Insight and Self-awareness in Patients with Alzheimer's Disease

阿茲海默氏病患者之病識感與自覺

詹金烈(Jin-Lieh Chan) ； 林志遠(Chih-Yuan Lin) ； 李黔芳(Chyan-Fang Lee) ； 詹麗琴(Li-Chen Chan) ； 林靜玉(Ching-Yu Lin)

《北市醫學雜誌》 11卷3期 (2014/09) Pp. 7-11

https://doi.org/10.6200/TCMJ.2014.11.3.02

摘要

目的：阿茲海默氏病（阿氏病）病人的自我認知逐漸地喪失，但失憶認知似乎比自我認知維持較久，果真如此，若能証實殘餘的、即使有缺陷的學習能力還在，而有助於建構更合宜的、個人化的復健策略將是實用的。方法：81位阿氏病病人，男女比28:53，年齡介於59~102歲，依簡易智能測驗（mini-mentalstatus exam）分數分為四組（早期：＞/=21, n=16；輕度：16-20, n=19；中度：11-15, n=30；重度：＜/=10,n=16）。每組都給予三項測試：1）自我認知：詢問病人的姓名、年齡、生日和子女數；2）目視物的口語命名：鉛筆、梳子、鑰匙；及3）失憶認知︰詢問病人是否有記憶障礙。只有答對每一項測試的全部細目，該測試才被視為正確反應（CR）。每一組病人中每一項測試的所有正確反應予以收集後加以比較、分析。結果：1）阿氏病的嚴重度與測試結果有一致性傾向。2）在輕度及中度阿氏病，當自我認知消失（CR=42%→0%），失憶認知還明顯存在（CR=84%→60%）。3）在早期阿氏病，有四位病人否認他們有記憶障礙。4）在輕度及中度阿氏病，目視物的口語命名結果與失憶認知較接近。結論：1）在輕度及中度阿氏病，當病人的自我認知逐漸消失之際，失憶認知還明顯存在，顯示它是一種學習效應。2）經由每日互動，在輕度至重度阿氏病，這學習而得的失憶認知比自我認知維持較強也較久。3）四位早期阿氏病病人否認他們有記憶障礙，乃因無法從周遭回饋中學習的結果。4）在輕度及中度阿氏病，失憶認知與目視物的口語命名結果較接近可能解釋為它是一種語言的皮質學習過程。阿氏病病人的學習潛能或可為輕、中度阿氏病的復健策略帶來指引的曙光。

關鍵字

失憶認知 ； 自我認知 ； 阿茲海默氏病 ； 學習潛能

並列摘要

Objectives: Self awareness is progressively vanishing in Alzheimer's disease (AD) patients, while insight of amnesia seemingly stays longer than self awareness. It is clinically informative to prove that the residual learning ability of the patients exists, though defective, to help construct a better individualized rehabilitative strategy. Methods: Eighty-one patients (M:F=28:53), aged 59~102, with AD dementia were divided into four groups by mini-mental status examination (MMSE) scores (early: ＞/=21, n=16; mild: 16-20, n= 19; moderate: 11-15, n=30; severe: ＜/=10, n=16). Each group was tested for 1) self awareness by asking each individual name, age, birthday and children number, 2) visual confrontation naming of 3 presented objects, namely pencil, comb, and key, and 3) insight of amnesia by asking whether or not they have memory problems. Only completing right answers to all items in each test was counted as correct response (CR). Numbers of CR in each test were collected for analysis. Results: A concordant trend was noted between the severity of AD and test results. In mild and moderate AD patients whose self awareness were vanishing (CR=42%→0%), the insight of amnesia remained to a significant degree (CR=84%→60%). In early AD, four patients denied memory problems. The test result of confrontation naming was closer to that of insight of amnesia in mild and moderate AD patients, as compared to that of self awareness. Conclusions: While self awareness is vanishing in mild and moderate AD patients, their insight of amnesia remained to a significant degree, suggesting a learning effect. The learned insight of amnesia, through daily interaction, stays longer and stronger than self awareness in mild to severe AD patients. The four patients in their early AD denying memory problems did not learn from environmental feedbacks. The closer test results of insight of amnesia with confrontation naming in mild and moderate AD patients suggest a cortical language learning process. The potential of learning in AD patients sheds guiding light on rehabilitative strategy in mild and moderate AD.

並列關鍵字

Awareness of amnesia ； self awareness ； Alzheimer's disease ； learning potential