自陳式認知功能量表之發展與試驗

王曉琳

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自陳式認知功能量表之發展與試驗

The development and validation of the self-reported cognitive function scale

王曉琳 , Masters　　Advisor：潘璦琬　　

繁體中文

認知障礙；神經疾患生活品質成效計劃；自陳式量表；認知功能量表；羅序分析模式； Cognitive function ； Self-reported scale ； Rasch model ； Quality of Life in Neurological Disorders measures(NEUROQOL) ； Cognitive Function Scale

Abstract │ Reference (85) │ Altmetrics

Abstract 〈TOP〉

中文版神經疾患生活品質應用式認知一般關注事項 (簡稱為中文版NEUROQOL一般關注量表)以及中文版神經疾患生活品質應用式執行功能量表 (簡稱為中文版NEUROQOL執行功能量表)為兩份用以評估認知功能的工具，分別包含44題及42題，皆為5分量尺。本研究的目的為驗證此兩份量表應用於居住於社區的健康個案的心理計量品質。
本研究共收集200位健康個案的資料。其年齡介於20至63歲之間，平均年齡是28.55歲(標準差=9.7歲)。其中62%是男性；77%個案未婚；31%是學生。本研究以羅序分析模式與傳統測量理論檢驗量表之內在一致性、建構效度、同時效度及區辨效度。
本研究結果將中文版NEUROQOL一般關注量表調整為四十題，部分項目評分調整成四分量尺後所有項目的合適度皆符合羅序分析模式，，具有單一建構效度，可精確地測得個案的一般關注認知程度 (98%)．可用以將個案分為十二階層來區辨其一般關注認知程度。中文版NEUROQOL執行功能表調整為二十九題，部分項目評分調整成三分及四分量尺後，所有項目的合適度皆符合羅序分析模式，具有單一建構效度，可精確地測得個案的執行功能認知程度(70.5%)．可用以將個案分為九階層來區辨其執行功能認知程度。本研究結果也證實此兩份量表具有可接受之內在一致性(Cronbach’α值為0.955及0.967)。中文版NEUROQOL執行功能量表與簡短智能量表、魏氏記憶力測驗第三版及分測驗數--字序列呈現中度顯著相關(r=.424,p<0.001；r=.331,p<0.001；r=.347,p<0.001)，與威斯康辛卡片分類測驗呈現低度到中度顯著相關(r=.052~.249,p=.000~.464；r=-.112~-.237, p=.000~.115)。中文版NEUROQOL一般關注量表的分數在正常和重度憂鬱組間具有顯著差異；在正常與輕度及正常與中度焦慮組間具有顯著差異；在台大症狀量表組間結果顯示正常與各組間及輕度與中重度及重度有顯著差異。中文版NEUROQOL執行功能量表在憂鬱組間無顯著差異；在正常與輕度及正常與中度焦慮組間具有顯著差異，在台大症狀量表組間結果顯示正常與輕中度及極輕度與輕中度有顯著差異。以上結果顯示此兩份量表可有效地區辨不同程度憂鬱、焦慮及精神症狀組個案的認知功能。
根據研究結果建議，可考慮進一步應用此量表到思覺失調症個案上，做為檢測個案是否有認知復健之需求的工具。根據本研究收案的經驗，由於此兩份量表的題目直接與日常生活任務相關，因此所得的分數能夠反應復健的需求與方向。透過羅序分析模式，也一併提供此兩份量表的等級分數，用以區分個案認知功能。由於本研究是透過建置於網路的問卷，並以平板電腦來蒐集資料，過程顯示是一個有效能的收集資料模式，可做為未來臨床使用之參考。

Parallel Abstract 〈TOP〉

The Chinese Version of NEUROQOL Applied General Concerns Scale (NeuroQOL-AC-GC) and NEUROQOL Applied Executive Function Scale (NeuroQOL-AC-EF) were developed to evaluate the cognitive functions of the clients with neurological disease. There were 44 and 42 items within each scale. The aim of this study are to investigate the psychometric properties of these two scales for normal subjects dwelling in community of Taiwan.
There were 200 normal subjects participating in the study. Their age ranged from 18 to 63, the mean age is 28.55(SD=9.7); 62% were male; 76.5% were single. Rasch measurement model and classic test theory were applied to analyze the data. The final NeuroQOL-AC-GC contains 42 item of 4 or 5-point rating scales. All item had acceptable fit statistics and met unidimensionality requirement with Rasch analysis. It can measure participants’ cognitive level up to 98% accuracy. It can also be used to classify the subjects into 12 statistically distinct levels. The NeuroQOL-AC-EF contains 29 item of 3 or 4 or 5-point rating scales. All item had acceptable fit statistic and met unidimensionality requirement with Rasch analysis. It can measure participants’ cognitive level up to 70.5% accuracy. It can also be used to classify the subjects into 9 statistically distinct levels. The internal consistency of two scales were excellent (Cronbach's alpha = 0.955 and 0.967 prospectively). There was mild to moderate correlation among variables of NeuroQOL-AC-EF and Wisconsin Card Sorting Test-64 (r=.052~.249,p=.000~.464；r=-.112~-.237, p=.000~.115). There were moderate correlation among variables of NeuroQOL-AC-EF, Mini-Mental State Examination, WMS-III Working Memory total scole and Letter-Number Sequencing scole.(r=.424,p<0.001；r=.331,p<0.001；r=.347,p<0.001). There were significant differences of the general concerns score among groups varying degree of depression and anxiety severity. So were the results of the NeuroQOL-AC- GC. These results indicate that two scales can be used to differentiate the cognitive functions among persons with varying level of depression and anxiety. 
The findings provide further implication to suggest that these two scales could be potentially used as a tool to evaluate the needs for cognitive rehabilitation. According to our experiences, the results of the questionnaire were easy to transform to day to day task for training. The level of cognitive functions provided by the analysis could be used as an index of the progress of the rehabilitation of the clients. Finally, since the data of the the study was collected through the use of tablet PC via internet-based questionnaire, we found that it was easy and time-saving . In the future, there is need to collect data on the subjects with various mental illness diagnoses to provide further evidence of its psychometric qualities.

Reference ( 85 ) 〈TOP〉

Arnadottir, G., & Fisher, A. G. (2008). Rasch analysis of the ADL scale of the A-ONE. Am J Occup Ther, 62(1), 51-60.
連結：
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連結：
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連結：

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