探討預測酒精使用疾患的平衡能力之臨床與認知因素

研究目的有三：(1) 比較酒精使用疾患 (alcohol use disorder, AUD) 患者與年齡相若的健康成人在平衡與認知能力的表現差異：(2) 探討AUD嚴重度對平衡變項的影響；以及 (3) 檢驗預測AUD患者平衡能力的認知因素。本研究共招募酒癮患者（依據DSM-5的酒精使用障礙或酒精中毒之診斷標準）與年齡相若之健康成人各60名（年齡介於45-65歲），並收集受試者之人口學/臨床資料、平衡功能和認知能力（注意力、視知覺及執行功能），並分別採用單因子變異數分析、因素分析及迴歸分析檢驗不同族群之平衡和認知差異，以及平衡功能之認知預測因子。本研究主要發現有三：(1) 健康成人於所有平衡和認知測驗的平均分數均高於AUD患者； (2) 平衡測驗中以單腳站立測驗、功能性伸展測驗和計時起走測驗最能顯示出不同AUD患者之間以及與健康者之間的平衡表現差異。認知測驗中則以路徑描繪測驗、班頓線條方向判斷測驗與洛文斯坦職能治療認知評估工具的思考操作分量表最能顯示出不同AUD患者之間以及與健康者之間的認知能力差異； (3) 洛文斯坦職能治療認知評估工具的思考操作分量表（執行功能）對各種平衡功能測驗之迴歸係數均較高 (Beta = 0.311)，顯示其為AUD患者平衡功能之較佳預測因子。總結而論，酒癮程度確會影響患者之平衡功能，且單腳站立測驗、功能性伸展測驗和計時起走測驗最能呈現其平衡功能之差異，而該平衡功能的差異較能為洛文斯坦職能治療認知評估工具的思考操作分量表所預測。本研究之結果將有助於臨床人員及早透過合適的評估工具來篩選並瞭解不同AUD患者的平衡和認知程度，並擬定對應之介入計畫，減少跌倒風險頻率，且教導認知缺陷的生活代償方式，達到職能治療預防性成效和提升日常生活品質。

關鍵字

酒精使用疾患；平衡；注意力；視知覺；執行功能

並列摘要

The purpose of this study is threefold: (1) To demonstrate the magnitude of alcohol use disorder (AUD) patients’ balance and cognition deficit with age-paired healthy adults; (2) To explore the effect of AUD severity on the balance function; and (3) To examine the cognitive predictors of AUD patients’ balance ability. The study recruited each of 60 participants in the AUD (according to criteria of the DSM-5) and normal groups with age ranged from 45 to 65 years. We collected the participants’ demographic and clinical variables, and measured their balance function and cognition ( attention, visual perception, and executive function). The one-way analysis of the variance and factor analysis wre used to demonstrate differences of the participants’ average balance scores whilst the multiple regressions was used for identify the cognitive predictors of balance function. The results had 3 main findings: (1) The average scores in balance and cognition of normal group were better than those of the patients with AUD; (2) It is best to show that the difference in balance between different AUD and the normal group is the One-leg standing test (OLS), the Functional Reach Test (FRT) and the Timed Up and Go Test (TUG), and the difference in cognitive ability is the Trail Making Test (TMT), the Benton Judgment of Line Orientation Test (BJLOT) and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) thinking operations ; and (3) The thinking operations subscale (executive function) showed the higher standardized regression coefficient (Beta = 0.311) than those of other measures. In conclusion, the AUD severity appears having effect on patients’ balance function, which can be well demonstrated by the OLS, the FRT and the TUG, and predicted by the LOTCA- thinking operations subscale . These results can be helpful for clinicians to screen and understand the balance and awareness of different AUD patients through appropriate assessment instruments and develop corresponding intervention plans to reduce the frequency of falls and teach cognitive compensation for life compensation. To achieve functional preventive effects and improve the quality of daily life.