以生活為導向老年人認知訓練效果之先驅試驗

本研究之目的從「預防」及「減緩」高齡者身心失能的觀點出發且運用實證介入研究的方法，結合職能治療學系「臨床見習」課程，研究者與師生共同設計一套以生活情境與生活導向為基礎並結合認知刺激治療(CST)的活動-「生活認知刺激活動」，並探討此活動介入後能否增加或維持高齡認知衰退者認知、憂鬱與生活品質功能。以高雄市長青綜合服務中心日間照顧中心內的高齡者為本研究的收案對象，經初步篩選後，邀請25位具輕度認知缺損或輕度失智患者(MMSE大於等於14)參與此次研究；同時，採非隨機分派的方式將研究對象分成：實驗組(12人)參與14個主題的「生活認知刺激活動」；對照組(13人)參與機構一般日常活動或其他類型的團體活動。兩組於實驗前、後均檢測包含了主要成效測量為：簡易智能狀態測驗(MMSE)、阿茲海默症評估量表(ADAS-COG)、生活品質量表(QoL-AD)、及醫院焦慮憂鬱量表(HADS)。經14週的課程介入後，實驗組其認知功能變化於前測平均26.30 ± 8.88，後測平均19.99 ± 4.89，且於統計上達顯著差異(t =4.483，pp= .001)；而在對照組發現認知功能變化 (前測21.7± 10.05，後測20.83 ± 11.44)，但無顯著差異(t =1.613，pp= .133)。憂鬱和生活品質則無顯著差異。此數據顯示實驗組在「生活認知刺激活動」介入後，認知功能可改善並優於對照組。從臨床角度來看，14週以生活為導向老年認知訓練認知刺激介入活動對於輕度認知衰退者是有助益的，未來可作為社區健康促進計畫之參考。

關鍵字

認知刺激活動；輕度認知障礙；失智症

並列摘要

This study developed a Cognitive Stimulation (CST) activity, based on the live circumstances and life guide, to prevent and mitigate the elder with MCI and dementia for activities of daily living and quality of life. Thirty elders with MCI and dementia (65 to 85 years old and MMSE ≥ 14) from the senior citizen's service center in Kaohsiung city were enrolled in a fourteen-week cognitive stimulation therapy activity, and they were divided into an experimental group (15 participants who participated in the cognitive stimulation activity in live) and a control group (15 participants who participated in daily living or group activities). A one-group pretest-posttest design was employed to evaluate the effect of the treatment on participants’ MMSE, ADAS-COG, QoL-AD, and HADS. The experimental results showed the experimental group had significant improvements in their ADAS-COG (t =4.483，p= .001) between pre-test (26.30 ± 8.88) and post-test (19.99 ± 4.89). In contrast, the control group had no significant improvements in their ADAS-COG(t =1.613，p= .133) between pre-test (21.7± 10.05) and post-test (20.83 ± 11.44). The analytical results indicated that the participant’ cognitive function displayed positive improvement when they were involved in Cognitive Stimulation (CST) activity. Moreover, there was a meaningful finding associated with using cognitive stimulation activity future researchers and designers, namely, make it prevent and mitigate the elder with MCI and dementia for activities of daily living and quality of life from a clinical point of view.

並列關鍵字

CST ； MCI ； Dementia

參考文獻

Rejeski, W. J., & Mihalko, S. L. (2001). Physical Activity and Quality of Life in Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(suppl 2), 23-35. doi: 10.1093/gerona/56.suppl_2.23

王培寧、林克能、劉秀枝 (2012)。輕度認知障礙之診斷與治療: 台北榮總經驗。應用心理研究，55，15-35.