臺灣博碩士論文加值系統

背景：頸動脈支架手術已被廣泛使用來治療頸動脈狹窄病患，但目
前研究對於頸動脈支架手術對認知改善的實際效果並沒有一致的結
論。可能的理由除了方法學上的問題之外，很少研究有討論到因重
複測驗造成的練習效果所扮演的角色。本研究目標在調查頸動脈支
架手術對認知改變的長期性影響，並且會強調練習效果對病人在手
術後的認知軌跡所造成的影響。
方法：一百七十七位頸動脈狹窄病患參與本研究，並依據病患接受
的治療分配到不同組：選擇進行頸動脈支架手術(CAS，n = 101)及選
擇藥物治療組(MED，n = 76)。此外招募四十位年紀相仿的志願者為
控制組。所有研究參與者在術前及術後六至十二個月的神經心理測
驗結果以二因子重複量數變異數分析進行檢驗。本研究也以控制組
在兩階段的測驗表現求得信賴改變指標(RCI)用來檢驗兩病人組在兩
階段測驗表現的進步程度是否有顯著差異。
結果：兩病人組在多數測驗表現無顯著差異，但控制組在兩階段原
始分數均顯著高於病人組。三組的再測分數在多數測驗出現進步，
但進步幅度無顯著差異。兩病人組在各測驗的信賴改變指標上皆無
顯著差異，且兩組在各認知領域出現缺損或進步的人數也無顯著差
異。
結論：頸動脈狹窄與認知功能障礙有關，不過，頸動脈支架手術在
改善患者認知功能的作用上與藥物的效用無差異。認知測驗分數的
提高可能主要是由於練習效果。

Background: Carotid artery stenting (CAS) has been widely used to treat patients with internal carotid artery stenosis (ICAS), but the effects of CAS on cognition remains elusive. In addition, few studies have addressed the issues of practice effect arising from repeated testing in cognitive functions of patients with ICAS. The aims of the study were to investigate the long-term effects of CAS on cognitive changes, in particular the effects of learning on the cognitive trajectories during post CAS follow up will be emphasized.
Methods: One hundred and seventy-seven patients with carotid artery
stenosis participated in the study. They were assigned to different groups according to the treatment received: carotid stenting group (CAS, n = 101) and medical treatment group (MED, n = 76). In addition, forty age-matched volunteers were recruited as the control group. The performance of all participants on neuropsychological tests obtained at the pretreatment and post-treatment (6-12 months) phase were analyzed by two-factor ANOVA with repeated measure. The reliable change index (RCI) was derive based on the data of the control group obtained from two phases of assessment to understand whether the changes in test scores between two phases in patient groups were statistically significant.
Results: There was no significant difference in performance between the two patient groups on most tests, but the raw scores of the control group were significantly higher than those of the patient groups at both phases. The retest scores of the three groups showed improvement in most tests, but there was no significant difference in the extent of the improvement. The RCIs of two patient groups were not significantly different in any test, and there were no significant differences between the two groups in the number of people with significant declines or improvement in any cognitive domain.
Conclusion: Cognitive impairments were associated with ICAS.
However, the effects of CAS on improvement in cognitive performance
did not differ from the effects of medications. The improvement in
cognitive test scores might be mostly due to the practice effect.

Table of Contents
Recommendation Letter from the Thesis Advisor………………………
Thesis/Dissertation Oral Defense Committee Certification…………….
致謝…………………………………………………………………….iii
中文摘要……………………………………………………………….iv
English Abstract………………………………………………………. vi
Table of Contests………………………………………………………viii
List of Figures…………………………………………………………..x
List of Tables…………………………………………………………...xi
Chapter 1. Introduction…………..………………………………..........1
1.1 Carotid Artery Stenosis…………………………………..........3
1.2 Internal Carotid Artery Stenosis and Cognitive Functions……5
1.3 Interventions of Carotid Artery Stenosis………………………8
1.4 Issues in Serial Assessment…………………………………...11
1.5 The Aims of Present Study……………………………………15
Chapter 2. Method…...………………………………………………...17
2.1 Participants………………………………….………..............17
2.2 Cerebrovascular Investigations ……………...........................19
2.3 Treatment of Carotid Artery Stenosis………………………..20
2.4 Neuropsychological Assessment……………...……………...21
2.5 Procedures………………………………….………………...26
2.6 Data analysis………………………………….………………27
Chapter 3. Results...……………………………………………………30
3.1 Baseline Data…………………………...…………………….30
3.2 Neuropsychological Performance.…………………................34
3.3 Changes of Neuropsychological Performance…......................41
3.4 Reliable Change Index………………………..………………45
Chapter 4. Discussions...………………………………………….........53
4.1 Clinical Conditions……………………………………………53
4.2 Cognition in Patients with Carotid Artery Stenosis…………..54
4.3 Effects of CAS on Cognitive Changes………………………..56
4.4 Factors Related to Learning Effect……………………………57
4.5 Understanding the Effects of CAS with RCIs…………………59
4.6 The Limitation of This Study………………………………….61
Chapter 5. Conclusions...………………………………………….........62
References…..…………………………………………………………..63

List of Figures
Figure 1. Flow diagram of patient selection…………………….……..18
Figure 2. Distributions of composite reliable change indexes for memory
and dexterity functions…………………………………………………51
Figure 3. Distributions of composite reliable change indexes for
executive functions…………………………………………………….52

List of Tables
Table 1. Demographic and Medical Data of All Participant Groups at
Baseline…………………………………………………………………31
Table 2. The Mean (SD) Raw Scores of the Neuropsychological Tests at
Baseline and Follow-up Phases……………………………………….. 35
Table 3. Mean (SD) Differences of Neuropsychological Testing Scores
across Baseline and Follow-up Phases……………………….…………42
Table 4. Correlation Coefficients of Stroke-related Risk Factors between
Changes of Neuropsychological Test Scores………………...................44
Table 5. Correlation Coefficients of Test Scores for Volunteers between
Baseline and Follow-up Phases….……………………………………..48
Table 6. The Mean (SD) Reliable Change Indexes in Clinical
Groups…………………………………………………………………..49

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