失智症患者認知功能障礙程度與步態平衡、跌倒之相關性探討

A Correlational Study of Cognitive Impairment Level, Gait, Balance, and Falls in Persons with Dementia

陳幼珍(Yu-Chen Chen)

指導教授 ： 曾月霞

中山醫學大學/醫學院/醫學研究所/碩士(2005年)

https://doi.org/10.6834/CSMU.2005.00072

摘要

全國約有二至四萬名失智老人，每年國內新增失智症約在一萬五千名左右，失智的主要內涵是認知障礙，隨著疾病的進展，失智症患者的肌力和動作功能(motor function)退化以及步態異常也是常被觀察到的，這些改變容易造成跌倒發生，而跌倒的後果是骨折住院、固定不動、壓瘡、以至死亡。本研究旨在了解失智症患者的平衡與步態的情形，並探討認知功能障礙程度與步態平衡、跌倒之相關性，以確認跌倒的高危險失智症患者。
以中部某醫學中心級以上之醫院失智症門診為研究地點，研究對象需符合：(1)由醫師診斷，符合美國精神協會失智症診斷標準(DSM-IV)，且病歷中有失智症診斷記錄之患者；(2)年齡滿18歲以上。本研究採橫斷式相關性研究設計，使用結構式CASI C-2.0中文版知能篩檢測驗及Tinetti平衡步態評估表來收集認知功能及平衡步態之資料，由研究者一對一訪談146位失智症患者。
研究結果為(1) 失智症患者認知功能程度會受到失智時間、教育程度、性別的影響。(2) 失智症患者認知功能程度會影響步態平衡的表現。(3) 失智症患者不同認知功能層面與步態、平衡有顯著相關。(4) 失智症患者認知功能中的定向能力與舊記憶可以預測步態平衡的表現。(5) 有無跌倒之失智症患者其步態平衡有顯著差異。本研究結果可提供設計增加失智患者認知功能以提昇其步態及平衡表現之措施參考，並以簡易的平衡步態評估來篩檢可能跌倒的失智症患者。

關鍵字

失智症 ； 認知功能 ； 步態平衡 ； 跌倒

並列摘要

There are 20,000 to 40,000 persons with dementia in Taiwan. There are 15,000 new cases each year. Dementia is cognitive impairment. When cognitive function worsens gradually, muscle power weakness, motor function degeneration and gait abnormality are often observed. These changes will make persons with dementia easy to fall. Once falls occur, it will result in fracture, hospitalization, immobility, pressure sore, and even death. The purpose of the study was to understand balance and gait in persons with dementia, and to identify the correlation between cognitive impairment level, balance and gait, and falls. The study setting was dementia outpatient department of a medical center in the middle of Taiwan. The eligible criteria to participate in the study were: (1) Dementia that met DSM-Ⅳ criteria was diagnosed by a physician and was recorded in the chart. (2) Subjects were 18 years old and above. A cross-sectional correlational research design was used. Structured questionnaires, including CASI C-2.0 and Tinetti assessment scale were used to obtain data about cognition, gait, and balance. The findings of this study are (1) Duration of dementia onset, educational level, and gender are correlated to cognitive function. (2) Cognitive function affects gait and balance performance. (3) Cognitive function domains are significant correlated with gait and balance. (4) Orientation and old memory could predict gait and balance performance. (5) Gait and balance are significantly different between persons with and without falls. These findings can be used to design interventions to increase cognitive function, and thus enhance gait and balance. For those who are at high risk of falls could be identified by easy gait and balance assessment.

並列關鍵字

dementia ； cognition function ； gait ； balance ； falls

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