輕度阿茲海默氏症患者的執行功能缺失與日常生活功能之關聯性

Executive function impairment and its relationship to activities of daily living in patients with mild Alzheimer’s disease

黃淑芬(Shu-Fen Huang)

指導教授 ： 蘇純瑩

共同指導教授 ： 汪宜霈(Yee-Pay Wuang)

高雄醫學大學/健康科學院/職能治療學研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00134

摘要

本研究的目的有四：(1) 分析輕度阿茲海默氏症患者與正常組在執行功能測驗表現的差異；(2) 探討輕度阿茲海默氏症患者在執行功能測驗的缺失模式；(3) 區辨執行功能測驗於輕度阿茲海默氏症患者和正常組的效度，以及 (4) 討論輕度阿茲海默氏症患者的執行功能缺失與日常生活功能之關聯性。本研究採方便取樣的方式招募31位58-87歲之輕度阿茲海默氏症患者 (臨床失智評估量表的分數為1分) 與31位年齡及教育程度相若的健康成人。每位受試者接受一系列的評量包括整體認知功能、智力、執行功能、日常生活功能和憂鬱。研究結果顯示輕度阿茲海默氏症患者在各個執行功能測驗的表現普遍落後於正常組，僅威斯康辛卡片分類測驗的結果無顯著差異。Z 分數顯示威斯康辛卡片分類測驗的固著反應、圖形設計流暢度、倫敦塔測驗的起始時間與叫色測驗皆低於平均值0-1個標準差；而彩色路徑描繪測驗、倫敦塔測驗總移動步數與破壞規則次數及語意流暢度則低於平均值1-2個標準差。彩色路徑描繪測驗和倫敦塔測驗具中等以上的良好區辨性。另一方面，叫色測驗的色字之顏色命名與輕度阿茲海默氏症患者的日常生活功能呈中度相關。總結而論，輕度阿茲海默氏症患者於不同執行功能面向皆有缺失，其中又以認知彈性、問題解決、計劃能力及干擾訊息的抑制有較顯著的缺損。抑制能力會影響患者的日常生活功能。這些發現可作為輕度阿茲海默氏症的評估與治療之重要參考。

關鍵字

輕度阿茲海默氏症 ； 執行功能 ； 日常生活功能

並列摘要

The purposes of this study were fourfold: (1) to analyze the differences in executive function between patients with mild Alzheimer's disease (AD) and normal controls, (2) to examine the patterns of executive function deficits in AD patients, (3) to investigate the discriminant validity of measures of executive function, and (4) to evaluate the relationships between executive function and activities of daily living in AD. Convenience sampling was used to recruit thirty-one mild AD patients aged 58-87 (Clinical Dementia Rating Scale score = 1) and 31 age- and education- matched healthy controls. All participants were administered a series of tests on global cognitive function, intelligence, executive function, activities of daily living and depression. The results showed significant between-group differences in all measures of executive function except the Wisconsin Card Sorting Test (WCST). Patients had z scores of between 1 and 2 standard deviations (SD) below the control mean on the Color Trails test (CTT), the total move and rule violation scores of the Tower of London (TOL), and verbal fluency, while their z scores on the WCST perseverative responses, figure fluency, the TOL initiation time, and the Stroop test fell within -1 SD of the control mean. The CTT and TOL had moderate discriminant validity. In addition, the Stroop test color-word was moderately correlated with the total scores of the basic and instrumental activities of daily living scales. Taken together, mild AD patients exhibited deficits in almost all executive function tests, of which cognitive flexibility, problem solving, planning, and response inhibition were the most impaired. The response inhibition was associated with functional abilities. These results provide an important basis for the evaluation and treatment in patients with mild AD.

並列關鍵字

mild Alzheimer's disease ； executive function ； activities of daily living

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