臺灣博碩士論文加值系統

臨床上「知感」（feeling-of-knowing, FOK）判斷正確性有助於醫療人員的診療。然而，常見的記憶障礙疾患--阿茲海默型失智症的「知感」研究卻很少，目前尚未有確切的結論，且未考量不同失智嚴重度的異質性問題；國內亦缺乏知感的研究。阿茲海默型失智症早期出現記憶障礙，但執行功能是否亦有缺損目前仍看法不一。知感心理機制與記憶或執行功能的關係亦未有定論。本研究改善國外研究方法上的缺失，檢視國內阿茲海默型失智症病人的知感功能，探討可能影響知感表現的認知功能。主要的研究問題包括：（1）疑似及輕度失智症患者的「知感」功能是否缺損？（2）早期阿茲海默型失智症在記憶障礙之外，執行功能是否亦有缺損？（3）若患者「知感」功能缺損，是否與記憶、執行功能表現缺損有關？本研究包括疑似失智症病人、輕度失智症病人各30名、控制組30名，接受研究知感現象的Recall-Judgment-Recognition （RJR）派典及神經心理功能評估。結果顯示：疑似及輕度失智症病人在記憶、執行功能及知感功能皆顯著較控制組為差。此結果除了證實國外文獻報告早期阿茲海默失智症病人的事件記憶知感功能缺損之外，更發現疑似阿茲海默失智症病人的知感功能已出現缺損。此外，本研究結果進一步推論阿茲海默型失智症的事件記憶「知感」功能，可能會受到記憶及執行兩種能力的影響。

Literature regarding whether the early demented patients with Alzheimer’s disease (AD) have deficits in the feeling of knowing (FOK) function of episodic memory is scanty, and issues of whether these patients evidence executive dysfunction and of the underlying neuropsychological mechanism for FOK function have been controversial. The present study was explored these issues in questionably and mildly demented patients with AD. A total of 90 adult participants including, 30 questionably and 30 mildly demented patients with AD, and 30 normal healthy controls matched for the sex, age, and education level participated in this study. All subjects received a RJR paradigm task and a battery of neuropsychological tests, mainly including memory and executive function measures. The results revealed that both questionably and mildly demented patients’ performance on the FOK judgment task was significantly poorer than that of normal control counterparts, and these demented patients evidenced deficits of executive function other than memory impairment. Most of the demented patients with defective function of FOK also manifested impairments of memory and executive function. These results partially confirm findings evident in the literature, and we further suggest that deficits of both memory and executive function might account for the impairment of FOK in our demented patients. Nonetheless, since majority of our current aging people including demented ones in Taiwan are low-educated, the verbal FOK task used in this study might not be adequate for them. Further investigation on this issue in these low-educated demented patients is necessary.

第一章 緒論……………………………………………………………………… 1
第一節 阿茲海默型失智症的「知感」表現……………………………….1
第二節 阿茲海默型失智症的認知功能缺損……………………………….7
第三節 「知感」的心理機制……………………………………………….9
第四節 研究目的…………………………………………………………….16
第二章 研究方法………………………………………………………………….19
第一節 受試者……………………………………………………………….19
第二節 研究工具…………………………………………………………….21
第三節 研究程序…………………………………………………………….29
第四節 統計分析…………………………………………………………….30
第三章 研究結果………………………………………………………………….32
第一節 三組受試者之神經心理功能表現………………………………….32
第二節 知感判斷之結果…………………………………………………….35
第三節 記憶功能、執行功能與「知感」功能的關係…………………….38
第四節 總結………………………………………………………………….43
第四章 討論……………………………………………………………………….44
第一節 疑似失智組及輕度失智組之「知感」判斷正確性是否缺損？….44
第二節 早期阿茲海默型失智症患者除了記憶障礙之外，執行功能是
否亦有缺損？……………………………………………………….45
第三節 若患者「知感」功能缺損，是否與記憶、執行功能缺損有關?....46
第四節 整合國內的「知感」研究資料，以較有代表性的正常老年人樣
本，重新檢視本研究台灣南部之疑似失智組及輕度失智組患者
的「知感」缺損與記憶及執行功能的關係。…………………….49
第五節 比較三組受試者的主觀記憶抱怨是否能反應客觀記憶問題？….54
第六節 總結………………………………………………………………….64
第七節 本研究限制………………………………………………………….66
第八節 本研究貢獻及未來方向…………………………………………….67
參考文獻…………………………………………………………………………….69
附錄一 RJR派典之研究材料…………………………………………………….77
附錄二 研究對象同意書………………………………………………………….78

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