使用Counting Backwards快速篩選不識字之失智症患者之探討

The Use of Counting Backwards as a Rapid Screening Test for Dementia In Illiterate

黃心蔓(Hsin-Man Huang)

指導教授 ： 戴志達

高雄醫學大學/健康科學院/行為科學研究所/碩士(2005年)

摘要

失智症（Dementia）會造成記憶力及其他大腦功能，如語言、判斷、空間辨別能力等的衰退，影響日常的工作與生活。使用紙筆測驗評估認知功能，對於不識字者而言，易產生困難、壓力而無法完成測驗。因此，本研究的研究目的欲探討一個適用於不識字者之失智症患者的快速篩選工具。本研究分為研究一與研究二進行探討，研究一的部分主要目的在探討Counting Forwards與Counting Backwards的信度與效度，研究二的部分主要在瞭解Counting Forwards與Counting Backwards應用於不識字之失智症患者的情形。研究工具包括：基本資料、Counting Forwards、Counting Backwards、CASI、Neuropsychiatric Inventory（NPI）、Clinical Dementia Rating（CDR）。在研究一中，信度檢定的受試者共27人，效度檢定的受試者共182人。在研究二中，參與研究的受試者共102人，病人組60人，對照組42人。

在本研究結果中，Counting Backwards較Counting Forwards適用於篩選不識字之失智症患者。Counting Backwards的再測信度與評分者間信度為.99與.98，與MMSE、CASI的效標關聯效度為-.61與-.68，信度與效度皆有統計學上的顯著水準（p ＜0.01）。使用ROC曲線決定其最佳的界斷分數為38.5秒，敏感度為.850，特殊性為.786。本研究結果呈現Counting Backwards屬於優秀的不識字之失智症患者的篩選工具，只需要受試者口語的表達，施測所需的時間最多僅需100秒，可用於社區大規模篩選或臨床上快速的篩選，將低於界斷分數懷疑有失智症者，再進一步安排完整的神經心理學檢查，可節省篩選失智症患者的時間。

關鍵字

失智症 ； 不識字 ； 快速篩選測驗 ； Counting Backwards

並列摘要

Dementia is a progressive degenerative brain disorder that results in the deficits of memory and cognitive functions, such as language, judgment, visuospatial abilities. For illiteracy, using pen & paper tests to evaluate cognitive functions may have difficulty and stress in performing neuropsychological tests. The purpose of the present study was to find a rapid screening test for dementia in illiterate. The present study included study 1 and study 2. In study1, we wanted to understand the reliability and validity of Counting Forwards and Counting Backwards. In study 2, we would apply Counting Forwards and Counting Backwards to illiterate dementia patients. Tests of Counting Forwards, Counting Backwards, Cognitive Abilities Screening Instrument （CASI）, Neuropsychiatric Inventory（NPI）, and Clinical Dementia Rating（CDR） were administered. In study 1, there were twenty-seven participants in the analysis of reliability, and one hundred and eighty-two participants in the analysis of validity. In study 2, there were all one hundred and two participants, sixty Alzheimer’s disease patients, and forty-two illiterate controls.

The results showed that Counting Backwards was superior Counting Forwards to screen dementia in illiterate. The test-retest and inter-rater reliabilities of Counting Backwards were .99 （p ＜0.01）and .98（p ＜0.01）, and the correlation with MMSE and CASI were -.74（p ＜0.01） and -.77（p ＜0.01）. The ROC curve showed 38.5 seconds as the optimal cutoff point for these illiterate, and having a sensitivity of 85.0％ and a specificity of 78.6％. Counting Backwards has good sensitivity and specificity for dementia screening in the illiterate, it just needs oral expression, and the time of administration is less than 100 seconds. Therefore, Counting Backwards can apply to communities or clinical as a rapid screening test for dementia in the illiterate, referring high of cutoff point subjects to receive intact neuropsychological examination to evaluate the impairments of cognitive functions.

並列關鍵字

Dementia ； illiterate ； Counting Backwards ； rapid screening test

參考文獻

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