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  • 學位論文

早期阿茲海默症患者之前向式記憶功能:臨床意義及其與監控記憶之關係

Prospective memory in the early stages of Alzheimer’s disease: Clinical implications and its relation to metamemory Prospective memory in the early stages of Alzheimer’s disease: Clinical implications and its relation to metamemory

指導教授 : 花茂棽

摘要


前向式記憶是個體記得在特定時刻進行某一意向的能力,其仰賴多項認知功能與廣布的神經網絡協作方得以完成。此功能在偵測早期阿茲海默病具有敏感性,並且在日常生活功能具有重要性,相關研究已逐漸受到重視。然而目前臨床上仍缺乏有關該功能的有效衡鑑工具、其背後的神經心理機制亦尚待釐清,故本論文進行四項研究,嘗試檢驗前向式記憶測驗工具在臨床診斷早期阿茲海默病的敏感度,並探討患者的監控記憶功能在前向式記憶缺損中所扮演的角色。在第一個研究中,我們檢驗台灣版前向與逆向記憶量表的心理計量特性,結果發現該量表具有內部一致性與建構效度,其因素結構具有一個普通因素、即情節記憶因素,與一個特定因素、即前向性記憶因素。在第二個研究中,我們評估由家屬填寫的前向與逆向記憶量表,是否能有效反映患者的前向記憶功能,結果發現它具有內部一致性與效標關聯效度,在辨識失智症患者時亦具有不錯的敏感度、特異性、及增益效度。在第三個研究中,我們測試單一嘗試的前向式記憶作業,在主觀報告有記憶問題、但在客觀認知測驗表現正常的年長者中,是否能偵測到其細微的認知功能改變?基於以時間作為線索的前向式記憶作業需仰賴額外的、自我起始的內在控制能力,結果發現該記憶作業,可敏感地偵測出這類屬於阿茲海默病的高風險族群。在第四個研究中,我們探討失憶型輕微認知功能障礙患者的監控記憶與其前向式記憶功能的關係,結果顯示輕微認知功能障礙患者,在前向式記憶作業表現不佳,並且在與前向式記憶作業同時進行的分心作業中,顯現較少因同步進行雙重作業時,需付出作業性代價(performance cost)的正常特徵;然而,患者有關監控記憶的知識、與對作業的監視(monitoring)和健康組沒有顯著差異。本論文指出在臨床衡鑑中測量前向式記憶功能的重要性與可行性,特別在阿茲海默病的早期偵測具有價值,基於研究發現,我們建議使用前向與逆向式記憶量表,與以時間為線索的前向式記憶作業,作為初步評估的工具。此外,由於監控認知的確影響輕微認知功能障礙患者的前向式記憶表現,針對阿茲海默病前驅期患者設計認知復健計畫時,應將監控記憶的處遇納入考慮。本研究屬於橫斷性質,有待進一步以追蹤性研究證實前向式記憶測量的預後價值。

並列摘要


Prospective memory, which is the timely execution of an intended action, is a multi- componential process that relies on multiple cognitive operations and conjoint functions of a distributed neural network. This cognitive construct has received growing attention because of its sensitivity to the early cognitive decline in Alzheimer’s disease (AD) and its functional relevance in real life. However, insufficient research has been conducted to develop practical tools for clinical assessment and to disentangle the underlying neuropsychological mechanisms. We thus performed four serial studies to examine the sensitivity of the screening methods and to investigate the role of the metamemory in prospective memory impairment of patients in the early stages of AD. In the first study, we evaluated the psychometric properties of the Taiwanese version of the Prospective and Retrospective Memory Questionnaire (PRMQ) in healthy adults. The results verified the internal reliability and construct validity of the PRMQ, where a general episodic memory factor and a specific prospective memory factor were fitted. In the second study we assessed the clinical utility of the informants’ ratings on the PRMQ. The results confirmed the internal reliability, criterion-related validity, and incremental validity of the informant form of the PRMQ. The informant-rated PRMQ also demonstrated good sensitivity and specificity in identifying patients diagnosed with dementia. In the third study, we examined if single-trail prospective memory tasks were capable of detecting subtle cognitive change in old adults who reported subjective cognitive decline (SCD) with normal performances on conventional cognitive tests. The results showed that a time-based prospective memory task, which additionally relies on self-initiated internal control, was a distinctively sensitive measure to detect this risk group of AD. In the fourth study, we measured metamemory functioning and observed its relation with prospective memory performance in patients with amnesic mild cognitive impairment (MCI). The results showed that the MCI patients performed poorly on the prospective memory test and evinced less costs of speed when performing concomitant activities. However, their metacognitive knowledge and prospective monitoring of prospective memory abilities were compatible to those of the controls. The present thesis highlights the significance and feasibility of prospective memory assessment in clinical practice, especially for the early detection of AD. Based on the present findings, we thus recommend using the PRMQ and time-based prospective memory tasks for the initial evaluation. Furthermore, since poor metacognitive control did contribute to the prospective memory impairment in patients with MCI, it thus appears necessary to highlight the role of the theoretical elements of metamemory in developing neurorehabilitation programs that aid individuals with prodromal AD. Nevertheless, longitudinal studies are needed to verify the prognostic value of prospective memory tests.

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