- 學位論文
音樂對於健康老人與主觀認知退化個案之自律神經系統與焦慮情緒之影響
The Effects of Music on Autonomic Nervous System and Anxiety in Healthy Elderly and Persons with Subjective Cognitive Decline
摘要
失智症是全球關注的重要議題，近年來相關研究也逐漸往前延伸至被視為是失智症危險因子的主觀認知退化(subjective cognition decline, SCD)。此族群雖尚無症狀出現，但除認知相關抱怨外，也常伴隨焦慮之情緒，而此焦慮情緒可能會進一步導致認知功能的退化，然而目前關於主觀認知退化族群多聚焦於其認知功能的介入，少有焦慮相關介入。在焦慮介入方面，音樂被視為是具效果，且安全、容易執行的介入方法。因此本研究將探討音樂應用於主觀認知退化族群之降低焦慮之效益，並進一步比較主觀認知退化族群與健康老人的焦慮情緒反應差異。 本研究使用單組前、後測之研究設計，參與本研究之受試者為神經內科門診轉介主觀認知退化個案10人及社區據點招募之健康對照老人15人。以主觀自評量表（中文版特質焦慮量表、焦慮視覺類比量表）與客觀評估工具（心律變異性、膚電活動）作為結果評量。研究流程如下：受試者先穿戴生物回饋之偵測系統，接著進行認知任務以提升其緊張與焦慮程度，再以隨機順序提供其喜愛的音樂或白噪音，比較音樂與白噪音對於降低焦慮情緒之立即效益，並進一步比較兩族群的效果差異。 結果顯示心率變異性之高頻功率與副交感神經的變化無一致之反應，但代表交感神經活性之膚電活動在音樂介入（p = .002，Z = -3.027）及白噪音介入（p = .001，Z = -3.323）後有顯著下降，而單純休息則無顯著下降；主觀焦慮視覺類比量表之分數也有相同的正面效果，但差異並未達顯著。此外，也發現主觀認知退化個案與焦慮特質較高者有較大的自律神經變化幅度。 音樂與白噪音介入皆可有效降低客觀之焦慮情緒反應，而音樂有較高的主觀接受度，顯示音樂應用於健康老人與主觀認知退化個案族群，為一有立即效果且可行性高的焦慮介入方式。建議未來可增加樣本數，延長介入及收集資料的時間並選擇合適之焦慮刺激，以驗證音樂對於主觀及客觀焦慮情緒反應之效應。
並列摘要
Subjective cognitive decline (SCD) is considered as a risk factor of dementia and associates not only with cognition deterioration but with higher anxiety level. Anxiety may further lead to decreasing cognitive function and negative impacts on the well-being and quality of life. To ease anxious emotions, music has been viewed as an effective, safe and easy alternative to medication. However, little research has focused on older adults and persons with SCD. Thus, the purpose of this study is to investigate the effects of music on reducing anxiety of the healthy elderly and persons with SCD and to compare the anxiety level between SCD and healthy controls. Single subject pretest-posttest design was used. 10 SCD subjects referred from the memory clinics and 15 healthy controls recruited form the community participated this study. The anxiety level was assessed both by self-reports (State-Trait Anxiety Inventory and Visual Analogue Scale of Anxiety) and by objective measurements related to autonomic nervous system activities (heart rate variability and electrodermal activity). Preferred music and white noise were provided to ease participants’ anxious emotion which was raised by cognitive iPad games. Although there was no positive effect after three interventions in the aspect of heart rate variability, results of electrodermal activity showed that only music and white noise could decrease skin conductance and the activation of sympathetic nervous system. The results were consistent with self-reported VAS scores. Furthermore, persons with SCD and higher anxious trait tended to have larger physiological responses. Music and white noise both showed positive effects on reducing anxious level in both subjective and objective aspects and music seems to be more acceptable and feasible. Further studies with larger sample size are needed to reach more significant and generalizable outcomes. The recording time of baseline status and interventions can be increased to ensure that participants get calm and ready.
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