探討認知刺激介入對輕度失智症長者改善認知功能與憂鬱狀態之成效

Exploration of the ability of a cognitive stimulation intervention to improve cognitive function and reduce depression in elderly individuals with mild dementia

張雅雯(Ya-Wen Chang)

指導教授 ： 李淑杏

中山醫學大學/醫學院/護理系長期照護碩職專班/碩士(2021年)

https://doi.org/10.6834/csmu202100235

摘要

背景：台灣失智症人口增加，隨著年紀愈大盛行率愈高，老人健康照護問題更日趨複雜化，政府於2016年9月通過「長期照顧十年計畫2.0」政策，在全台灣每個縣市發展失智症社區服務資源，結合醫療專業與失智社區照顧服務資源其延緩失智症成效值得探討。
目的：本研究探討認知刺激介入對失智據點65歲以上輕度失智症長者其認知功能與憂鬱狀態之成效。
設計：本研究採類實驗性研究設計。
方法：於2020年01月至06月期間，以中部某醫院其設置失智據點及神經內科門診之65歲以上輕度失智症個案為收案對象，採非隨機分成實驗組及對照組。本研究收案43位，實驗組21位、對照組22位。
實驗組與對照組完成前測，實驗組給予認知刺激介入活動。每週2次、每小時之認知刺激介入，控制組則無介入活動，兩組並於第4週、8週、12週進行後測。研究最後階段，實驗組流失1位，對照組流失2位，完成率為93%。資料進行編碼，再以SPSS進行統計分析；敘述性與推論性分析含X2test,t-test, repeated ANOVA 與 GEE。
結果：本研究對象平均年齡76.6±7.2歲，實驗組與對照組人口學資料、生活型態與疾病特性同質性高。認知刺激介入後，實驗組在第4、8、12週的認知功能和憂鬱狀態均較對照組明顯改善(p <.05)。採用GEE模式分析輕度失智症長者認知功能變化，研究結果顯示，教育程度、年齡及時間交互部分對輕度失智症長者認知功能有顯著相關性，達統計上顯著意義(p <.05)。輕度失智症長者的認知功能每年下降0.366分，實驗組教育國中程度的認知功能比不識字者提高9.397分；隨著介入時間越長，實驗組的認知功能顯著增加。以GEE模式分析輕度失智症長者憂鬱狀態變化，研究結果顯示，性別、教育程度及時間交互部分對輕度失智症長者憂鬱狀態具有顯著相關性，達統計上顯著意義(p <.05)。有受教育的人比不識字的人不易出現憂鬱情形，而隨著時間的變動，男性比女性更不容易出現憂鬱情形；且實驗組的憂鬱狀態隨著介入時間的增加而顯著改善。
結論：本研究結果顯示透由12週認知刺激介入活動，隨著時間增加，能提升輕度失智症長者的認知功能並改善憂鬱狀態。故本研究實驗實證數據結果可提供後續長照據點之課程運用，配合政府長照2.0政策，於社區的據點針對失智症長者安排一系列認知訓練課程，不需要昂貴設備或器材，即可延緩失智症長者認知退化、憂鬱狀態；培訓並教育護理人員及長照人員學習認知刺激活動課程，並運用在臨床實務上，帶給許多失智症長者在認知刺激與生活情感上的體驗。

關鍵字

輕度失智症 ； 認知刺激介入 ； 認知功能 ； 憂鬱狀態

並列摘要

Background: The number of patients with dementia in Taiwan is increasing. The ability of community service resources, combined with medical professional and community care service resources, to delay dementia are worth exploring.
Aim: To explore the ability of a cognitive stimulation intervention to improve cognitive function and reduce depression in elderly individuals with mild dementia.
Design: Quasi-experimental research design.
Methods: Between January and June 2020, 43individuals over 65-years-old with mild dementia from a mainly dementia and neurology clinic at a central hospital were recruited and non-randomly divided into the experimental (n=21) or control (n=22) groups. Both groups completed the pre-test. The experimental group was exposed to cognitive stimulation intervention activities for one hour twice a week; the control group received no intervention activities. Both groups were subjected to post-tests in the 4th, 8th, and 12th weeks. In the final stages of the study, the experimental group lost one subject and the control group lost two subjects (completion rate, 93%). The data was coded and analyzed using SPSS; narrative and inferential analysis includedΧ2tests, t-tests, repeated ANOVA and GEE.
Results: The average age of the subjects was 76.6±7.2 years; the demographic, lifestyle and disease characteristics of the groups were highly homogenous. After the cognitive stimulation intervention, the experimental group exhibited significant improvements in cognitive function and reductions in melancholy state at 4, 8 and 12 weeks (p<.05 vs. control group). The GEE model showed that the level of education, age, and time correlated significantly with cognitive function (p<. 05). The cognitive function of elderly individuals with mild dementia decreased by 0.366 each year. The cognitive function of the experimental group with middle school education increased by 9.397 than those who were illiterate. The cognitive function of the experimental group increased significantly as the duration of the intervention increased. The GEE model also showed that the interaction of gender, education level, and time correlated significantly with depression status (p<.05).Educated individuals were less likely to be depressed than illiterate individuals; as time progressed, males were less likely to be depressed than females; and the depressive state of the experimental group significantly improved as the duration of the intervention increased.
Conclusion: Twelve weeks of cognitive stimulation interventional activities improved the cognitive function and reduced depression among elderly individuals with mild dementia. Therefore, these experimental empirical results provide a basis for follow-up long-term care. In line with the Government's Long-Term Care 2.0 Policy, a series of cognitive training courses that do not require expensive equipment or equipment could be arranged at community hubs. Nursing and long-term care staff could be trained to deliver these cognitive stimulation activity courses in clinical practice to improve the cognitive stimulation and life emotions of many elderly people with dementia.

並列關鍵字

mild dementia ； cognitive stimulation intervention ； cognitive function ； depression

參考文獻

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