臺灣博碩士論文加值系統

目的
隨著人口的快速老化，認知功能障礙的人口增加速度逐年加快，積極找出其危險因子，並加以預防，是防治的重點。本研究藉由國民健康局「台灣中老年人身心社會狀況長期追蹤調查」1999-2003的資料，以探討影響台灣老人認知功能障礙的相關因子。
方法
研究選取1999年調查無認知功能障礙的老人並於2003年再次進行追蹤。調查於1999年完訪個案數為2,310人，扣除掉認知障礙的個案，死亡及資料不全者，有效樣本為1,224人。個案的認知功能狀況是以9題式SPMSQ量表於1999及2003年予以評估，每答對一題一分，共9分。答對六題及以下者為認知功能障礙。研究以1999年無認知功能障礙的老人之年齡、性別、籍貫、教育、婚姻狀態、高血壓、糖尿病，心血管疾病、中風、癌症、肺部疾病、憂鬱、自覺健康、ADL、IADL、身體活動能力、參與志工、宗教信仰、參與社團、蔬菜攝取、食用水果、喝茶習慣、BMI指數及跌倒、住院、急診、入住機構等過去史作為自變項，並以2003年後續追蹤老人之認知功能障礙與否為依變項。先以卡方檢定作為各相關因子與老人認知功能障礙的單變項分析，再將卡方檢定分析所得有顯著差異的變項，依據(1)人口特質、(2)慢性疾病、(3)活動功能、(4)健康習慣、(5)社會參與及(6)營養狀態等六類變項，建立了六種模式，依序逐步進入階層邏輯斯迴歸分析，並分析其勝算比（Odds Ratio；OR）與95％信賴區間（95％confideace interval；95％ CI）。
結果
從1999年至2003年，共有155位經評估為認知功能障礙，累積發生率為31.1/千人年。透過階層邏輯斯迴歸分析發現，六種模式的整體適配度良好。年齡75歲以上者(OR=2.45, 95% CI=1.59-3.76; p < 0.0001)、教育程度低者(OR = 2.24, 95% CI = 1.05-4.76)、有癌症病史(OR=3.25, 95% CI=1.26-8.38)、過去一年中曾經住院 (OR=1.858, 95% CI=1.23-3.11)、工具性日常生活活動功能障礙者(OR=3.09, 95% CI=1.98-4.83)，顯著增加認知功能障礙的風險。相反的，男性(OR=0.56, 95%CI=0.35-0.87)則與認知功能障礙呈現負相關。
結論
年齡75歲以上、女性、低教育程度、有癌症病史、過去一年中曾經住院、工具性日常生活活動功能障礙者，為台灣老人認知障礙顯著且獨立的預測因子。

Objectives
The population of cognitive impairment increases rapidly because of fast growing elderly population. The importance is to explore and prevent the risk factors that affect the cognitive function. This study aims to explore the risk factors of cognitive impairment in elderly persons without dementia from a longitudinal study of “Survey of Health and Living Status of the Elderly in Taiwan”, during a 4-year period (1999~2003).
Methods
Data were derived from a population-based cohort study of 2,310 elderly Taiwanese that were collected in 1999. Cognitive function was measured by the Short Portable Mental Status Questionnaire (SPMSQ) both in 1999 and in 2003. Each item scored one point, and the scores ranged from 0 to 9. The nine item SPMSQ was adequate to assess cognitive function. To reconcile this inconsistency, we chose the nine items shared by the 1999 and 2003 SPMSQ. Using nine-item criterion, a score of 6–9 was intact cognition; accordingly, in the present study, normal cognitive function was defined as a score of six or greater. A total of 1,224 participants free of cognitive impairment at baseline were included in these analyses. Gender, age, race, marriage, chronic diseases, voluntary, BMI, dietary behavior (intake of vegetable, fruit and drinking tea), depression, ADL, IADL, physical activity, falls, religion, and self-perceived health status, has been admitted to a hospital, ER, or any hospitalization were independent variables and the cognitive function in 2003 was the dependent variable. A Chi-square test was used to analyze the relationships among dependent variable and independent variables first. Secondly, the stratum logistic regression was used to establish six models by using the significant variables based on the results of chi-square including (1). basic characteristics, (2). chronic diseases, (3). Physical activity, (4). Health behaviors, (5). Social participation, and (6). nutrition and then analyze the Odds Ratio and the 95％confidence interval.
Results
One hundred and fifty-five out of 1,224 elderly were diagnosed with cognitive impairment between 1999 and 2003. The accumulated prevalence rate was 31.1 persons/1,000 persons. Through the stratum logistic regression analysis, it’s found that the goodness of fit is adequate enough for the purpose to predict cognitive impairment among the elderly. In the logistic regression model adjusted for age, education, hypertension, cancer, heart disease, stroke and so on at baseline, persons who are 75 (Odds ratio = OR = 2.45; 95% CI = 1.59-3.76; p < 0.0001), those who had lower educational background (OR = 2.24, 95% CI = 1.05-4.76), those who were diagnosed with cancer (OR = 3.25, 95% CI = 1.26-8.38), those who has been admitted to hospital in the past year (OR = 1.96, 95% CI = 1.23-3.11), those who has IADL impairment (OR = 3.09, 95% CI = 1.98-4.83) were significantly to develop cognitive impairment. On the contrary, males has lower risk to develop cognitive impairment. (OR = 0.56, 95% CI = 0.35-0.87).
Conclusion
Aged 75 years old, females, lower educational background, who were diagnosed with cancer, has been admitted to hospital in the past year, has IADL deficit were found to be the risk factors of cognitive impairment in this study.

中文摘要----------------------------------------------------------------------------------------- I
英文摘要------------------------------------------------------------------------------ ---------- III
第一章 緒論------------------------------------------------------------------------------------- 1
第一節 研究背景------------------------------------------------------------------------- 1
第二節 研究目的------------------------------------------------------------------------- 3
第三節 名詞解釋及定義---------------------------------------------------------------- 4
第二章 文獻回顧------------------------------------------------------------------------------- 6
第一節 認知障礙/失智症的流行病學---------------------------------------------- 6
第二節 認知障礙/失智症的危險因子─人口特質------------------------------ 12
第三節 認知障礙/失智症的危險因子─心血管因子--------------------------- 15
第四節 認知障礙/失智症的危險因子─心理社會因子與其他-------------- 21
第三章 研究方法------------------------------------------------------------------- ----------- 25
第一節 研究架構及假說------------------------------------------------------------- 25
第二節 研究設計、研究資料及樣本---------------------------------------------- 28
第三節 研究變項---------------------------------------------------------------------- 30
第四節 統計分析---------------------------------------------------------------------- 33
第四章 研究結果------------------------------------------------------------------------------ 36
第一節 研究對象的基本資料------------------------------------------------------- 36
第二節 認知功能障礙相關因子---------------------------------------------------- 38
第五章 討論------------------------------------------------------------------------------------ 44
第一節 樣本人口學特性------------------------------------------------------------- 44
第二節 認知功能障礙的相關因素探討------------------------------------------- 45
第三節 研究限制---------------------------------------------------------------------- 49
第六章 結論與建議--------------------------------------------------------------------------- 50
第一節 結論---------------------------------------------------------------------------- 50
第二節 建議---------------------------------------------------------------------------- 51
參考文獻---------------------------------------------------------------------------------------- 53
圖一 「台灣老人認知功能障礙危險因子研究」樣本數變化情形---------------------82
表一 1999年樣本的人口特質-------------------------------------------------------------83
表二 存活與死亡樣本分析---------------------------------------------------------------- 84
表三 認知障礙危險因子之單變項分析------------------------------------------------- 86
表四 認知障礙危險因子之多變項分析-模式一--------------------------------------- 89
表五 認知障礙危險因子之多變項分析-模式二--------------------------------------- 90
表六 認知障礙危險因子之多變項分析-模式三--------------------------------------- 92
表七 認知障礙危險因子之多變項分析-模式四--------------------------------------- 94
表八 認知障礙危險因子之多變項分析-模式五--------------------------------------- 96
表九 認知障礙危險因子之多變項分析-模式六--------------------------------------- 98

附錄

附錄1: 台灣中老年人身心社會狀況長期追蹤調查簡介(1996年)
附錄2: 台灣中老年人身心社會狀況長期追蹤調查1999年問卷

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