臺灣常見腦部疾病患者智力之組型與病前智力推估於臨床適用性之探討

An Exploration on the Intelligence Patterns in Taiwanese Patients with Common Brain Diseases and the Clinical Utility of the Premorbid Estimation of Intellectual Function

陳嘉淳(Jia-Chun Chen)

指導教授 ： 花茂棽

國立臺灣大學/理學院/心理學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201701968

摘要

背景：台灣仍缺少中樞神經系統疾患患者之智力組型及分數資料庫，為瞭解患者過去的認知功能水準，在取得患者的人口學變項後，使用回歸公式推估其病前智力。雖然魏氏成人智力量表具備有良好的測驗信效度及臨床適用性，而目前使用的推估公式也與國外文獻所建議的分測驗組合一致，但使用至今尚未有研究檢驗此公式的臨床適用性，公式也尚無機會發表。目的：(一)建立臺灣常見中樞神經系統疾患患者之智力組型的資料庫；(二)檢驗目前估計病前智力之回歸公式，是否具備臨床適用性。方法：本研究回顧臺大醫院神經部2005至2017年2月，完成全套神經心理衡鑑、並包含魏氏成人智力量表十項分測驗之患者，共440名；依據症候群及病因分成12組，建立智力分數數據，並以失憶單項型輕度認知障礙(aMCI-s)為參照組，驗證估計方式之臨床適用性。結果：由阿茲海默症及血管問題引起的aMCI-s，進展至失憶多項型輕度認知障礙(aMCI-m)時，整體智力表現即有所退步，又以失智症組的分數退化最多；而巴金森氏症(PD)無論在單純或多面向型失憶型輕度認知障礙、極早期失智症的智力表現均無明顯差異，但操作智商顯著低於語文智商。根據臨床適用性，針對aMCI-s組，人口學變項合併常識或類同分測驗適合估計病前語文智商，而人口學變項合併圖畫補充或矩陣推理適合估計病前操作智商；針對PD組，人口學變項合併語文分測驗適合估計病前語文智商，然而病前操作智商僅適用單純人口學變項估計。此外，亦發現可供臨床實務使用及參考的其他不同組合之估計方式。結論：本研究完整呈現12組患者的智力組型，包含過去研究甚少探討的輕度認知障礙，並提供病前智商的估計參考。建議未來研究重複驗證單純及多面向型輕度認知障礙的各別智力組型，以利臨床衛教及預後之參考。

關鍵字

魏氏成人智力量表第三版 ； 智力組型 ； 病前智力推估 ； 輕度認知障礙 ； 失智症 ； 阿茲海默氏症 ； 腦血管疾病 ； 巴金森氏症

並列摘要

Background: No studies to date have investigated the intelligence patterns of patients with CNS diseases in Taiwan. To understand patients’ premorbid abilities, clinicians usually collect their demographics and use regression equations to estimate the premorbid IQ. However, no research to date has validated the clinical utility of those regression equations in Taiwan. Objectives: (1) To explore the intelligence patterns in Taiwanese patients with common CNS diseases. (2) To validate the clinical utility of premorbid estimation of intellectual function. Methods: The current study recruited 440 patients of neurology clinics of NTUH from January 2005 to February 2017 in Taipei, Taiwan. All participants had completed comprehensive neuropsychological assessments including ten WAIS-III subtests. Based on etiologies, the study assigned participants into different syndrome groups, calculated the intelligence scores for each group, and compared the clinical utilities of the different combinations of formulae according to disease characteristics. Results: Intelligence scores declined as aMCI-s-AD and aMCI-s-CVD progressed to aMCI-m, and those of subjects with dementia deteriorated the most. Patients with MCI-s, MCI-m, and very mild dementia due to PD had similar intelligence patterns, and their PIQs were significantly lower than their VIQs. In consideration of the clinical utility, the study suggests using demographic variables (DV) with the Information or Similarities subtest to estimate premorbid VIQ, and using DV with Picture Completion or the Matrix Reasoning subtest to estimate premorbid PIQ for aMCI-s patients. Moreover, the study recommends using DV with Verbal subtests to estimate premorbid VIQ and using DV only to estimate premorbid PIQ for all PD groups. Moreover, the results also revealed different combination methods for estimated premorbid IQ scores that might match the needs of practical settings. Conclusion: The current study presents the intellectual patterns of 12 neuropsychological syndromes due to CNS diseases, including MCI subtypes that were previously uninvestigated. The study also presents appropriate methods of estimating premorbid IQ. The results need further validation, especially those of MCI subtypes, as a possible reference in mental health education and prognosis.

並列關鍵字

WAIS-III ； intelligence pattern ； estimated premorbid IQ ； mild cognitive impairment ； dementia ； Alzheimer’s disease ； cerebral vascular disease ； Parkinson’s disease

參考文獻

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