臺灣博碩士論文加值系統

目的：Vecchi等人（1999）發現測驗所需的主動操弄量能敏感地偵 測到輕度阿茲海默氏症(Mild Dementia of Alzheimer’s disease, 簡稱MDAT)患者的工作記憶變化，所謂「主動操弄」指得是負責對儲存的訊息進行轉換、操弄或統整。本研究藉由比較社區老人與不同程度之早期阿茲海默氏症患者在主動操弄測驗上的表現來探討極輕度阿茲海默氏症(Very mild Dementia of Alzheimer’s disease, 簡稱VMDAT)患者的認知功能障礙，以做為未來診斷與治療之參考依據。

方法：受試者包括MDAT病患29名、VMDAT患者31名、及32名社區正常老人，以多種語文和非語文的主動操弄測驗為衡鑑工具來進行比較，包括魏氏記憶測驗—邏輯記憶、曾氏語文工作記憶量表、生活性語文工作記憶量表、廣泛性非語文記憶力測驗組（Comprehensive Non-verbal Memory Test Battery, 簡稱CNMT）、物體記憶檢查(Fuld Object Memory Evaluation, 簡稱FOME)。

結果：相較於社區組，MDAT組在所有測驗的表現均較差；除FOME的提取無效與再認之外，社區組在其他測驗分數指標的表現皆優於VMDAT組；VMDAT組在魏氏記憶測驗—邏輯記憶、FOME的所有分數指標、CNMT學習階段的有效記憶項與能夠完成學習階段的人數比率均較MDAT組佳。

討論：本研究結果顯示VMDAT患者無論在語文或非語文部分的主動操弄能力都呈現受損。當語文刺激加上邏輯概念時，MDAT病患所遭遇的困難多於VMDAT患者，而在非語文部分則呈現VMDAT與MDAT患者在學習歷程中的穩定性和執行功能已出現障礙，且在部分代表學習能力的向度上可見MDAT病患的表現不如VMDAT患者，由上述結論可見VMDAT病患在認知處理歷程的工作記憶部件之退化程度明顯不同於社區老人與MDAT患者。未來將依此結果設計適合篩檢VMDAT之測驗模組，進而藉此規劃適合的介入方案。

Objective：Vecchi et al. (1999) proposed the amount of active processing could detect the variation of working memory in patients with Mild Dementia of Alzheimer’s Type (MDAT). Active processing refers to the modification, integration, or transformation of information which may be required by a task. This research was designed to investigate the level of cognitive deficit in patients with Very Mild Dementia of Alzheimer’s Type (VMDAT), by comparing the performance between healthy elderly and patients with dementia in distinct stage in active processing task. It was expected that the exploration of this research could be regarded as a basis of clinical diagnosis and treatment.

Methods：Participants include 29 patients with MDAT, 31 patients with VMDAT, and 32 healthy elderly. A variety of verbal and nonverbal active processing tasks were performed, include Logical Memory of Wechsler Memory Scale-III (WMS-III), Zing’s scale of verbal working memory, Scale of instrumental verbal working memory of daily life, Comprehensive Non-verbal Memory Test Battery (CNMT), Fuld Object Memory Evaluation (FOME).

Results：Comparing to patients with MDAT, healthy elderly performed better in all index. Healthy elderly performed more superior to patients with VMDAT in all index except for ineffective reminders and retention of FOME. Patients with VMDAT were doing better than patients with MDAT at Logical Memory of WMS-III, all index of FOME, CL of CNMT. More healthy elderly achieve learning stage in CNMT than patients with VMDAT.

Conclusion：The results suggested that verbal and nonverbal active processing were impaired in patients with VMDAT. Patients with VMDAT performed better than patients with MDAT while verbal information accompany with logical concept. The stability and executive function in learning nonverbal information was impaired in patients with VMDAT and MDAT. Patients with MDAT were also performed worse than patients with VMDAT on some component of learning ability. It concluded that the deterioration of working memory component in patients with VMDAT was significant different from healthy elderly and patients with MDAT. The exploration were be used to design a test battery for screening patients with VMDAT, and a cognitive rehabilitation program for training patients with VMDAT.

中文摘要............................................. I
英文摘要.............................................III
第壹章、 緒論........................................ 1
第一節、 研究動機.................................... 1
第二節、 文獻探討....................................5
壹、阿茲海默氏型失智症與極輕度阿茲海默氏型失智症. 5
一、阿茲海默氏型失智症............................... 5
二、極輕度阿茲海默氏型失智症......................... 9
貳、工作記憶......................................... 18
一、Baddeley的工作記憶理論...........................19
二、工作記憶之運作功能............................... 23
參、極輕度阿茲海默氏型失智症的工作記憶功能........ 24
第三節、 研究目的與假設..............................26
壹、研究目的......................................... 26
貳、研究問題.........................................27
參、研究假設.........................................27

第貳章、研究方法.....................................28
第一節、研究設計.....................................28
第二節、研究對象..................................................28
第三節、研究工具...................................................31
壹、篩檢測驗.........................................31
1基本資料表................................. 31
2智能篩檢測驗中文版C-2.0版..................32
3簡短式心智狀態檢查表.......................33
4臨床失智評量表.............................34
5照護需求層級量表...........................36
6症狀檢核量表...............................38
7漢氏憂鬱量表...............................39
貳、工作記憶測驗.....................................40
一、語文性工作記憶測驗......................40
1魏氏記憶測驗-邏輯記憶I ＆ II...............40
2曾氏語文工作記憶測驗.......................40
3生活性語文工作記憶測驗.....................41
二、非語文性工作記憶測驗....................43
1Fuld物體記憶檢查...........................43
2廣泛性非語文記憶力測驗組...................45
第四節、 研究程序....................................53
第五節、 資料分析....................................56

第參章、 研究結果....................................57
第一節、 基本人口學統計資料..........................57
第二節、 工作記憶測驗表現............................60
壹、語文性工作記憶測驗...............................61
1魏氏記憶測驗-邏輯記憶I ＆ II...............61
2曾氏語文工作記憶測驗.......................63
3生活性語文工作記憶測驗.....................63
貳、非語文性工作記憶測驗.............................65
1Fuld物體記憶檢查...........................65
2廣泛性非語文記憶力測驗組...................71

第肆章、討論.........................................81
第一節、受試者功能狀態之討論.........................81
壹、本研究之受試者狀態...............................81
一、神經心理測驗表現之探討..................81
二、日常生活和一般認知功能狀況之探討........83
三、教育程度之探討..........................88
貳、與其他研究受試者之比較...........................89
第二節、研究工具之討論...............................90
壹、本研究之工具討論.................................90
貳、與其他研究之工具比較.............................92
第三節、研究結果分析與比較...........................97
壹、語文性工作記憶...................................97
貳、非語文性工作記憶................................102
參、執行功能........................................106
第四節、認知復健之建議..............................107
第五節、未來研究方向................................108

參考文獻............................................111

附 錄 ...........................................122
附錄一、基本資料...........................122
附錄二、SES社經地位表......................123
附錄三、智能篩檢測驗中文版C-2.0版..........124
附錄四、簡短式心智狀態檢查表...............131
附錄五、臨床失智評量表.....................132
附錄六、照護需求層級量表...................136
附錄七、症狀檢核量表.......................141
附錄八、漢氏憂鬱量表.......................143
附錄九、魏氏記憶測驗-邏輯記憶I & II........147
附錄十、工作記憶測驗.......................153
附錄十一、生活性語文工作記憶量表...........155
附錄十二、Fuld物品記憶檢查.................169
附錄十三、廣泛性非語文記憶力測驗組.........171

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