臺灣輕微認知功能障礙樂齡族群眼生理與視功能之相關比較

Relationship between eye physiology and visual function among senior citizen with mild cognitive impairment in Taiwan

朱禹(CHU YU)

指導教授 ： 蘇國禎

共同指導教授 ： 鄭靜瑩(Ching-Ying Cheng)

中山醫學大學/醫學科技學院/視光學系/碩士(2021年)

https://doi.org/10.6834/csmu202100097

摘要

目的
臺灣人口老年化的狀況日趨嚴重，隨著年齡的增長，出現認知功能障礙的人愈來愈多，造成社會成本的增加，若能在輕微認知功能障礙(MCI)的階段裡接受適當的治療或處置，就能有效預防發病或減緩發病的速度。由此，本研究企圖以臨床的雙眼視覺功能變化或視網膜的變化預測MCI的發展，並用以推測兩者之間的因果關係。
方法
本研究對象收納年齡為60歲以上之臺灣成年人，研究對象先填寫基本資料及認知問卷(Addenbrooke’s Cognitive Examination-ACE-R第三版)之後，接著進行他覺式驗光、自覺式驗光、遠（近）距離之眼位測量、立體視覺、近距離對比敏感度、色彩視覺、King Devick Test、眼動發展測驗(DEM)、干涉光視網膜斷層掃描儀(OCT)和黃斑部色素檢測。研究將所有研究對象之檢測結果、基本資料、及認知問卷之得分，以SPSS V22.0進行統計分析。
結果
年齡與教育程度是ACE各項度得分的重要因子，尤其在記憶方面退化得最為明顯；同時年齡與教育程度亦對雙眼視覺功能以及眼生理的檢測結果造成某個程度的關聯性。
在雙眼視覺、眼生理與認知功能的分析當中，眼位狀態、色覺與認知功能之間並無顯著相關；KD、DEM、黃斑色素、以及視網膜的厚度分析均可顯著的鑑別受測者在認知能力中的表現。其中黃斑厚度對記憶的有很強的相關性，且眼動異常者就算黃斑厚度正常，其記憶的表現亦不佳；DEM與黃斑部外圈下側厚度均不佳的患者，亦可能更突顯其對記憶的關聯性。DEM及黃斑色素密度均不佳的患者，更突顯其對總分、流利性、及語言項目的關聯性；此外，DEM及黃斑部內圈下側厚度均不佳的患者，會突顯其對視覺空間及語言流利性的關聯。
討論
認知功能障礙在初期或者是發病早期並不容易被發現，臨床使用簡單、便宜的KD和DEM來做做為檢測工具，可以有效的預測輕微認知功能障礙。若進一步輔以黃斑密度或視網膜厚度檢測，視覺功能與眼生理的交互分析下，可以有效的預測認知、記憶、語言能力、語言的流利性、及視覺空間的發展。除了早期發現早期治療之外，未來是否有可能透過視覺訓練延緩失智症發展的進程，非常值得努力。

關鍵字

雙眼視覺機能 ； 輕微認知功能障礙 ； 視覺生理 ； 失智症

並列摘要

Purpose
The problem of aging society in Taiwan is becoming more serious. More people suffer from cognitive impairment with aging, which leads to an increase in social cost. If managed with appropriate treatments during the progression mild cognitive impairment (MCI) stage, the diseasr can be effectively prevented or slowed.Therefore, this study attempts to establish relationship between the development of MCI and the change in binocular visual function change and retinal physiolog.
Methods
Subjects recruited in this study were Taiwanese adults over the age of 60, who were asked to fill out basic personal information and cognitive questionnaires (Addenbrooke's Cognitive Examination-ACE-Ⅲ), Objective refraction, subjective refraction, dissociated phoria tests at both distance and near, stereopsis test, contrast sensitivity test at near, color vision test, King Devick Test, Developmental Eye movement Test, Optical Coherence Tomography test(OCT), and macular pigment screening.were also performed The study used SPSS V22.0 for statistical analysis of all the test results.
Results
Age and educational level are important factors that influnence the scores of ACEs, especially in terms of memory degradation. Furthermore, age and educational level also have a certain degree of correlation with binocular visual function and ocular physiology test results.
The analysis on binocular vision, visual physiology and cognitive function showed that there is no significant correlation between dissociated phoria, color vision and cognitive function; however, KD, DEM test, macular pigment, and retinal thickness analysis can clearly differentiate participants’ cognitive abilities.
The thickness of the macula has a strong correlation with memory. However, those with abnormal eye movements have poor memory performance regardless of macular thickness.
Patients with poor eye-movement and is also associates with thin outer inferior ring of the macula may also has strong correlation with memory abilty.
In patients with poor eye-movement and uneven macular pigment density,the correlation with total score, language ability and fluency are more prominent; in addition, patients with poor eye-movement and patients with thin inner inferior ring of the macula have low visuospatial ability and language fluency.
Discussion
Cognitive dysfunction is not easily identified in the early stage of onset. The use of simple, inexpensive clinicey tests like KD and DEM test as diagnostic tools can effectively predict patients as having mild cognitive impairment. With the combined use of macular density or retinal thickness detectors, and visual function and visual physiology analysis, we can effectively predict the degradation of cognition, memory, language ability, language fluency and visual space and peripheral awareness. Inaddition to the strategy of early detection and early treatment, the possibility of slowing down the development of dementia through visual training is worthy exploring.

並列關鍵字

Binocular vision ； Mild Cognitive Impairment ； Visual physiology, Dementia

參考文獻

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