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研究生:陳育芬
論文名稱:老人疾呆症盛行率及相關因子之研究中文版簡易智能狀態檢查應用於田野調查之信度及效度
指導教授:劉景寬劉景寬引用關係藍守仁藍守仁引用關係
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:1994
畢業學年度:82
語文別:中文
論文頁數:135
中文關鍵詞:疾呆症中文版簡易智能狀態檢查臨界值
外文關鍵詞:dementiaCMMSEcut-off points
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本研究為二階段的痴呆症流行病學研究,以高雄市三民區65歲或以上的老人為對象,採分層等比例隨機抽樣1200人,進行第一階段的中文版簡易智能狀態(CMMSE)篩選調查。將教育程度分為三組,不識字組,國小組,中學組,再將各組依CMMSE分數低於臨界值(cut-off points)的做第二階段詳細檢查。第二階段由醫師及神經心理測驗師共同進行臨床診斷檢查。診斷準則根據DSM-III-R。
第一階段共訪視1016名,第二階段檢查結果,共有45人為痴呆症者,盛行率為上4.4%,男性盛行率為3.2%,女性為5.8%。按教育程度分三組後,痴呆症盛行率為不識字組6.2%,國小組3.2%,中學組2.8%。年齡、性別調整後,各組間的盛行率沒有明顯差異。年齡分成65-74、75-84、85歲以上三組,盛行率各別為2.0%、8.3%、24.4%,隨著年齡增加盛行率也愈高(P<0.001)。
年齡與腦中風有很強的相關,隨著年齡的增加,老人痴呆症盛行率也愈高。腦中風主要與65-74歲這年齡層有強烈相關,75歲以上則不顯著。可能的相關因子利手(相對危險性OR=3.8, 95%信賴區間(95%CI):1.5-9.7)。依教育程度分三組後,本研究所取的CMMSE的臨界值分別為不識字組14/15,小組19/20,中學組21/22,敏感度可達100.0%,特異度:95.0%-99.0%均相當高。
本研究顯示臺灣地區老人痴呆症已相當盛行,隨著老年人口的增加,痴呆症勢必成為老人醫療保健之重大課題。臺灣地區高盛行的腦中風與痴呆症有很強的相關,由此可見腦中風防治工作刻不容緩。CMMSE不失為一測量痴呆症的良好工具,若用於社區大量篩檢時,我們建議教育程度最好分三組,各別取其臨界值,可大大提高效度。
This is a two-phase dementia epidemiological study. We got our subject from the non-institutionalized inhabitants whose age was 65 years or over in the San-Min district of Kaohsiung city. A proportional multi-stratify random sampling method were used to get 1200 target subjects for the first phase of CMMSE (Chinese Mini-Mental State Examination) survey. Responders were classified into three groups by educational levels, illiterate, literate grate school, and higher than grade school in the second phase. Subjects'' CMMSE score lower than the cutoff points were recruited for clinical examination. The second phase was conducted by neurologists and neuropsychologist. DSM- III -R was used for the clinical diagnoses of dementia.
1016 subjects received the first phase survey, 45 patients were diagnosed as dementia in the second phase. The overall prevalence of dementia was 4.4%, 3.2% in men and 5.8% in women. The prevalence of dementia by educational groups were 6.2% in illiterate, 3.2% in grade school, and 2.8% in high school. The prevalence of dementia by aged groups were 2.0% in 65-74 years, 8.3% in 75-84 years and 24.4% in 85 years or over. The prevalence of dementia increased with increasing age.
Age and dementia are strong correlation;stroke and those age 65-74 years are strong correlation, 75 years and over are non-significant. Left-handedness may be a correlation factor(odds ratio=3.8,95% confidence interval:1.5-9.7)for dementia. Responders were classified into three groups by educational levels, the CMMSE cutoff points:14/15 for those illiterate,19/20 for those grade school, 24/25 for those high school. The sensitivity of the CMMSE is estimate as 100.0%; the specificity is estimate 95.0-99.0%.
Conclusion is that the prevalence of dementia was close to the developed countries in Taiwan, which implied that dementia has become a major medical task.The high prevalence of stroke and dementia are high correlation,so it is a important medical task to prevent stroke in Taiwan.The CMMSE is a good screening tool for dementia.The results suggest the differential CMMSE cutoff points according to educational levels of responds, that will have a high validity.
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