本研究目的是藉由認知缺損危害需求驅動之行為模式來探討在社區中早期到中期失智患者睡眠障礙與遊走行為的相關性，以及遊走行為之影響因素。研究設計使用描述性橫斷式研究法，研究工具為結構式問卷；包括臨床失智評量表、整體認知功能評量表、神經學病徵量表、中文阿爾格氏遊走行為問卷之社區版及李氏睡眠障礙評量表等，採面對面訪談失智症者與家庭照顧者以收集資料。研究對象採立意取樣方式，於北台灣4家醫院神經內科門診及1所失智症老人日間照顧中心，排除有急性疾病、感官缺損、慢性酒精中毒或使用其他可能影響中樞神經功能之藥物者。共選取180對失智症患者及家庭照顧者，所獲得資料以SPSS進行描述性統計、獨立樣本t檢定、單因子變異數分析、簡單線性迴歸、皮爾森積差相關、淨相關及階層迴歸等統計方法進行資料分析。研究結果：一、失智症患者睡眠障礙總平均分數為65.54分(標準差為37.68)，睡眠障礙症狀嚴重度平均分數為58.15分(標準差為28.52)，睡眠障礙生活困擾程度平均分數為7.39分(標準差為13.62)，顯示失智症患者僅有中下程度的睡眠障礙困擾。二、遊走行為總平均分數為54.61分(標準差為18.69)，屬於中下程度遊走行為的困擾。以用餐時間衝動行為頻率最高，其次為兩點間來回踱步，在其次為戶外迷路行為，頻率最低為隨意移動。三、遊走行為之相關因素為受教育年數、失智症診斷、慣用語言、焦慮行為、失智症嚴重度、整體認知功能及睡眠障礙等因素。四、控制遊走行為之相關因素後，睡眠障礙總分與遊走行為總分、負向結果淨相關達統計上的正相關。五、遊走行為影響因素為受教育年數、焦慮行為分數、MMSE分數、失智症診斷及睡眠障礙總分等5個變項，能夠有效解釋遊走行為的變異量(R2)為26.7%-39.7%。結論:認知缺損危害需求驅動之行為模式能夠協助護理人員及家庭照顧者了解失智症患者遊走行為之背景因素與立即因素(睡眠障礙)，並解釋背景因素與立即因素(睡眠障礙)如何影響失智症病人的遊走行為，進而適切地評估背景因素與立即因素、遊走行為等問題行為，以提昇失智症病人照護品質。

Objective: The purpose of this study was to discuss the relationship between sleep disturbance and wandering behavior in patients with early to moderate dementia in community, by using the Need-Driven Dementia-Compromised Behavior Model (NDB) Model. Methods: It was a cross-sectional design with a purposeful sampling. Patient with dementia and their main family caregivers were recruited from outpatient memory clinics of four teaching hospitals and one day-care center for dementia in northern Taiwan. The exclusive criteria included acute illnesses, sensory impairment, chronic alcohol abuse or current use of drugs with possibly central nerve system effects. A comprehensive battery included the Clinical Dementia Rating (CDR), the Mini-Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), the Chinese Revised Algase Wandering Scale-Community Version (CRAWS-CV) and the Lee’s Sleep Disturbance scale (SD). Data Analyses: Data was analyzed by using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s product moment correlation, partial correlation, and hierarchical regression models. Results: One hundred and eighty dyads of patient with dementia and their family caregivers were enrolled. 1. The mean of SD score was 65.54 (SD =37.68), representing a low to middle level of sleep disturbance in patients, while the mean of SD Severity subscore was 58.15 (SD = 28.52), and the mean of SD Influence subscore was 7.39 (SD=13.62).2.The mean of CRAWS score was 54.61 (SD=18.69),showing a low to middle level of wandering behaviors. the most frequently-observed wandering behavior was meal-time impulsivity / temporal aspect, the second one was pacing, and The third one was getting lost outdoor. The less frequently observed wandering behavior was random pattern.3. The overall wandering behavior was significantly correlated with years of education, dementia diagnoses, language, anxiety, CDR, MMSE, and SD.4. The partial correlation coefficients showed that only sleep disturbance significantly correlated with overall wandering behavior and its’ negative outcome. 5. The significant predictors of wandering behaviors were years of education, diagnoses of dementia, language, anxiety, CDR, MMSE, and SD, explaining 26.7%-39.7% of variance by using hierarchical regression models. Conclusions: NDB model is helpful when assessing wandering behaviors in dementia. In addition, sleep disturbance can be and should be managed to reduce wandering behavior in patients with dementia living in communities.

指導教授推薦書…………..………………………………………………………….
論文口試委員會審定書………………………………………………………………
長庚大學著作授權書…………………………………………………………………
誌謝………………………………………………………………………………. iii
中文摘要…………………………………………………………………………… v
英文摘要…………………………………………………………………………. vii
目錄………………………………………………………………………………. ix
圖表目錄…………………………………………………………………………. xii
附錄目錄………………………………………………………………………… .xiii
第一章 緒論……………………………………………………………………... 1
第一節 前言…………………………………………...……………………… 1
第二節 研究重要性………………………………………………………… 1
第三節 研究的目的………………………………………………………… 3
第四節 研究的問題………………………………………………………… 4
第五節 名詞界定………………………………………………………… 4
第二章 文獻查證…………………………………………………….………. 7
第一節 認知缺損危害需求驅動之行為模式理論概述………..………… 7
第二節 認知缺損危害需求驅動之行為模式理論與遊走行為實證性研 究…………………………………………………….………. 9
第三節 遊走行為定義…………………………………………………… 28
第四節 遊走行為測量指標相關性研究……………………………… 36
第五節 睡眠障礙與遊走行為影響之相關性研究……………………… 43
第六節 總結………………………………………………………… 49
第三章 研究方法……………………………………………………………..…. 51
第一節 研究設計…………………………………………………………… 51


第二節研究架構………………………………………..……… 51
第三節 研究場所及對象…………………………………………………… 52
第四節研究工具及信效度………………………………………. 54
第五節研究步驟……………………………………………………… 65
第六節 倫理考量………………………………………………………… 65
第七節 研究資料分析方法……………………………………………… 66
第四章 研究結果……………………………………………………………..... 69
第一節 失智症患者及其家庭照顧者人口學特性、神經學因素與認知能力、睡眠障礙及遊走行為分佈情形…………………………… 69
第二節 失智症患者人口學特性、失智症診斷、失智症患者的神經學因素、認知能力與睡眠障礙的相關性….…………………………. 77
第三節 失智症患者人口學特性、失智症診斷、失智症患者的神經學因素、認知能力與遊走行為相關性…………………………….… 81
第四節 失智症患者睡眠障礙對遊走行為的相關性………………….… 88
第六節 失智症患者人口學特性、神經學因素與認知能力對睡眠障礙及
遊走行為達顯著相關或差異性因素統整………………………… 94
第六節 失智症患者人口學特性、神經學因素、認知能力、睡眠障礙與遊走行為的重要影響因素……………………….…………………..97
第七節 睡眠障礙為遊走行為的重要影響因素………………………. 109
第五章 討論………………………………………………………………… 110
第一節 失智症患者背景因素分析……………………………………… …. 110
第二節 失智症患者立即因素之睡眠障礙因素及相關因素分析…………..114
第三節 失智症患者遊走行為因素及相關因素分析…………………..….115
第四節 失智症患者遊走行為影響因素……………………………………120第六章 結論、建議與限制……………………………………………………. …123
第一節 結論……………………………………… …………………………..123
第二節 研究建議…………………………………………………………...125
第三節 研究限制…………………..……………………………………….129

參考資料…………………………………………………………………….……..131
中文參考資料………………………………………………………….……..131
英文參考資料………………………………………………………….……..133
附錄………………………………………………………………………………… 145
































圖 目 錄
圖1認知缺損危害需求驅動之行為模式(NDB)……………………………….. 9
圖2研究架構概念圖…………………………………………………………… 52

表 目 錄
表1-1認知缺損危害需求驅動之行為模式與遊走行為實證性研究…….. 21
表 2-1 遊走行為的定義………………………………………………………… 31
表 2-2遊走行為的定義………………………………………………………… 47
表 3-1 研究工具信效度……………………….....………………………………..56
表 3-2 MMSE評估分數區分對照表………………………………………………..60
表 4-1 統計分析方法………………………………………………………… 68
表 5-1失智症的人口學特性分佈情形…………………………………… 71
表 5-2失智症的家庭照顧者人口學特性分佈情形…………………….. 73
表 5-3失智症患者測量量表得分結果………………………………… 76
表 6-1失智症患者人口學特性(類別變項)、失智症診斷、認知能力與睡眠障礙的相關情形…………………………………………………..79
表 6-2失智症患者的人口學特性(連續變項)、認知能力神經學(連續變項)因素與睡眠障礙的相關情形…………………………………………..80
表 7-1失智症患者人口學特性(類別變項)、失智症診斷與遊走行為的相關情形……………………………………………………………..86
表 7-2失智症患者的人口學特性(連續變項)、認知能力、神經學(連續變項)因素與遊走行為的相關情形………………………………………..87
表 8-1失智症患者睡眠障礙與遊走行為Pearson相關性統計…....................90
表 8-2控制人口學因素、神經學因素及認知能力因素後，失智症患者睡眠障礙與遊走行為淨相關性統計……………………………………………….93
表9-1失智症患者人口學特性、神經學因素、認知能力、睡眠障礙與遊走行為達顯著相關或差異性統整表……………….…....................95
表9-2失智症患者人口學特性、神經學因素、認知能力對睡眠障礙達顯著相關或差異性統整表………………………………………….…....................96
表10-1失智症患者遊走行為總分(CRAWS-CV)的影響因素…………….............101

表10-2失智症患者逃走行為(EB)的影響因素………………………................104
表10-3失智症患者負向結果(NO)的影響因素………………………................107

附 錄 目 錄
附錄一、研究工具量表: 使用研究資料同意書………………………………..1

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