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題名 失憶型輕度認知功能障礙患者在模擬空間脈絡記憶之表現
Spatial-context memory in amnesic-mild cognitive impairment作者 王宣閔
Wang,Hsuan-Min貢獻者 楊建銘
王宣閔
Wang,Hsuan-Min關鍵詞 輕度認知功能障礙
失智症
阿茲海默症
mild cognitiv impairment
dementia
Alzheimer`s disease日期 2008 上傳時間 8-Dec-2010 11:38:06 (UTC+8) 摘要 失憶型輕度認知功能障礙（a-MCI）患者被認為是演變成為阿茲海默症的高危險群，在早期由於海馬迴結構的神經纖維糾結，患者會開始產生記憶障礙。Braak和Braak在1991年將神經纖維糾結分成六個時期，開始會先從海馬迴結構的前內鼻區和側海馬迴產生病變，最後才會順延到海馬迴本體。由於前內鼻區主要處理事件及物件特徵，側海馬迴主要處理空間背景訊息，海馬迴本體主要處理空間位置記憶，所以本研究假設事件及物件特徵與空間背景訊息的配對記憶在a-MCI階段就會產生障礙，而空間位置記憶則在輕度阿茲海默症會開始產生障礙，如果不同階段神經病變的認知功能表現，可以在研究結果中呈現出來，或許可以協助找到早期偵測海馬迴結構病變的神經認知功能指標。本研究受試者主要包含正常組（NC組）30人，失憶型輕度認知功能障礙組（a-MCI組）30人和輕度阿茲海默症組（AD組）30人，共計90人。每組受試者均接受神經心理測驗衡鑑和本研究自行發展的空間脈絡記憶測驗。空間脈絡記憶測驗總共分為三個部分：（1）空間位置記憶測驗：要求受試者回憶之前在地圖上隨機出現的建築物位置；（2）事件與地點連結測驗：事件和地點配對出現後，要求受試者選擇事件所配對的地點背景為何；（3）地點與物體的連結測驗：物體和地點配對出現後，要求受試者選擇該地點之前出現的物體為何。研究結果呈現，不同組別在神經心理測驗結果，a-MCI組在延宕提取以及記憶保留的部分相較於其他認知功能顯著較差，而AD組相較於a-MCI組，除了記憶力表現更差外，其他認知功能的缺損也更為嚴重。而不同組別在空間脈絡記憶的結果，空間位置記憶分測驗呈現NC組>a-MCI組>AD組的結果，在事件與地點的連結分測驗呈現NC組>a-MCI組＝AD組的結果，在地點與物體的連結分測驗呈現NC組>a-MCI組>AD組的結果。從ROC曲線分析呈現，空間脈絡記憶測驗相較於其他篩檢測驗，在區分NC組和a-MCI組的敏感度及特異度較好，而MMSE則在區分a-MCI組和AD組的敏感度及特異度較好。研究結果呈現a-MCI受試者在一般認知功能尚未顯著下降的同時，空間脈絡記憶就已經呈現障礙，這可能和早期神經纖維糾結所破壞的區域有關，結果也呈現空間脈絡記憶測驗在a-MCI階段，比其他篩檢測驗能更敏感的區分出正常和異常的患者。目前臨床常用的MMSE測驗，因為複合了多項認知功能，反而適合用於篩檢已經為輕度阿茲海默症的患者。
Background: Amnesic mild cognitive impairment (a-MCI) was identified to have a high risk to become Alzheimer’s disease (AD). In early stage of AD, because of neurofibrillary tangles, patient began complaining progressive memory deficits. The progressive course of neurofibrillary tangles was divided into 6 stages (Braak and Braak, 1991). Initially, the neurofibrillary tangles destroyed perirhinal and parahippocampus neurons, which may correspond to the a-MCI stage and then proceed to hippocampal body that correspond to early AD. According to previous studies, the perirhinal is primarily associated with item features encoding, the parahippocampus associated with scene features encoding, and the hippocampus associated with spatial location memory. Based on these findings, we hypothesized that the item and scene features association memory would show impairments in a-MCI and the spatial location memory would not be impaired in a-MCI but in early AD. If the different stages could be discriminated by the performance on spatial context memory test that we design, it can be utilized in clinical settings to assist the diagnosis of a-MCI. Method: Three groups of subjects were selected from the clinic of the neurological department of Chang Gung Memorial Hospital, including normal subjects (n=30), a-MCI subjects not diagnosed with dementia (n=30), and mild AD subjects (n=30). All of them were administered a package of neuropsychological tests and a self-developed spatial context memory test that include three sub-tests: (1) a spatial location memory test: subjects have to recognize the location of a building that was appeared in a map; (2) an event-place association memory test: subjects need point out which spatial scene that was associated with this event; and (3) a place-object association memory test: subjects need point out which object that was associated with this place shown before.Result: In neuropsychological tests, a-MCI group demonstrated significant impairment in delay retrieval and memory retention in comparison to their performance on tests for other cognitive functions. The AD group showed decline in overall cognitive functions including declarative memory and others. In the spatial context memory test, both the spatial location memory test and the place-object association memory subtest showed a decline in a-MCI group, and a further decline in AD group; the event-place association memory test presented significant decreases in both a-MCI and AD group in comparison to normal control, but no difference between the two clinical groups. Conclusion: The current study shows that the spatial context memory in a-MCI patients has greater impairment than their general cognitive function. Compared with other screening test, the spatial context memory has greater sensitivity and specificity to discriminate a-MCI from NC.參考文獻 近年我國老人總數一覽表（96年版）【資料檔】。台北市。內政部戶政司。
郭乃文、劉秀枝、王珮芳、廖光淦、甄瑞興、林恭平、陳祖裕、徐道昌（民 77年）。『簡短式智能評估』之中文施測與常模建立。中華民國復健醫學會雜誌，7，52-9。
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國立政治大學
心理學研究所
94752006
97資料來源 http://thesis.lib.nccu.edu.tw/record/#G0094752006 資料類型 thesis dc.contributor.advisor 楊建銘 zh_TW dc.contributor.author (Authors) 王宣閔 zh_TW dc.contributor.author (Authors) Wang,Hsuan-Min en_US dc.creator (作者) 王宣閔 zh_TW dc.creator (作者) Wang,Hsuan-Min en_US dc.date (日期) 2008 en_US dc.date.accessioned 8-Dec-2010 11:38:06 (UTC+8) - dc.date.available 8-Dec-2010 11:38:06 (UTC+8) - dc.date.issued (上傳時間) 8-Dec-2010 11:38:06 (UTC+8) - dc.identifier (Other Identifiers) G0094752006 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/49441 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學研究所 zh_TW dc.description (描述) 94752006 zh_TW dc.description (描述) 97 zh_TW dc.description.abstract (摘要) 失憶型輕度認知功能障礙（a-MCI）患者被認為是演變成為阿茲海默症的高危險群，在早期由於海馬迴結構的神經纖維糾結，患者會開始產生記憶障礙。Braak和Braak在1991年將神經纖維糾結分成六個時期，開始會先從海馬迴結構的前內鼻區和側海馬迴產生病變，最後才會順延到海馬迴本體。由於前內鼻區主要處理事件及物件特徵，側海馬迴主要處理空間背景訊息，海馬迴本體主要處理空間位置記憶，所以本研究假設事件及物件特徵與空間背景訊息的配對記憶在a-MCI階段就會產生障礙，而空間位置記憶則在輕度阿茲海默症會開始產生障礙，如果不同階段神經病變的認知功能表現，可以在研究結果中呈現出來，或許可以協助找到早期偵測海馬迴結構病變的神經認知功能指標。本研究受試者主要包含正常組（NC組）30人，失憶型輕度認知功能障礙組（a-MCI組）30人和輕度阿茲海默症組（AD組）30人，共計90人。每組受試者均接受神經心理測驗衡鑑和本研究自行發展的空間脈絡記憶測驗。空間脈絡記憶測驗總共分為三個部分：（1）空間位置記憶測驗：要求受試者回憶之前在地圖上隨機出現的建築物位置；（2）事件與地點連結測驗：事件和地點配對出現後，要求受試者選擇事件所配對的地點背景為何；（3）地點與物體的連結測驗：物體和地點配對出現後，要求受試者選擇該地點之前出現的物體為何。研究結果呈現，不同組別在神經心理測驗結果，a-MCI組在延宕提取以及記憶保留的部分相較於其他認知功能顯著較差，而AD組相較於a-MCI組，除了記憶力表現更差外，其他認知功能的缺損也更為嚴重。而不同組別在空間脈絡記憶的結果，空間位置記憶分測驗呈現NC組>a-MCI組>AD組的結果，在事件與地點的連結分測驗呈現NC組>a-MCI組＝AD組的結果，在地點與物體的連結分測驗呈現NC組>a-MCI組>AD組的結果。從ROC曲線分析呈現，空間脈絡記憶測驗相較於其他篩檢測驗，在區分NC組和a-MCI組的敏感度及特異度較好，而MMSE則在區分a-MCI組和AD組的敏感度及特異度較好。研究結果呈現a-MCI受試者在一般認知功能尚未顯著下降的同時，空間脈絡記憶就已經呈現障礙，這可能和早期神經纖維糾結所破壞的區域有關，結果也呈現空間脈絡記憶測驗在a-MCI階段，比其他篩檢測驗能更敏感的區分出正常和異常的患者。目前臨床常用的MMSE測驗，因為複合了多項認知功能，反而適合用於篩檢已經為輕度阿茲海默症的患者。 zh_TW dc.description.abstract (摘要) Background: Amnesic mild cognitive impairment (a-MCI) was identified to have a high risk to become Alzheimer’s disease (AD). In early stage of AD, because of neurofibrillary tangles, patient began complaining progressive memory deficits. The progressive course of neurofibrillary tangles was divided into 6 stages (Braak and Braak, 1991). Initially, the neurofibrillary tangles destroyed perirhinal and parahippocampus neurons, which may correspond to the a-MCI stage and then proceed to hippocampal body that correspond to early AD. According to previous studies, the perirhinal is primarily associated with item features encoding, the parahippocampus associated with scene features encoding, and the hippocampus associated with spatial location memory. Based on these findings, we hypothesized that the item and scene features association memory would show impairments in a-MCI and the spatial location memory would not be impaired in a-MCI but in early AD. If the different stages could be discriminated by the performance on spatial context memory test that we design, it can be utilized in clinical settings to assist the diagnosis of a-MCI. Method: Three groups of subjects were selected from the clinic of the neurological department of Chang Gung Memorial Hospital, including normal subjects (n=30), a-MCI subjects not diagnosed with dementia (n=30), and mild AD subjects (n=30). All of them were administered a package of neuropsychological tests and a self-developed spatial context memory test that include three sub-tests: (1) a spatial location memory test: subjects have to recognize the location of a building that was appeared in a map; (2) an event-place association memory test: subjects need point out which spatial scene that was associated with this event; and (3) a place-object association memory test: subjects need point out which object that was associated with this place shown before.Result: In neuropsychological tests, a-MCI group demonstrated significant impairment in delay retrieval and memory retention in comparison to their performance on tests for other cognitive functions. The AD group showed decline in overall cognitive functions including declarative memory and others. In the spatial context memory test, both the spatial location memory test and the place-object association memory subtest showed a decline in a-MCI group, and a further decline in AD group; the event-place association memory test presented significant decreases in both a-MCI and AD group in comparison to normal control, but no difference between the two clinical groups. Conclusion: The current study shows that the spatial context memory in a-MCI patients has greater impairment than their general cognitive function. Compared with other screening test, the spatial context memory has greater sensitivity and specificity to discriminate a-MCI from NC. en_US dc.description.tableofcontents 第一章 緒論-----------------------------1第二章 文獻探討--------------------------3第一節 輕度認知功能障礙-------------------3第二節 記憶和阿茲海默症之間的關係---------13第三章 方法----------------------------20第一節 研究對象-------------------------20第二節 程序----------------------------21第三節 資料分析-------------------------26第四章 結果-----------------------------27第一節 三組間的人口學資料及失智症嚴重程度分析--27第二節 三組間不同神經認知功能測驗結果分析------27第三節 不同篩檢測驗間的ROC曲線分析------------34第四節 不同篩檢測驗對於區分不同組別的樹狀模型分析----38第五章 討論-------------------------------------41第一節 不同階段的神經病變在神經認知功能的表現-------41第二節 不同階段的神經病變在空間脈絡記憶的表現-------42第三節 不同臨床篩檢測驗間的ROC曲線分析-------------44第四節 區分不同組別的樹狀模型分析------------------45第五節 研究貢獻與限制-----------------------------46第六節 未來的研究方向-----------------------------48參考文獻----------------------------------------49附錄一 受試者同意書------------------------------60附錄二 簡式智能量表（MMSE）-----------------------62附錄三 CERAD套裝測驗------------------------------63附錄四 畫鐘測驗-----------------------------------68附錄五 視覺配對記憶測驗（VAMT）---------------------69附錄六 空間脈絡記憶測驗（SCMT）---------------------70附錄七 NC組和a-MCI組的切點分析表--------------------71附錄八 a-MCI組和AD組的切點分析表--------------------74 zh_TW dc.format.extent 276902 bytes - dc.format.extent 126715 bytes - dc.format.extent 140159 bytes - dc.format.extent 494816 bytes - dc.format.extent 906853 bytes - dc.format.extent 1833107 bytes - dc.format.extent 584498 bytes - dc.format.extent 634254 bytes - dc.format.extent 477045 bytes - dc.format.extent 2190678 bytes - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.language.iso en_US - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0094752006 en_US dc.subject (關鍵詞) 輕度認知功能障礙 zh_TW dc.subject (關鍵詞) 失智症 zh_TW dc.subject (關鍵詞) 阿茲海默症 zh_TW dc.subject (關鍵詞) mild cognitiv impairment en_US dc.subject (關鍵詞) dementia en_US dc.subject (關鍵詞) Alzheimer`s disease en_US dc.title (題名) 失憶型輕度認知功能障礙患者在模擬空間脈絡記憶之表現 zh_TW dc.title (題名) Spatial-context memory in amnesic-mild cognitive impairment en_US dc.type (資料類型) thesis en dc.relation.reference (參考文獻) 近年我國老人總數一覽表（96年版）【資料檔】。台北市。內政部戶政司。 zh_TW dc.relation.reference (參考文獻) 郭乃文、劉秀枝、王珮芳、廖光淦、甄瑞興、林恭平、陳祖裕、徐道昌（民 77年）。『簡短式智能評估』之中文施測與常模建立。中華民國復健醫學會雜誌，7，52-9。 zh_TW dc.relation.reference (參考文獻) 劉景寬、戴志達、林瑞泰、賴秋蓮（民89 年）。台灣失智症的流行病學(1)。應用心理研究，7，157-169。 zh_TW dc.relation.reference (參考文獻) American Psychiatric Association (1994). 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