montreal Cognitive Assessment (MoCA), working memory test, carotid artery flow velocity, urinary magnesium and food frequency questionnaire.

We recruited 50 (21 men and 29 women) ≥60 years elderly (placebo group: 75.0± 7.4 years; intervention group: 75.3± 7.6 years) with MMSE and MoCA cognitive score ≤26. In body mass index(BMI), education level, medical history(Hypertension, Heart disease, Type 2 Diabetes Mellitus and Hyperlipidemia) and daily magnesium intake, there were not significant difference between both groups. At baseline, urinary magnesium (placebo group: 5.4 ± 2.4 mg/dL, intervention group: 6.5 ± 5.2 mg/dL), urinary creatinine (placebo group: 70.7 ± 40.2 mg/dL, intervention group: 88.7 ± 52.8 mg/dL) and urinary magnesium/creatinine (placebo group: 0.088 ± 0.032, intervention group: 0.076 ± 0.036) did not significant difference between groups. The score of MoCA in placebo group was higher than intervention group but the difference was not significant (placebo group: 20.6 ±4.0, intervention group: 18.0 ± 6.2, P-value=0.0896) in baseline. Post-test was conducted two hours after intervention group was consumed 300mg magnesium citrate. Results indicated that there were no significant differences for all post-test measures between groups after two-hour intervention except for their MoCA score (placebo group: 23.8 ± 4.0，intervention group: 20.1 ± 6.6 , P-value=0.0226) and mean velocity of common carotid artery in left (placebo group: -1.57 ± 6.40 cm/s, intervention group: -5.11 ± 5.35 cm/s，P-value=0.0381). The amounts of urinary magnesium (placebo group: 4.5 ± 2.3 mg/dL, intervention group: 6.6 ± 4.4 mg/dL) and creatinine (placebo group: 57.5 ±34.5 mg/dL, intervention group: 87.8 ±63.0 mg/dL) were found higher in the intervention group compared to placebo group, but the differences were not statistically significant. Two hours after consuming magnesium citrate, urinary magnesium/creatinine increases were observed in both groups(placebo group: 0.090 ±0.038, intervention group: 0.085 ± 0.035) even though the changes were not significant.

The one-time intervention of magnesium could not improve blood flow of carotid and cognitive function in 3 hours in this study. Our finding suggested that long-term magnesium intervention has more health-improving effect.

Key words：Magnesium, double-blind, elderly, cognitive function, one-time intervention

口試委員審定書 ………………………………………………………………………i
誌謝 ……………………………………………………………………………………ii
中文摘要 ………………………………………………………………………………iii
英文摘要 ………………………………………………………………………………v
第一章 前言……………………………………………………………………………1
第二章 文獻回顧………………………………………………………………………3
第一節 失智症之簡介…………………………………………………………3
第二節 飲食與認知功能………………………………………………………5
第三節 鎂之簡介………………………………………………………………6
第四節 頸動脈流速……………………………………………………………8
第五節 鎂與中風及失智症……………………………………………………10
第三章 研究設計………………………………………………………………………12
第一節 受試者招募……………………………………………………………13
第二節 實驗介入方式…………………………………………………………14
第三節 評估方式………………………………………………………………15
第四節 實驗收案流程…………………………………………………………18
第五節 實驗進行操作流程……………………………………………………20
第六節 資料處理及統計方法…………………………………………………22
第四章 結果……………………………………………………………………………23
第五章 討論……………………………………………………………………………27
第六章 結論……………………………………………………………………………30
參考文獻 ………………………………………………………………………………31
表格 ……………………………………………………………………………………39
附錄 ……………………………………………………………………………………50
表目錄
表一、受試者個人資料分佈………………………………………………………… 39
表二、尿鎂、尿肌酐酸檢測結果…………………………………………………… 40
表三、認知功能及工作記憶測試資料……………………………………………… 41
表四、飲食鎂資料…………………………………………………………………… 44
表五、血壓、頸動脈流速等前測結果……………………………………………… 45
表六、血壓、頸動脈流速等後測結果……………………………………………… 46
表七、血壓、頸動脈流速等前後測差異結果……………………………………… 47

附錄目錄
附錄一、醫學研究倫理委員會研究計畫審查通過證明…………………………… 51
附錄二、受試者同意書……………………………………………………………… 52
附錄三、個人資料表………………………………………………………………… 57
附錄四、生活習慣及飲食頻率問卷………………………………………………… 58
附錄五、工作記憶問卷……………………………………………………………… 72
附錄六、蒙特利爾認認知評估……………………………………………………… 75
附錄七、介入樣品資料 ………………………………………………………………77
附錄八、通知書……………………………………………………………………… 79
附錄九、招募海報…………………………………………………………………… 80

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