2015-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646014摘要：背景：輕度認知障礙(Mild Cognitive Impairment, 簡稱MCI)是處於認知功能正常與失智症之間的過渡狀態，國內65歲以上老人約達19%有MCI的情形，其為轉變為失智症的高危險群。如何提供有效的非藥物治療，維持患者認知及日常功能，延緩其退化至失智症，減輕社會醫療照護的花費，乃健康照護之重要課題。目的：探討複合式認知功能介入於提升MCI患者之認知功能、日常生活功能、生活品質，及延緩轉變為失智症診斷之立即療效與長期療效。並進一步探討三個月追蹤期持續提供低頻認知介入，對於療效維持的影響。方法：此二年期計畫為二階段式之縱貫性研究，研究對象為大台北地區醫學中心經確診之失憶型MCI患者，預計招募60位。研究第一階段，所有患者接受複合式認知介入，為期十二週，每週1次(90分鐘)之團體活動（含1次個別介入），內容將融合以下三類介入類型之理念與原則1) 認知訓練(注意力及記憶功能之強化活動訓練，與認知策略教導及演練)，2) 認知復健（瞭解個別日常活動執行之困難，進行問題解決與策略運用、輔助提醒工具的練習，並於模擬或真實情境中進行演練）， 及 3)生活型態介入（建立參與日常認知活動的習慣）。療效評估將於介入前及十二週介入結束後進行，主要成效評量指標為患者之認知功能（注意力、記憶等）、日常生活功能表現（主觀與客觀評量），次要成效評量為患者之生活品質及轉變為失智症的比率。第二階段為複合式認知介入方案追蹤期，研究者將執行單盲隨機控制試驗以探究低頻介入對於療效維持之可能效果。第一階段60名失憶型MCI患者將隨機分派至低頻介入追蹤組或關懷追蹤組，前者於第一階段3個月介入結束後持續提供第4-6個月，每兩週1次之複合式認知介入共計6次；後者則於相同時間點，每兩週提供衛教宣傳品及說明，第6個月之後則兩組均無任何介入，於第6個月、第9個月、第12個月進行再評，同時記錄患者之診斷是否轉變為失智症。資料分析： 第一階段將採paired t test，探討複合式認知介入後，患者在認知功能、日常生活功能、及生活品質是否有顯著改善。第二階段則使用廣義估計方程式(Generalized Estimating Equations, GEE)以瞭解兩組於各測量時間點(第3個月、第6個月、第9個月、第12個月)在各項評量指標之差異，以瞭解低頻介入對於提升患者之認知功能、日常生活功能、生活品質、降低照顧負荷是否仍保有療效，得知二組在各面向進展的趨勢，並比較二組轉變為失智症之比例是否有差異。研究結果可作為未來規劃MCI患者認知介入方案之參考，並優化失智預防與照護之醫療資源分配。<br> Abstract: Background: Mild cognitive impairment (MCI) is a transitional state between normal cognition and mild dementia. The prevalence of MCI among persons over 65 years old reach to almost 19%. This population is at greater risk of developing dementia. Therefore, it is important to develop effective interventions to maintain their cognitive and activities of daily living (ADL) function, which will also delay their progression to dementia and reduce the healthcare costs.Purpose: This study aims to: (1) determine the immediate and long-term efficacy of a combinative cognitive intervention in enhancing the cognitive and ADL function and the, quality of life, and in delaying progression to dementia in persons with MDI. (2) examine the efficacy of an additional 3-month low-intensity intervention in maintaining the treatment effects.Methods: Sixty persons with amnesic type of MCI diagnosis confirmed by physicians will be included from a medical center in Taipei. This 2-year longitudinal project will be carried out in two phases. In phase I, all participants will receive 12 weekly 90-minute combinative cognition interventions (11 group sessions and 1 individual session). Based on different assumptions and principles, 3 types of interventions are integrated in our intervention program: cognitive training, cognitive rehabilitation, and life style intervention. All participants will be assessed before and after the intervention using the cognitive tests (attention and memory), the ADL evaluation, the quality of life of AD, and the rate of progression to dementia. In phase two, the follow-up stage of the cognitive intervention, the efficacy of low-intensity intervention on the maintenance of treatment effects will be investigated in a single-blinded randomized control trial. Sixty persons with MCI will be assigned to the low-intensity follow-up group (receive intervention once per two weeks from the 3rd to the 6th month) or the usual group (receive health related educational booklet and instructions). Outcome assessments will be carried out during the follow-ups at 6, 9, and 12 months.Paired t test will be used to examine the immediate effects of combinative cognitive intervention on each of the outcome measures. A Generalized Estimating Equations (GEE) will be used in phase two to compare the performances of each outcome measure at each time point (the 3rd, 6th, 9th, an 12th month).The results can be used as a guideline for developing an effective cognitive intervention program and appropriate allocation of health care resources in persons with MCI.輕度認知障礙阿茲海默症認知訓練復健日常生活活動Mild cognitive impairmentAlzheimer’s diseasecognitive trainingrehabilitationactivities of daily living