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研究生:徐倩儀
研究生(外文):Chiann-Yi
論文名稱:健康行為與認知功能之短期、中期、長期影響之相關性分析
論文名稱(外文):Associations of health behaviors and cognitive function: the short-term, middle-term and long-term effect
指導教授:葉志嶸葉志嶸引用關係
指導教授(外文):Chih-Jung Yeh
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:公共衛生學系碩士班
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:2010
畢業學年度:98
語文別:中文
論文頁數:93
相關次數:
  • 被引用被引用:7
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第一部份 健康行為
研究目的:隨著國人平均壽命提高及全球失智症盛行率急遽增加,預防失智症臨床前期的認知功能障礙相形重要。影響認知功能障礙之因素,可改變之健康行為對於公共衛生實務至為重要。因此本研究探討不抽菸、喝酒、適當睡眠、均衡飲食及運動等健康行為之相關性,並以不同健康行為組合及其持續與累積性對認知功能之影響。
材料方法:1993年至2003年國民健康局『台灣中老年人身心社會狀況長期追蹤調查』的資料,依追蹤時間點區分成短期(1999-2003)、中期(1993-1999)及長期(1993-2003),樣本數分別為1557人、1680人、1250人;認知功能之正常與否,以簡易失智狀態問卷(SPMSQ)來評估,分數範圍0至9分,分數≧6分為認知功能正常。
結果:不適當睡眠在中期及長期分別有1.69及1.77倍認知功能障礙危險,並以不喝酒及不適當睡眠的不健康行為組合之影響最為顯著(HR=1.61、HR=1.80)。無論短期、中期、或長期,持續不運動、越多不健康行為及持續或累積越多不健康行為皆會提高認知功能障礙之危險,且隨著不健康行為個數或累積時間越長,認知功能障礙之危險性隨之提高。
結論:不健康行為個數增加或持續時間越長,認知功能障礙危險性逐步提高。可藉由改善健康行為之個數及其持續性,來降低老年族群之認知功能障礙危險。


第二部份 休閒活動
研究目的:隨著國人平均壽命提高及全球失智症盛行率急遽增加,預防失智症臨床前期的認知功能障礙相形重要。老人日常生活進行之休閒活動,無論活動之數量或活動之類別,其對於認知功能之影響,對於預防老人失智之公共衛生實務,非常重要。因此本研究探討這些休閒活動之相關性,並以不同組合的休閒活動及其持續性對認知功能之影響。
材料方法:1993年至2003年國民健康局『台灣中老年人身心社會狀況長期追蹤調查』,依追蹤時間點區分成短期(1999-2003)、中期(1993-1999)及長期(1993-2003),樣本數分別為1557人、1680人、1250人;認知功能以簡易失智狀態問卷(SPMSQ)評估,分數範圍0至9分,分數≧6分為認知功能正常。
結果:不下棋/打牌在中期及長期分別有6.43及3.82倍認知功能障礙危險,可歸因危險百分比82.59%及70.89%;無論短期、中期、或長期,隨休閒活動個數越少、持續時間越短,認知功能障礙危險性隨之增加。
結論:下棋/打牌、休閒活動數越多及持續時間越長,皆能降低認知功能障礙之危險性。休閒活動可藉認知存儲之提高,來預防認知功能障礙之危險性,為具體可推行之老人認知功能障礙的預防策略。



Part A. Health Behavior
Objectives: The prevention of cognitive impairment, a prodrome of dementia, is crucial due to the increasing life expectancy and growing prevalence of dementia. Among the risk factors of cognitive impairment, health behaviors such as smoking, drinking, sleeping, diet, and physical activity, are potentially modifiable as far as public health intervention is concerned. This study aimed to examine the relation between cognitive function and health behaviors.
Methods: Longitudinal data were drawn from “The Survey of Health and Living Status of the Near Elderly and Elderly in Taiwan” in 1993, 1996, 1999, and 2003. Four-year follow-up retrieved from 1999 to 2003, 6-year follow-up 1993-1999, and 10-year follow-up 1993-2003 and the sample size was 1557, 1680, and 1250 respectively. Cognitive function was measured by the Short Portable Mental Status Questionnaire (SPMSQ). SPMSQ contains 9 items and the sum ranges from 0-9 as scores greater than 6 defined as normal.
Results: The hazard ratio (HR) of inadequate sleep duration in 6-year follow-up and 10-year follow up were 1.69 and 1.77, respectively. The HR for combination of no alcohol and inadequate sleep duration were 1.61 and 1.80, respectively. The less the physical activity is, the worse the cognitive function is. In addition, the number and the duration of unhealthy behaviors are negatively related to cognitive function.
Conclusion: A dose-response relationship between unhealthy behaviors and cognitive impairment was evident. Reducing the number or the duration of unhealthy behaviors might be associated with a reduced risk of cognitive impairment in the elderly.


Part B. Leisure activity
Objectives: The prevention of cognitive impairment, a prodrome of dementia, is crucial due to the increasing life expectancy and growing prevalence of dementia. Among the risk factors of cognitive impairment, health behaviors such as leisure activities, are potentially modifiable as far as public health intervention is concerned. This study aimed to examine the relation between cognitive function and leisure activities.
Methods: Longitudinal data were drawn from “The Survey of Health and Living Status of the Near Elderly and Elderly in Taiwan” in 1993, 1996, 1999, and 2003. Four-year follow-up retrieved from 1999 to 2003, 6-year follow-up 1993-1999, and 10-year follow-up 1993-2003 and the sample size was 1557, 1680, and 1250 respectively. Cognitive function was measured by the Short Portable Mental Status Questionnaire (SPMSQ). SPMSQ contains 9 items and the sum ranges from 0-9 as scores greater than 6 defined as normal.
Results: In 6-year and 10-year follow-ups, the hazard ratio (HR) of not playing games/cards was 6.43 and 3.82, and the population-attributable risk percent (PAR%) was 82.59% and 70.89% , respectively. Regardless of length of follow-ups, the less or the shorter duration the leisure activities were, the greater risk the cognitive impairment was.
Conclusion: Increasing the number and the duration of leisure activities, especially playing games/cards, was associated with reduced risk of cognitive impairment. Leisure activities might be “cognitive reserve” and further prevent cognitive impairment among the elderly.


目錄………………………………………………………………………Ⅶ
圖目錄……………………………………………………………………Ⅸ
表目錄……………………………………………………………………Ⅹ
第一部份 健康行為
中文摘要…………………………………………………………………Ⅲ
英文摘要…………………………………………………………………Ⅴ
前言………………………………………………………………………1
文獻探討…………………………………………………………………2
研究目的…………………………………………………………………9
研究架構…………………………………………………………………10
材料方法…………………………………………………………………13
結果………………………………………………………………………20
討論………………………………………………………………………25
結論與建議………………………………………………………………31

第二部份 休閒活動
中文摘要…………………………………………………………………XI
英文摘要………………………………………………………………XIII
前言………………………………………………………………………32
文獻探討…………………………………………………………………33
研究目的…………………………………………………………………37
研究架構…………………………………………………………………38
材料方法…………………………………………………………………41
結果………………………………………………………………………49
討論………………………………………………………………………56
結論與建議………………………………………………………………59
參考文獻…………………………………………………………………60
附錄………………………………………………………………………92
附錄一、與認知功能相關之飲食型態-減維度迴歸分析(RRR)
……………………………………………………………………………92
附錄二、簡易失智狀態問卷(Short portable mental status questionnaire, SPMSQ)………………………………………………93


圖目錄
圖1. B世代及A世代研究對象………………………………………70
圖1-1. 短期(1999年至2003年)研究對象……………………………70
圖1-2. 中期(1993年至1999年)研究對象……………………………71
圖1-3. 長期(1993年至2003年)研究對象……………………………71


表目錄
第一部份 健康行為
表A-1.追蹤對象的基線(1993 & 1999)特徵…………………………72
表A-2-1.健康行為對死亡之影響;認知功能為設限事件……………73
表A-2-2.健康行為對認知功能之影響;死亡為設限事件……………74
表A-2-3.健康行為對認知功能之影響…………………………………75
表A-3-1.結合健康行為對死亡之影響;認知功能為設限事件………76
表A-3-2.結合健康行為對認知功能之影響;死亡為設限事件………77
表A-3-3.結合健康行為對認知功能之影響……………………………78
表A-4.不健康行為持續性對認知功能之影響…………………………79
第二部份 休閒活動
表B-1.追蹤對象的基線(1993 & 1999)特徵…………………………81
表B-2-1.休閒活動對死亡之影響;認知功能為設限事件……………82
表B-2-2.休閒活動對認知功能之影響;死亡為設限事件……………83
表B-2-3.休閒活動對認知功能之影響…………………………………84
表B-3-1.結合休閒活動對死亡之影響;認知功能為設限事件………85
表B-3-2.結合休閒活動對認知功能之影響;死亡為設限事件………86
表B-3-3.結合休閒活動對認知功能之影響……………………………87
表B-4.休閒活動持續性對認知功能之影響……………………………88


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