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研究生:莊閔妃
研究生(外文):Min-fei Chuang
論文名稱:評估畫鐘測驗於辨識失智症患者行為精神症狀之適用性
論文名稱(外文):Clock drawing test as a feasible tool for identifying behavioral and psychological symptoms of dementia
指導教授:蔡欣志蔡欣志引用關係
指導教授(外文):Sin-Chee Chai
學位類別:碩士
校院名稱:慈濟大學
系所名稱:神經科學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
畢業學年度:96
語文別:中文
論文頁數:40
中文關鍵詞:畫鐘測驗失智相關之行為精神症狀
外文關鍵詞:clock drawing testbehavioral and psychological symptoms of dementi
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失智相關之行為精神症狀(Behavioral and psychological symptoms of dementia, 簡稱BPSD)泛指失智症患者出現之各式各樣心理反應、精神症狀及異常行為,例如:激動、攻擊行為、妄想、幻覺、憂鬱、睡眠障礙、漫遊等。失智相關之行為精神症狀相當常見,可發生在患者被診斷失智症之前或之後,對家屬造成的困擾遠遠超過患者記憶退化帶來的不便。在疾病失智相關之行為精神症狀的發生率和認知功能退化程度成正比,但目前沒有任何一種認知功能篩檢工具被報導和失智相關之行為精神症狀有關。畫鐘測驗(Clock drawing test,簡稱CDT)因其施測快速簡單、對受測者無傷害、不同施測者之間及重複測驗間之信度效度已獲證實,是一廣為使用的認知功能篩檢工具。本研究欲探求患者畫鐘測驗之表現與失智相關之行為精神症狀出現與否有無關聯,以評估畫鐘測驗於辨識失智症患者行為精神症狀的適用性。自民國九十六年十月底至九十七年四月底,共收錄170位因記憶衰退而至花蓮慈濟醫院神經科神經心理檢查室接受認知功能評估之患者。每位患者均接受常規認知功能評估及畫鐘測驗。收案結束後,由一位神經科專科醫師依曼諾斯氏十點計分法(Manos scoring system)為所有畫鐘測驗評分,並從病歷記載獲取病患基本資料、疾病診斷、及有無失智相關之行為精神症狀。為利於統計分析,依主要罹患之疾病分類將患者分成六組,分別為阿茲海默氏病、巴金森病、血管型失智症、腦實質傷害如腦瘤或頭部外傷病患、輕度知能障礙及他類組。各組畫鐘測驗的表現以多變異分析(One-way ANOVA)評估組間差異,再以事後檢定(Post Hoc Tests)分析差異的方向性。失智相關之行為精神症狀與畫鐘測驗表現不佳兩類別變項之間的關聯以開方檢定(Chi-Square Test)運算後,發現兩類別變相之分布極為相似,其結果已達明顯統計差異。故是否出現失智相關之行為精神症狀與畫鐘測驗之表現優劣有極高的相似度,意謂有失智相關之行為精神症狀的患者,通常畫鐘測驗的表現也不好。本研究結論證實畫鐘測驗可適用於辨識失智症患者行為精神症狀。
Behavioral and psychological symptoms of dementia (BPSD) describe a heterogeneous range of psychological reaction, psychiatric symptoms and behaviors occurring in people with dementia of any etiology. These symptoms include agitation, aggression, delusion, hallucination, depression, sleep disturbance and wandering. BPSD is quite common and more troubling than amnesic symptoms. The occurrence of BPSD could be precede, concomitant with or after the onset of dementia. Although the prevalence of BPSD increased with disease severity, not any single cognitive screening instrument (Cognitive Abilities Screening Instrument [CASI], Mini-Mental Status Exam [MMSE], et al.) is reported to correlate with BPSD. Clock drawing test (CDT) is a popular screening instrument for cognitive impairments for its quick and easy to administer, non-threatening, and general good inter-rater and test-retest reliability. Performance on CDT correlates moderately to highly with cognitive tests. The study aimed to determine whether impairment of these neuropsychological tests could differentiate demented patient with BPSD from those without BPSD. CASI, MMSE and CDT were conducted in 170 consecutive patients (95 man, 75 woman, mean age 65±13,8, mean years of education 7±4.9) who were screening for cognitive impairments. Neuropsychological measure and CDT were executed by a trained assistant. The demographic data, diagnosis (including Alzheimer’s disease, Parkinson’s disease, vascular dementia, organic brain lesion, mild cognitive impairment and others) and presence of BPSD were obtained by medical record review. The CDT performance using Manos 10-point scoring system was retrospective blinded analyzed by a neurologist. Pearson Chi-Square and contingency coefficients were calculated and indicate excellent correlation between BPSD and poor CDT performance, so as BPSD and low CASI scores. CDT is a useful tool for screening cognitive impairment and BPSD in demented patients.
誌謝 I
論文摘要 II
目錄 V
正文
緒論 1
實驗方法 13
結果 16
討論 21
圖表 24
附錄 29
參考文獻 30
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