臺灣博碩士論文加值系統

輕度認知障礙近年來逐漸受到重視，目前被視為失智症的早期狀態。目前針對輕度認知障礙者的認知介入主要為認知訓練與認知復健，認知訓練透過結構化的認知活動有助於提升輕度認知障礙者的特定認知功能，認知復健則針對日常生活中的問題提供策略或調適方法來改善日常活動表現或提高生活品質。目前療效型研究發現，複合式的介入可同時包含多重效果，且認知介入應以生活化認知活動加上團體互動的模式方有較佳成效，而運用職能治療之專業特色可設計難度適中且與個人生活結合的介入方式，但目前台灣尚無相關類型的研究，國外研究之療效評估也較缺乏在日常生活表現的呈現。
本研究結合認知訓練與認知復健，搭配部分認知刺激活動，並以職能治療的活動設計原則與日常生活策略設計此介入方案，以方便取樣招募社區中符合輕度認知障礙條件的長輩進行12周，每周1次，每次90分鐘的複合式認知介入，目標為探討 (1)認知訓練與認知復健在主觀及客觀認知評估的療效、(2)認知介入在日常生活功能表現的轉移效果。
本研究分期進行，經歷五期介入團體後，介入組共20位符合條件之成員完成；控制組共17位符合條件之成員完成。兩組平均年齡分別為71及70歲，兩組MMSE平均分數約在26分左右。兩組在之人口學資料無顯著差異。結果顯示本介入方案可有效促進輕度認知障礙者之視覺注意力(p=0.005)、轉移性注意力(p〈0.001)、分散性注意力(p〈0.001)、短期記憶(p=0.029)、視覺記憶(p〈0.001)與日常口語記憶(p=0.041)；但在主觀的日常認知功能量表則未見顯著改善。
相較過去研究，本介入重點為與個案個人經驗相關之注意力訓練與日常記憶策略，對客觀認知評估有顯著的療效，其中注意力功能之進步來自於團體認知訓練中的大量生活化練習，以及治療師隨成員能力隨時進行的難度調整；日常記憶功能進步則來自於注意力改善後提升資訊蒐集能力的幫助，以及團體中的日常策略練習。日常認知主觀表現則未見顯著改善，可能原因為問卷的天花板效應與敏感度不足所導致，或是個案在學習策略後需要更長時間在生活中實際練習以顯現成效，未來相關之策略學習與認知訓練研究可考量追蹤長期成效或選用更敏感之測量工具。
本研究結論為：複合式且活動導向之認知介入團體可有效改善輕度認知障礙者之客觀認知功能，為台灣地區在社區進行認知介入的先驅研究，期望將來可做為針對輕度認知障礙個案在社區臨床認知介入的方案參考。

This study is to develop an occupation-based multicomponent cognitive training and cognitive rehabilitation to enhance both cognitive ability and performance of activities of daily living (ADL) of persons of MCI and to evaluate its effectiveness. A 12-session, 90-minutes, once-a-week cognitive intervention was given to the subjects with MCI in the community in 5 rotations. In this quasi-experimental design study, cognitive function and ADL of people who had been coded as intervention groups (n=20) and control groups (n=17) were collected and aggregated. The result revealed significant inter-group differences in visual attention, alternative attention, divided attention, visual contextual memory and daily verbal memory. The progress in attention can be attributed to the cognitive training specifically designed to enhance attention. The improvement in visual memory and everyday memory may due to the weekly group discussion on application of cognitive strategies to daily lives. However, due to the ceiling effect, timing of evaluation, and the sensitivities of the questionnaires, there was no significant improvement in the subjective daily cognition questionnaires. This study showed that the multi-component intervention is effective in improving the cognitive functions of people with MCI in the community. Follow-up examination of daily living improvements is recommended.

中文摘要 i
Abstract iii
誌謝 vi
目錄 viii
表目錄 x
圖目錄 xi
第壹章 緒論 1
第貳章 文獻回顧 3
第一節 輕度認知障礙之概述 3
第二節 認知功能與輕度認知障礙之認知缺陷 6
第三節 對輕度認知障礙者進行注意力介入之理論基礎 9
第四節 針對輕度認知障礙族群進行之認知介入 11
第五節 文獻回顧小結 24
第參章 研究方法 26
第一節 研究設計 26
第二節 研究對象 27
第三節 評估及篩檢工具 29
第四節 認知介入措施 37
第五節 資料分析 40
第肆章 結果 41
第一節 結果樣本人口學資料與團體參與情況 41
第二節 兩組認知功能在前測之評估比較 44
第三節 兩組組內前後測之認知功能評估比較 45
第四節 兩組組間前後測認知功能改善之結果 46
第五節 兩組受試者之認知自我察覺 47
第伍章 討論 48
第一節 複合式認知介入對注意力具顯著成效 49
第二節 注意力進步與短期記憶力表現進步之關聯 52
第三節 認知介入對日常生活功能表現之影響 55
第四節 結合職能治療介入策略之優勢 59
第五節 研究限制 61
第陸章 結論 63
第柒章 參考文獻 64
第捌章 附錄 72
團體企畫書-第一周 86
團體企畫書-第二周 88
團體企畫書-第三周 91
團體企畫書-第四周 93
團體企畫書-第五周 95
團體企畫書-第六周 98
團體企畫書-第七周 100
團體企畫書-第八周 103
團體企畫書-第九周 106
團體企畫書-第十周 108
團體企畫書-第十一周 111
團體企畫書-第十二周 113

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