口述語意聯想測驗篩檢阿茲海默失智症之臨床應用

Screening for Alzheimer's Disease Using the Controlled Oral Word Association Test

曾光佩(Guang-Pei Tseng)

《北市醫學雜誌》 4卷6期 (2007/06) Pp. 460-469

https://doi.org/10.6200/TCMJ.2007.4.6.04

摘要

目的：口述語意聯想測驗(controlled oral word association test, COWAT)是一個運用相當廣泛的臨床神經心理測驗，但受限於語言本身的限制與文化上的差異，一直無法運用在國內的臨床實務上，使得該測驗的運用受到很大的限制；本研究的目的是在於發展一個適合國內使用的老人口述語意聯想測驗，同時施測於健康老人與患有阿茲海默失智症老人，藉此來決定本測驗的界斷值，同時比較測驗中所使用的類別刺激項（共有「水果」、「動物」及「動作」三大類別刺激項）是否會造成不同的反應。方法：共有120位大於64歲之健康老人和阿茲海默失智症老人參與研究，以中文版簡短式智能評估做為篩選是否有認知功能損傷的工具，最後施以口述語意聯想測驗，請受測者在一分鐘內儘快說出各類別刺激項之反應。結果：阿茲海默失智症組在口述語意聯想測驗的表現確較健康老人組顯著地差；在健康老人組中，「動物」類別反應量會因為教育程度愈高而有愈多的反應量，但在阿茲海默失智症組中，「動物」類別反應量不會因為教育程度不同而有不同的反應量。再者，口述語意聯想測驗在各類別反應量的特異性在0.72至0.77間、敏感度在0.78至0.93間及正確區域在0.86至0.89間，顯示本研究結果確可有效地確立各反應類別之界斷值。另外，「動物」類別反應量顯著高於「水果」類別，且「水果」類別反應量顯著高於「動作」類別。結論：口述語意聯想測驗確有建立本土化常模之必要性，且由本研究亦可確立各類別刺激的界斷值以作為國內老年期之阿茲海默失智症者的有效篩檢工具，而各類別刺激項的反應數量差異更值得進一步釐清，以建立對各類失智症或是認知功能障礙有更精確的篩檢意義與指標。

關鍵字

口述語意聯想測驗 ； 老年期 ； 界斷值 ； 阿茲海默失智症

並列摘要

Background and Purpose: The Controlled Oral Word Association Test (COWAT) is a widely used clinical neuropsychological assessment. However, limited by the language and cultural differences, the COWAT was unable to be used in the clinical field in Taiwan. The purpose of the present study was to develop an appropriate COWAT for the elderly population in Taiwan. The test was given to both the healthy population and the elderly population with Alzheimer's Disease in order to decide the cut-off values, and at the same time to compare whether the stimulus (”fruit” category, ”animal” category, and ”action” category) would cause different reactions. Methods: There were 120 elderly subjects, with age of 64-years old or older, who participated in the present study. Initially, the Chinese version of Mini Mental Status Examination (CMMSE) was used to screen for cognitive impairment. Then the COWAT was given to the elderly to see the responses that they could provide within 1 minute. Results: The group diagnosed with Alzheimer's performed significantly worse than the group of healthy elderly subjects. In the healthy group, the higher the individual's education level, the higher the responses would be for the ”animal” category. However, the same pattern did not occur in the Alzheimer's group. In addition, the responses for the COWAT in all categories' for specificity was between 0.72 and 0.77, sensitivity was between 0.78 and 0.93, and true area was between 0.86 and 0.89, showing that the present study was validated in the cut-off values of all categories. Furthermore, the responses for the ”animal” category were significantly higher than that for the ”fruit” category, and the ”fruit” category was significantly higher than that for the ”action” category. Conclusion: The results of the present study showed efficiently the cut-off values of various categories of stimulus in order to screen Alzheimer's Disease among elderly subjects in Taiwan. The differences between the amounts of responses in various categories of stimulus are worthwhile to be further clarified for establishing more accurate meanings of the screening and index of different types of Alzheimer's Diseases or other handicaps of cognitive functions. Therefore, it is certainly essential to establish standardized norms of COWAT in Taiwan.

並列關鍵字

Controlled Oral Word Association Test COWAT ； Elderly ； Cut-off values ； Alzheimer's Disease