臺灣博碩士論文加值系統

本論文的目地在探討施用「台灣版蒙特利爾認知評估」（The Taiwanese version of Montreal Cognitive Assessment，簡稱MoCA-T）於神經性語障患者的臨床表現，並瞭解病患的個人、疾病和語言相關因素與MoCA-T分數的相關性和預測力。研究對象包括神經性腦傷病患（含失語症、言語障礙和無語障者）47人以及正常健康者49人。所有個案均接受MoCA-T與MMSE測試，失語症病患則需再接受「簡明失語症測驗」，以瞭解其語言障礙嚴重度。結果顯示，神經性腦傷病患組與正常健康組以及病患組各次組（失語症組、言語障礙組和無語障組）與健康組在MoCA-T及MMSE的總分，均達顯著差異（p < .001），但均未達原版MoCA的切截分數（26分）。另外，病患在MoCA-T與MMSE得分以及MoCA-T的語言和非語言認知分數皆呈高度正相關（p < .001），而年齡、病灶位置（皮質區）及語言障礙診斷（失語症）與MoCA-T總分呈現低度負相關（p < .05），教育程度、發病時長、病灶位置（不明區）與MoCA-T總分呈現低、中度正相關（p < .05），在預測力方面，「年齡」、「教育程度」、「發病時長」、「病灶位置（皮質區）」、「病灶位置（不明區）」與「語言障礙診斷（失語症）」皆可用以預測MoCA-T分數的表現。依據結果可推論，MoCA-T應可施用於神經性語障患者，而且病患的語言和認知表現皆具相關性，未來可進一步再探測MoCA-T施用於神經性語障患者的切截分數與探討臨床的施用性。

This study aims to assess the cognitive function of patients with post neurogenic disorders (including aphasic, dysarthric and non-speech/language-impaired) using the Taiwanese version of Montreal Cognitive Assessment (MoCA-T). Forty-seven patients (mean age: 61.77±16.67, 29 males and 18 females) and 49 gender- and age-matched controls (mean age: 56.49±16.48, 28 males and 21 females) were recruited. MoCA-T scores were determined based on the published cutoffs by Tsai et al. (2012). All participants underwent the examination of both MoCA-T and Mini-Mental State Examination (MMSE) over two clinical visits. A standardized language battery, the Concise Chinese Aphasia Test, CCAT (Chung et al., 2003) was only administered with patients with aphasias. The t-test and Kruskal-Wallis test were used to determine the difference between the groups and between the neurogenic subgroups (p< 0.05). The results showed that the patient group performed significantly lower scores than the controls across all items of the MoCA-T. Similar results were demonstrated between the subgroups and the controls. However, there was no difference among the three neurogenic subgroups. In addition, factors including age, education, onset time to the present, lesion site in cortex, aphasia, severity of speech/language disorders and the total raw score of the MMSE were significantly correlated with the MoCA-T score. Based on the MoCA-T scores, the pathologies that underlie the cognitive impairments in neurogenic patients with and without language/speech disorders can be speculated. The findings would shed light to the clinicians and call for the importance of developing MoCA-T cutoffs in Taiwanese population with neurovascular deficits.

目 錄
頁數
論文摘要...............................................................................................i
ABSTRACT..............................................................................................ii
目錄.....................................................................................................iii
圖目錄..................................................................................................v
表目錄.................................................................................................vi
第一章 緒論......................................................................................1
第二章 文獻探討..............................................................................5
第一節 認知和語言的關係............................................................5
第二節 神經性語障患者的認知問題...........................................10
第三節 神經性語障患者的認知評估...........................................18
第四節 國外蒙特利爾認知評估量表的研究...............................27
第五節 蒙特利爾認知評估量表台灣版的研究...........................30
第六節 研究目的與問題...............................................................32
第三章 研究方法.............................................................................35
第一節 研究設計...........................................................................35
第二節 研究對象...........................................................................37
第三節 研究材料...........................................................................41
第四節 研究程序...........................................................................45
第五節 資料分析...........................................................................48
第四章 研究結果.............................................................................51
第一節 測驗總分與測驗細項間的表現與差異............................51
第二節 MoCA-T分數與個人/疾病因素相關性分析....................56
第三節 語言治療與MoCA-T分數...................................................60
第五章 討論與建議..........................................................................63
第一節 測驗分數的表現與差異......................................................63
第二節 個人和疾病影響因素與MoCA-T得分之相關探討...........70
第三節 語言治療相關因素對MoCA-T得分之探討.......................73
第四節 MoCA-T與MMSE的總分與結果比較...............................73
第五節 研究限制及未來研究建議..................................................75
第六章 結論.......................................................................................77
參考書目.............................................................................................79
附錄.....................................................................................................91
附錄一 MoCA預試與圖片命名問卷.......................................91
附錄二 病患組基本資料........................................................101
附錄三 MoCA-T指導手冊與測驗紙......................................107


圖目錄
頁數
圖1-1 後天性溝障人數比例....................................................................2
圖2-1 認知和語言的關係圖....................................................................9
圖3-1 研究架構圖...................................................................................36
圖3-2 研究程序圖...................................................................................47
圖4-1 語言和非語言認知的關係............................................................58

表目錄
頁數
表2-1 台灣目前較常使用之認知測驗比較與測驗項目整理................24
表2-2 MoCA原版與所有亞洲版之資料整理.........................................26
表3-1 健康組與病患組的性別、平均年齡與平均教育程度資料.......39
表3-2 aphasia組、MSD組及NSLD組的疾病相關因素資料背景......41
表3-3 測驗評估工具簡介摘要...............................................................45
表4-1 健康組與各實驗組之MoCA-T與MMSE的粗分數簡表...........52
表4-2 健康組與病患組的MoCA-T及MMSE測驗分數之比較. .........53
表4-3 健康組、失語症組、言語障礙組及腦傷組的MoCA-T及MMSE
測驗項目分數之比較.................................................................................54
表4-4 健康組、失語症組、言語障礙組及腦傷組的MoCA-T及MMSE
得分之事後分析.........................................................................................56
表4-5 比較病患個人和語言相關因素與MoCA-T總分之相關性........57
表4-6 對MoCA-T分數具顯著預測力的病患疾病相關因素................60
表4-7 語言治療與否與MoCA-T是否達切截分數之交叉表................61

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