阿茲海默氏失智症長者的身體活動量、功能性體適能與憂鬱程度之相關研究

本研究針對輕、中度之阿茲海默氏失智症患者之身體活動量、功能性體適能、憂鬱程度，以及其主要照顧者之照顧負荷加以評估，並比對年齡相近之一般健康長者，以了解這些變項的退化程度與之間之相關性。本研究招募阿茲海默氏失智症長者20人及社區一般健康長者長者20人；社區一般健康長者先以簡易心智狀態問卷調查表進行篩選、確認為認知功能正常才可收案。兩組受試者皆進行老年人身體活動量表、老年憂鬱量表簡明版的測試，並評估其功能體適能，與手握力、肱二頭肌與股四頭肌肌力。阿茲海默氏失智症長者之主要照顧者需另完成主要照顧者負荷量表。資料分析使用的統計方法包括描述性統計、曼-惠特尼U檢定、皮爾森卡方檢定、皮爾森積差相關分析、斯皮爾曼等級相關係數。研究結果顯示，在阿茲海默氏失智症長者與社區一般健康長者的比較上，僅在身體活動量以及敏捷與動態平衡能力上有顯著差異；而將阿茲海默氏失智症長者進一步以臨床失智量表區分為輕與中度失智來比較，發現失智程度較嚴重者其身體活動量、敏捷與動態平衡能力、手握力及上肢肌力顯著較差，而主要照顧者負荷則有顯著增加。整體而言，阿茲海默氏失智症長者之身體活動量與手握力及上肢肌力為顯著負相關，憂鬱程度與上肢肌耐力、心肺耐力、手握力及上肢肌力為顯著負相關，但主要照顧者負荷為顯著正相關。總結本研究之結果發現，阿茲海默氏失智症長者在發病早期階段，大部分的體適能並不亞於社區一般健康長者，但敏捷與動態平衡能力較低。而隨著而認知能力進一步下降時（以臨床失智量表做分期），其身體活動量、敏捷與動態平衡能力、手握力及上肢肌力也會顯著下降，並伴隨有主要照顧者負荷增加的情形。另外，患者之憂鬱程度越高，則上肢肌耐力、心肺耐力、手握力及上肢肌力表現越差，主要照顧負荷也會提高。因此，阿茲海默氏失智症長者之體適能測試與長期追蹤有其必要性，並因以此作為訓練其體能、與維持身心狀態之依據。

關鍵字

阿茲海默氏失智症；身體活動；功能性體適能；憂鬱；主要照顧者負荷

並列摘要

This study was aimed to estimate the relationships of physical activity, functional fitness, depression and primary caregiver’s burden with patients among mild to moderate Alzheimer's dementia, comparing with healthy elderly, to understand the degree of degradation of these variables. We recruited 20 elderly patients who suffered from Alzheimer's disease (AD) and 20 healthy community elders (CE) in this study. The Short Portable Mental Status Questionnaire (SPMSQ) was used for the CE group to rule out any cognitive problem. Both groups had to complete the Physical Activity Scale for the Elderly (PASE) and Short-form Geriatric Depression Scale (GDS-SF), and tested for their functional fitness, including the handgrip, upper and lower limb strength. The main caregiver of Alzheimer’s disease also needed to complete the Caregiver Burden Scale (CBS). The statistical methods used for data analysis included descriptive statistics, Mann-Whitney U test, Pearson chi-square test, Pearson product correlation analysis and Spearman rank correlation coefficient. The results showed that there were significant differences in physical activity, agility and dynamic balance between AD and CE. When AD group with different stage of dementia (classified by the Clinical Dementia Rating Scale) were compared, we also found that when AD subjects’ cognitive declined, the amount of physical activity, agility and dynamic balance, handgrip strength, upper limb muscle strength were significantly decreased, and caregiver’s burden significantly increased. In the AD group, physical activity was found correlated with handgrip and upper strength, their depression was correlated negatively with upper limb muscle endurance, cardiopulmonary endurance, handgrip and upper limb muscle strength, but positively with the main caregiver’s burden. In this study, we revealed that in the early stage, AD subjects could perform as good as the CE group in most of the functional fitness testing except the agility and dynamic balance. However, with further cognitive declination, the physical activity, agility and dynamic balance, handgrip and upper limb muscle strength, and the main caregiver burden were significantly decreased. And with increase the level of depression in advanced AD subjects, the upper arm endurance, cardiopulmonary endurance, handgrip and upper limb muscle strength were decreased, and the caregiver burden increased. Therefore it is important to measure and to continuely monitor the physical fitness of the AD population, and provide training to maintain the physical capacity as well as psychological balance basing on these measurement results.