慢性精神分裂症個案執行認知與精細動作雙重任務的表現及其功能意義

Dual Tasks of Cognition and Manual Dexterity in Patients with Chronic Schizophrenia: Task Performance and Functional Significance

吳益芳(Yi-Fang Wu)

指導教授 ： 林克忠

國立臺灣大學/醫學院/職能治療研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.00263

摘要

背景：精神分裂症患者廣為周知伴隨明顯認知相關疾患的問題。對於精神分裂症患者而言，動作協調缺損問題也是常見的特徵。認知和動作協調也會影響在執行日常生活活動當中的表現。在日常生活活動當中，人們往往需要同時間執行多種的任務活動，也就是雙重任務。然而，僅有極少數的研究在比較精神分裂症患者和一般健康對照組在執行雙重任務的差異，以及精神分裂症患者在雙重任務以及日常生活功能的關係。
目的：比較精神分裂症患者和健康受訪者在有限的時間內手部操作的活動受到認知情境干擾下之表現，並且檢測雙重任務下之手功能表現與日常生活功能之關聯。
方法：本研究的受訪者即為精神分裂症患者，以及透過年齡和性別配對的對照受訪者。此設計為實驗組跟對照組兩組在單一任務及雙重任務之下的表現，反覆測量分析。
結果：精神分裂症患者在從事單一手功能任務，其表現較低於健康受訪者 (t = 5.38, p < .0001)。比較精神分裂症患者及健康受訪者在雙重任務下表現時，發現兩者的手功能出現較低的表現 (F3,48 = 28.69, p < .0001)。對於精神分裂症患者而言，在雙重任務下的普度手功能的表現，跟日常生活評量表 (ADLRS-Ⅲ) 有顯著相關性 (p = .0002)，以及與簡短型基於表現之技巧評量 (UPSA-B) 也有顯著的相關 (p = .0053)。
結論：我們推測精神分裂症患者在雙重任務之下的表現比起一般健康對照組有較明顯的差異，這些差異也在精神分裂症患者於日常生活表現有所關聯。這可能顯示在精神分裂症患者在執行雙重任務下的手功能表現與日常生活表現有相當程度的關係。我們推測精神分裂症患者在雙重任務下的手功能表現，或許適合當作真實日常生活功能的預後因子。

關鍵字

認知 ； 手部靈巧度 ； 雙重任務 ； 情境干擾 ； 精神分裂症

並列摘要

Background: Individuals with schizophrenia are noted to have significant cognitive deficits. Impaired motor dexterity is also a major characteristic of schizophrenia. Cognition and motor dexterity would influence performance of participating in activities of daily living (ADL). People perform several tasks simultaneously (dual task) in ADL. However, few studies compared the difference of performance at dual-task between the schizophrenia and the healthy group, and the relationships between dual-task and daily functions in individuals with schizophrenia.
Aims: To compare the performance of individuals with schizophrenia and healthy controls on a timed dexterity task by the context interference of adding a secondary cognitive task, and examine the relationship between dexterity and daily functions with schizophrenia.
Method: Individuals with schizophrenia as well as age-matched and sex-matched comparisons volunteered for the study. A repeated measures analysis of performance was designed for the 2 groups under single-task and dual-task conditions of dexterity function interfered by an adding cognitive task.
Results: For the single Purdue pegboard test task, dexterity of individuals with schizophrenia was poorer than the healthy controls (t = 5.38, p < .0001). Both groups had reduced dexterity when interfered by an additional cognitive task (F3,48 = 28.69, p < .0001). For schizophrenic participants, there were significant relationships among Purdue pegboard test at dual task and the most items of ADLRS-Ⅲ (p = .0002). There were significant relationships among Purdue pegboard test at dual task and the UPSA-B (p = .0053).
Conclusions: We suggested that dexterity that interfered by an adding cognitive task occurred in both groups but to significant differences in individuals with schizophrenia. The interference might be related with daily functions of people with schizophrenia. It perhaps revealed that there were considerable relationships between ADL and dexterity interfered by the secondary task in schizophrenia. We suggested that the performance of dexterity at dual task might be a predictive factor of prognosis for real-world daily functions with schizophrenia.

並列關鍵字

Cognition ； Dexterity ； Dual-task ； Context interference ； Schizophrenia

參考文獻

Kelly, V. E., Eusterbrock, A. J., & Shumway-Cook A. (2012). A review of dual-task walking deficits in people with Parkinson's disease: Motor and cognitive contributions, mechanisms, and clinical implications. Parkinson's Disease, 2012, 14 pages. doi:10.1155/2012/918719

Alvarez-Jimenez, M., Priede, A., Hetrick, S. E., Bendall, S., Killackey, E., Parker, A. G., ... Gleeson, J. F. (2012). Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophrenia Research, 139(1-3), 116-128. doi: 10.1016/j.schres.2012.05.007

Al-Yahya, E., Dawes, H., Smith, L., Dennis, A., Howells, K., & Cockburn, J. (2011). Cognitive motor interference while walking: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 35(3), 715–728. doi: 10.1016/j.neubiorev.2010.08.008

American Psychiatric Association. (2013). Diagnosis and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

Andreasen, N. C., Rezai, K., Alliger, R., Swayze II, V.W., Flaum, M., Kirchner, P., … O'Leary, D. S. (1992). Hypofrontality in neuroleptic-naive patients and in patients with chronic schizophrenia. Archives of General Psychiatry, 49, 943–958. doi: 10.1001/archpsyc.1992.01820120031006