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研究生:李志謙
研究生(外文):Chih-ChienLee
論文名稱:阿茲海默氏症的迷路初發與再發 -- 兩年半追蹤研究
論文名稱(外文):The incidence and recurrence of getting lost in patients with Alzheimer’s disease: A 2.5-year follow-up
指導教授:白明奇白明奇引用關係
指導教授(外文):Ming-Chyi Pai
學位類別:碩士
校院名稱:國立成功大學
系所名稱:行為醫學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:108
中文關鍵詞:阿茲海默氏症地域失定向迷路行為預測因子
外文關鍵詞:topographical disorientationgetting lost behaviorpredictors
相關次數:
  • 被引用被引用:1
  • 點閱點閱:421
  • 評分評分:
  • 下載下載:43
  • 收藏至我的研究室書目清單書目收藏:1
目的:本研究有兩大目標,首先為編製一套容易使用且具有信效度的評估工具,用以測量阿茲海默氏症 (Alzheimer’s disease, AD) 患者的認路障礙 (topographical disorientation, TD) 症狀。第二則為評估其迷路初發率 (getting lost incidence, GL incidence)、再發率 (GL recurrence) 及相關風險因子。
方法:邀請仍居住於社區之輕度至中度 AD 患者及其家屬參與研究,蒐集患者的人口學變項、日常生活型態與外出限制、迷路事件、神經心理功能 (Cognitive Ability Screening Instrument, CASI & Mini-Mental Status Examination, MMSE),並檢驗自編之日常生活認路能力問卷 (Questionnaire of Everyday Navigational Ability, QuENA) 的信效度。QuENA 的構念包括地標與街景失認 (landmark and scene agnosia)、自我中心失定向 (egocentric disorientation)、注意力缺損 (inattention) 與頭向失定向 (heading disorientation)。信度指標採內部一致性係數與重測信度,建構效度採用驗證性因素分析檢驗資料是否符合假設構念,效標效度則評估 QuENA 對迷路事件的預測力。在基線期 2.5 年後,有 185 AD 患者及其家屬完成追蹤期評估,其中有 90 位未曾發生過迷路事件 (Group A);95 位已在發病後發生過一次以上的迷路事件 (Group B)。
結果:QuENA 在患者自評與家屬評估均具有良好的信度,但患者自評的建構效度與預測效度均較差。185 位完成追蹤期評估者中,有 148 (80%) 位以面談完成,另外 37 (20%) 位以電訪完成。在 2.5 年間,Group A 中有 33.3% 初次發生迷路事件 (GL incidence),Group B 中則有 40.0% 迷路再次發生 (GL recurrence)。Multiple logistic regression 分析發現在 QuENA 中的注意力缺損與 CASI 中的定向感分數可預測迷路的初發。另一方面,在 Group B 中,年齡較輕與未將自己限制在安全範圍內的患者,其迷路再發風險較高。
結論:QuENA 是個容易施測且具有信效度的認路障礙評估工具,可用於評估 AD 患者的迷路風險。在迷路預測因子部份,神經心理功能中的「定向感」與 QuENA 中的「注意力缺損」可預測尚未迷路的 AD 患者的迷路風險,然而患者若已迷路過,其預測因子便有相當大的改變,對於年齡較輕且無安全範圍的患者而言,家屬需特別注意其迷路再發之風險。除此之外,迷路亦可能是 AD 亞型的行為表現之一,迷路者的退化模式與無迷路經驗者不同。
Objectives: To develop a feasible, reliable, and valid instrument to evaluate the topographical disorientation (TD) symptoms of the patients with Alzheimer's disease (PwAD) and to monitor the risk factors for getting lost (GL) events and to determine the incidence and recurrence rates of it.
Methods: A longitudinal study of community-dwelling PwAD was performed between April 2009 and March 2012 and encompassing baseline and a 2.5-year follow-up examination. The baseline information was used to establish the reliability and validity of the Questionnaire of Everyday Navigational Ability (QuENA). We focused on new GL events and the associated factors from their demographic data and daily functions by interview, cognitive functions by CASI and MMSE, and behaviors by the QuENA. The study population consisted of 185 PwAD and their co-habitant collaterals. At the baseline, 95 had ever experienced GL (Group B), while and the remaining 90 (Group A) had not.
Results: In the baseline evaluation, the construct validity of QuENA, confirmatory factor analysis showed that the caregiver version of the QuENA fits the proposed TD model well but the patient version does not. Regarding the internal consistency, the Cronbach’s α of the caregiver version was 0.91 and that for the patient version was 0.87. In the follow-up evaluation, 148 (80%) of the participants were interviewed by face to face, and 37 (20%) by telephone; no difference was detected between them in any variable of interest. After a 2.5-year period, 33.3% in the Group A developed GL (incidence) and 40% in the Group B developed GL (recurrence). Multiple logistic regression analysis revealed that inattention on the QuENA and orientation on the CASI had the independent effect on incidence, while being younger and the absence of safety range waved alarm for recurrence. Moreover, during the 2.5 years, PwAD with GL incidence deteriorated more in mental manipulation on CASI than those without.
Conclusions: Cognitive assessment and the QuENA can alarm for the risk of GL incidence. We suggest that once GL occurs, the collaterals of PwAD must take the responsibilities to prevent from the recurrence, in particular for younger patients. In addition, GL may be a behavioral manifestation for subtypes of AD.
第一章 緒論........................................................................................1
第一節、研究背景...................................................................................1
第二節、阿茲海默氏症............................................................................... 3
壹、臨床特徵.................................................................................... 3
貳、病理變化.....................................................................................3
參、AD 的異質性...................................................................................3
第三節、迷路與地域失定向.............................................................................5
壹、認知功能健康者的迷路行為.....................................................................5
貳、地域失定向的歷史演變............................................................................5
參、發生在熟悉環境的 TD 症狀...................................................................8
肆、地域失定向與迷路行為的關係...............................................................10
第四節、阿茲海默氏症患者的地域失定向症狀...............................................12
壹、個案研究..................................................................................................12
貳、團體研究..................................................................................................13
第五節、阿茲海默氏症患者的迷路行為...........................................................15
壹、AD 患者的迷路盛行率...........................................................................15
貳、AD 患者迷路行為的特質與定義...........................................................15
參、迷路相關風險因子...................................................................................16
第二章 研究目的與研究內容..............................................................................18
第一節、子研究一:地域失定向評估工具編製..............................................19
壹、研究目的與研究假設..............................................................................19
貳、研究方法..................................................................................................20
一、研究參與者...........................................................................................20
二、日常生活認路能力問卷之設計理念與評估重點...............................21
三、迷路行為評估.......................................................................................24
四、統計分析...............................................................................................25
參、結果分析..................................................................................................26
一、研究參與者..........................................................................................26
二、迷路行為..............................................................................................28
三、QuENA 信效度建立...........................................................................29
肆、討論..........................................................................................................39
一、QuENA 的信效度...............................................................................39
二、AD 患者的迷路行為..........................................................................41
第二節、子研究二:AD 患者之迷路風險因子...............................................43
壹、研究目的與研究假設...............................................................................43
貳、研究方法..................................................................................................44
一、研究參與者..........................................................................................44
二、研究測量..............................................................................................44
三、統計分析...............................................................................................47
參、結果分析...................................................................................................49
一、迷路初發與再發的相關風險因子.......................................................49
二、基線期與追蹤期之間的變化...............................................................66
肆、討論...........................................................................................................82
一、迷路初發與再發的預測因子...............................................................82
二、神經心理功能退化模式與迷路行為...................................................84
三、QuENA 評估的變化...........................................................................86
第三章 結論與建議.......................................................................................88
第一節、家屬扮演的角色...................................................................................88
第二節、研究優勢與限制...................................................................................89
第三節、結論...........................................................................................90
參考文獻................................................................................................91
附錄
附錄 I 參與者同意書....................................................................................99
附錄 II NINCDS-ADRDA 診斷準則...........................................................101
附錄 III DSM-IV-TR 之阿茲海默氏症診斷標準.......................................103
附錄 IV日常生活認路能力問卷....................................................................104 

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