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研究生:許庭榕
研究生(外文):HSU, TING-JUNG
論文名稱:本土化認知刺激治療方案應用於失智榮民之成效
論文名稱(外文):Effectiveness of Cognitive Stimulation Therapy with Cultural Adaptations for Veterans with Dementia
指導教授:李明德李明德引用關係
指導教授(外文):LEE, MING-DER
口試委員:毛慧芬蔡宜蓉
口試委員(外文):MAO, HUI-FENTSAI, YI-JUNG
口試日期:2018-01-08
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:長期照護研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:168
中文關鍵詞:榮民失智症非藥物認知刺激治療
外文關鍵詞:veteransdementianon-pharmacological cognitive stimulation therapy
相關次數:
  • 被引用被引用:4
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  • 下載下載:129
  • 收藏至我的研究室書目清單書目收藏:2
背景: 隨著臺灣高齡人口逐年增加,失智症人口也逐漸增加。失智症目前尚無有效的藥物治療,但非藥物治療皆一致公認是介入首選,尤其認知刺激治療更被國內外證實是能有效改善失智症個案認知功能的重要措施。榮民是國內老年人口中特殊的群體其失智發生亦隨年齡增長呈現逐年上升趨勢,然而針對此失智群體在認知刺激治療方案或成效之相關研究寥寥可數,由於榮民群體在文化背景與生命經驗上有別於一般的老年群體,因此有必要設計或發展符合失智榮民的認知方案,也才能發揮非藥物治療強調的目標與效益。

目的: 本研究特別聚焦於失智榮民嘗試發展出本土化失智榮民適切之認知刺激治療方案,並再針對所發展之方案分別檢測其認知功能、憂鬱程度及行為與精神症狀之介入前後成效。

方法: 本研究分兩階段進行: 第一階段為發展本土化失智榮民認知刺激治療方案;第二階段則採準實驗設計,以方便取樣於北部三處榮民之家失智專區選取符合研究條件之25位失智榮民,隨機分配為實驗組12位與對照組13位,其中實驗組接受為期七週,每週兩次,每次45分鐘的團體認知刺激治療方案,對照組則維持常規性團體活動。介入前及方案介入後兩組皆須進行認知功能、憂鬱程度及行為與精神症狀前後測評量。本研究工具包括有:阿茲海默氏症認知量表、康乃爾失智者憂鬱量表與簡短版神經精神量表,所有研究工具均具有良好信效度驗證。本研究採用SPSS 21.0英文版套裝軟體進行分析。

結果: 本研究結果發現實驗組在認知刺激治療方案介入相較對照組在認知功能、憂鬱程度及行為與精神症狀嚴重度和困擾程度皆有顯著改善(p< .05);其中認知功能之記憶力與語言能力面向(p< .005)、憂鬱程度中與情緒相關徵兆亦皆有顯著改善成效(p< .005)。而在行為與精神症狀方面,實驗組在憂鬱/情緒不佳之嚴重度及其照護者困擾程度呈現顯著改善成效(p< .05)。

結論: 本研究主要建立出適切失智榮民群體之本土化認知刺激治療方案,並驗證出本方案可能改善失智榮民認知功能、憂鬱程度以及行為與精神症狀,特別是在記憶力、語言能力及情緒憂鬱徵兆。依研究結果,本研究分別就實務、研究及政策等層面提出後續建議與參考。

Background:The aged population has increased rapidly in Taiwan. With the rapidly increasing aged population, the global prevalence of Alzheimer’s disease (AD) is expected to dramatically increase by 2050. The increasing prevalence of cognitive impairment in the general population emphasizes the need for early intervention and treatment. Although pharmacological interventions of the people with dementia are currently not effective, non-pharmacological interventions are known to be the first line treatment. Most of all, cognitive stimulation therapy (CST) is an important cognitive-oriented intervention that has been shown to have significant benefits in enhancing cognitive function of people with mild to moderate dementia worldwide. In Taiwan, veterans are the special population of elderly people;moreover, along with the aging of veterans, the senior veterans with dementia increase gradually every year. Nevertheless, the relevant studies about CST or the effectiveness of CST are scrace in Taiwan. Owing to the cultural uniqueness and special life experience of veteran population are different from the ordinary senior population. Hence, adaptaion or development of CST for veterans with dementia is necessary to bring emphasis on the objectives and effectiveness of non-pharmacological interventions.

Objective:The objectives of this study were to specially focus on adaptation of CST for Taiwanese veterans (CST-TVA) with dementia taking into account veteran’s cultural appropriateness, and then investigate the effectiveness of the CST-TVA on cognitive function, depression status, as well as behavioral and psychological symptoms of senior veterans living with dementia (BPSD) respectively by the pretest-posttest.

Methods:The methods of this study were divided into two stages. Stage one, this study culturally adapted and developed for the CST-TVA. Stage two, this study conducted a quasi-experimental design and a convenience sampling for enrollment of twenty-five veterans with dementia who met the inclusion criteria from three Veterans Homes in Northern Taiwan, and then randomly assigned them to the experimental group of twelve people and control group of thirteen people. The experimental group received each 45-minute CST–TVA session twice-weekly for seven weeks. The control group received routine activities. The experimental and control groups were measured pretest-posttest of cognitive function, depression status, BPSD before and after the intervention. The present study’s measurement included Alzheimer’s Disease Assessment Scale-Cognition (ADAS-Cog), Cornell Scale for Depression in Dementia (CSDD) and Neuropsychiatric Inventory Questionnaire (NPI-Q) . All measurement had well verified reliability and validity. SPSS 21.0 software package was conducted for data analysis.

Results:The findings indicated that the experimental group had more significant improvement than the control group not only in the overall ADAS-Cog score, CSDD score and NPI-Q’s severity and distress scores respectively (p< .05), but also in the ADAS-Cog subdomains of memory and language scores (p< .005), and the CSDD subdomain of mood-related signs score (p< .005). In terms of BPSD, there was a significant improvement on the NPI-Q subitem of depression/dysphoria score in the experimental group (p< .05).

Conclusions:This study mainly established an appropriate CST for Taiwanese veterans (CST-TVA) with dementia, and investigated the effectiveness of CST-TVA that may have significant benefits on cognitive function, depression status, and neuropsychiatric symptoms, in particular, memory, language and mood-related signs for veterans with dementia. According to the results, the present study may further provide recommendations as references on clinical practices, researches and policies respectively.

中文摘要 i
英文摘要 ii
目次 iv
表次 vi
圖次 vii

第一章 緒論
第一節 研究背景與動機 1

第二章 文獻查證
第一節 失智症與認知功能 4
第二節 失智症與憂鬱狀態 12
第三節 失智症與行為與精神症狀 19
第四節 認知刺激治療介紹 24
第五節 認知刺激治療在失智症個案相關實證研究 29

第三章 研究方法
第一節 研究設計與研究步驟 46
第二節 研究對象 51
第三節 研究工具 52
第四節 資料處理與分析 56
第五節 倫理考量 57

第四章 研究結果
第一節 發展本土化失智榮民認知刺激治療方案 61
第二節 認知刺激治療介入措施之成效分析 70

第五章 研究討論
第一節 發展本土化失智榮民認知刺激治療方案內容之探討 89
第二節 認知刺激治療方案對於失智榮民認知功能、憂鬱程度及行為與精神症狀之實證效用探討
92

第六章 結論與建議
第一節 結論 100
第二節 研究限制 101
第三節 建議 103

參考文獻
中文部分 105
英文部分 108

附錄
附錄一 阿茲海默氏症評估量表(ADAS-Cog) 123
附錄二 康乃爾失智者憂鬱量表(CSDD) 138
附錄三 簡短版神經精神量表(NPI-Q) 139
附錄四 失智榮民之訪談指引 140
附錄五 非結構性訪談失智榮民之資料內容分析 141
附錄六 本土化失智榮民認知刺激治療方案活動內容 144
附錄七 臺北榮民總醫院人體試驗委員會同意臨床試驗/研究證明書(中文版) 167
附錄八 臺北榮民總醫院人體試驗委員會同意臨床試驗/研究證明書(英文版) 168

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