2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646019摘要：輕度認知障礙(Mild Cognitive Impairment, 簡稱 MCI)是失智症的高危險群。如何提供有效的非藥物治療，促進其認知及日常生活功能，避免或延緩其退化至失智症，是健康照護之重要課題。然文獻中認知介入的形式與內容多元，介入內容主要分為回復性(remediation approach)及代償性(compensation approach)二類型訓練，目前極待釐清不同類型認知介入療效之異同，作為因應不同個案需求與介入目的時，認知介入內容設計之參考依據。此計畫主要目的為探討回復性訓練與複合性訓練(回復性及代償性訓練)對於MCI個案認知功能及日常生活功能之立即成效，與介入停止後之成效維持情況。研究問題為：是否複合性訓練較具改善日常生活功能之療效，而回復性訓練是否僅能提升其認知功能測驗之表現，而較無法轉移至日常生活功能？次要研究目的為探討照顧者態度(對MCI患者日常活動協助程度)，是否影響介入成效。研究設計為單盲隨機控制試驗，研究對象為60位大台北地區醫學中心神經科確診之MCI患者，隨機分配MCI患者至以下二組，每組6-8人，接受為期12週，每週1次(90分鐘)之認知介入團體：1) 回復性訓練組：教導認知策略，透過電腦遊戲或桌遊活動重複演練，強化注意力、記憶力、知覺處理速度、執行功能等，2) 複合性訓練（回復性訓練及代償性訓練）：每次團體一半時間為與回復性訓練組相同之活動，另一半時間為代償性訓練導向，討論其日常活動執行之困難，問題解決策略運用、輔助工具的使用練習，並於模擬或真實情境中進行演練。兩組團體各含1次個別居家介入。將於介入前、十二週介入結束後、及介入結束後十二週進行評量。主要成效評量指標為患者之日常生活功能表現（主觀與客觀評量）及認知功能（注意力、記憶、執行功能等），次要指標為患者之憂鬱程度、生活品質與照顧者負荷。另將進一步探討照顧者之照顧態度對療效之影響。研究結果預期可驗證回復性訓練與回復性訓練之立即與長期效益，並釐清回復性訓練與回復性訓練分別之效益，作為未來規劃MCI患者認知介入方案之參考。另可初步瞭解照顧者態度對於認知介入成效之影響。<br> Abstract: People with mild cognitive impairment (MCI) are at a greater risk of developing dementia. Therefore, it is important to develop effective non-pharmacological interventions to facilitate their cognitive and activities of daily living (ADL) function, which will also prevent or delay their progression to dementia and reduce associated healthcare and social costs. There are currently a variety of cognitive interventions, mainly categorized as remediation and rehabilitation approach. Research to compare their contents and effectiveness is strongly needed. The information can be used to individualize cognitive intervention based on specific cognitive profile of the patient.This study aims to determine the immediate and long-term efficacy of the remediation approach and rehabilitation approach in enhancing the cognitive and ADL function. The research questions include 1) whether the rehabilitation approach compared with the remediation approach has better effects on improving ADL function; (2) whether the remediation approach may only enhance the performance on the cognitive tests rather than on the ADL function. This study will also explore whether the attitudes of caregivers on providing ADL assistance affect effects of cognitive intervention.The study is designed by a single-blinded randomized control trial. Sixty persons with MCI, confirmed by physicians, will receive 12 weekly 90-minute cognition interventions in a group of 6-8 persons. All participants will be randomly assigned to the following groups: 1) Remediation approach: various cognitive strategies will be taught, and exercises involving the practice of these strategies to enhance the attention, memory, processing speed, and executive functions. 2) Combination of rehabilitation and remediation approaches: The first half of each session will focus on the remediation approach as described above. The second half of the session will apply rehabilitation approach. We will use group discussion to discuss everyday situations with memory problem and specific strategies (internal and external) related to real-life situations. We will also include one individual session in the 12 group sessions.All participants will be assessed at 3 time points: before intervention, right after intervention, and 12 weeks after the intervention. The primary outcomes are the ADL functions evaluated by subjective and objective measures, and cognitive function evaluated by tests of attention, memory and executive function. The secondary outcomes include the depression, the quality of life of the participants, and the caregivers’ load. The intervention effects will be further analyzed by the caregivers’ attitude regarding to the level of ADL assistance.The results can provide evidence to the immediate and long-term efficacy of the remediation and cognitive rehabilitation, and to clarify their individual effect, which may be used as a guideline for developing an effective cognitive intervention. The results of this study may also provide a preliminary understanding on how the caregivers’ attitude affects the performance of persons with MCI.輕度認知障礙認知介入復健日常生活活動mild cognitive impairmentcognitive interventionrehabilitationactivities of daily living