高齡者認知衰弱之概念分析

Cognitive Frailty in Older Adults: A Concept Analysis

10.6224/JN.202110_68(5).12

陳俐君(Li-Jun CHEN)；廖御圻(Yu-Chi LIAO)；胡芳文(Fang-Wen HU)

認知衰弱 ； 高齡者 ； 概念分析 ； cognitive frailty ； older adults ； concept analysis

護理雜誌

68卷5期（2021 / 10 / 01）

92 - 99

繁體中文

伴隨高齡化社會來臨，如何健康老化成為高齡照護的主要目標，致使預防失智與失能逐漸備受關注。衰弱不再侷限於生理層面，面對失智症等不可逆的認知疾病，認知衰弱的早期評估與預防更勝重要。本文以Walker和Avant（2019）概念分析步驟，統整高齡者認知衰弱之定義，先廣泛查證概念定義，以清楚陳述認知衰弱為：（1）主觀認知減退或輕度認知障礙、（2）需排除為阿茲海默症或其他類型的失智症、（3）同時具有生理衰弱以及（4）具可逆性等定義性特徵；再以典型、邊緣與相反案例來做認知衰弱的概念說明。最後，確認影響認知衰弱的前因後果與評析常用的實證性測量工具。期望藉此概念分析，增進護理人員瞭解認知衰弱概念，將此應用於臨床照護或研究上。

Healthy aging is the primary goal of healthcare for older adults in aging societies. The prevention of physical disabilities and dementia is becoming more important. As frailty involves both the physical and cognitive domains, detecting and preventing cognitive frailty early on is key to reversing cognitive diseases such as dementia. In this study, a concept analysis strategy (Walker & Avant, 2019) was applied to define the concept of cognitive frailty in older adults and identify the attributes of (1) presence of subjective cognitive decline or mild cognitive impairment, (2) exclusion of concurrent Alzheimer's disease or other dementia, (3) concomitant physical frailty, and (4) it is revisable. Using the constructed model, borderline and contrary cases were used to explain the concept of cognitive frailty. Finally, the antecedent and consequence factors of cognitive frailty were identified and the empirical measurement tools were evaluated. This analysis may be used to improve nurses' understanding of cognitive frailty in older adults and to benefit clinical practice and further research.

1. Ávila-Funes, J. A.,Amieva, H.,Barberger-Gateau, P.,Le Goff, M.,Raoux, N.,Ritchie, K.,Carrière, I.,Tavernier, B.,Tzourio, C.,Gutiérrez-Robledo, L. M.,Dartigues, J. F.(2009).Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: The three-city study.Journal of the American Geriatrics Society,57(3),453-461.
2. Bu, Z.,Huang, A.,Xue, M.,Li, Q.,Bai, Y.,Xu, G.(2021).Cognitive frailty as a predictor of adverse outcomes among older adults: A systematic review and meta-analysis.Brain and Behavior,11(1),Article e01926.
3. Cambridge University Press. (n.d.-a). Cognitive. In Cambridge dictionary. Retrieved February 17, 2021, from https://dictionary.cambridge.org/zht/%E8%A9%9E%E5%85%B8/%E8%8B%B1%E8%AA%9E/cognitive
4. Cambridge University Press. (n.d.-b). Frailty. In Cambridge dictionary. Retrieved February 17, 2021, from https://dictionary.cambridge.org/zht/%E8%A9%9E%E5%85%B8/%E8%8B%B1%E8%AA%9E/frailty?q=Frailty
5. Folstein, M. F.,Folstein, S. E.,McHugh, P. R.(1975)."Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.Journal of Psychiatric Research,12(3),189-198.
6. Fried, L. P.,Tangen, C. M.,Walston, J.,Newman, A. B.,Hirsch, C.,Gottdiener, J.,Seeman, T.,Tracy, R.,Kop, W. J.,Burke, G.,McBurnie, M. A.(2001).Frailty in older adults: Evidence for a phenotype.The Journals of Gerontology: Series A,56(3),M146-M156.
7. Gobbens, R. J. J.,Luijkx, K. G.,Wijnen-Sponselee, M. T.,Schols, J. M. G. A.(2010).Towards an integral conceptual model of frailty.The Journal of Nutrition, Health & Aging,14(3),175-181.
8. Huang, H.-C.,Tseng, Y.-M.,Chen, Y.-C.,Chen, P.-Y.,Chiu, H.-Y.(2021).Diagnostic accuracy of the clinical dementia rating scale for detecting mild cognitive impairment and dementia: A bivariate meta-analysis.International Journal of Geriatric Psychiatry,36(2),239-251.
9. Hughes, C. P.,Berg, L.,Danziger, W. L.,Coben, L. A.,Martin, R. L.(1982).A new clinical scale for the staging of dementia.The British Journal of Psychiatry,140,566-572.
10. Jessen, F.,Amariglio, R. E.,van Boxtel, M.,Breteler, M.,Ceccaldi, M.,Chételat, G.,Dubois, B.,Dufouil, C.,Ellis, K. A.,van der Flier, W. M.,Glodzik, L.,van Harten, A. C.,de Leon, M. J.,McHugh, P.,Mielke, M. M.,Molinuevo, J. L.,Mosconi, L.,Osorio, R. S.,Perrotin, A.,Wagner, M.(2014).A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease.Alzheimer’s & Dementia,10(6),844-852.
11. Junius-Walker, U.,Onder, G.,Soleymani, D.,Wiese, B.,Albaina, O.,Bernabei, R.,Marzetti, E.(2018).The essence of frailty: A systematic review and qualitative synthesis on frailty concepts and definitions.European Journal of Internal Medicine,56,3-10.
12. Kaya, D.,Isik, A. T.,Usarel, C.,Soysal, P.,Ellidokuz, H.,Grossberg, G. T.(2016).The Saint Louis University Mental Status Examination is better than the Mini-Mental State Examination to determine the cognitive impairment in Turkish elderly people.Journal of the American Medical Directors Association,17(4),370.E11-375.E15.
13. Kelaiditi, E.,Cesari, M.,Canevelli, M.,Van Kan, G. A.,Ousset, P.-J.,Gillette-Guyonnet, S.,Ritz, P.,Duveau, F.,Soto, M.,Provencher, V.,Nourhashemi, F.,Salva, A.,Robert, P.,Andrieu, S.,Rolland, Y.,Touchon, J.,Fitten, J. L.,Vellas, B.(2013).Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group.The Journal of Nutrition, Health & Aging,17(9),726-734.
14. Lauretani, F.,Longobucco, Y.,Ferrari Pellegrini, F.,De Iorio, A. M.,Fazio, C.,Federici, R.,Gallini, E.,La Porta, U.,Ravazzoni, G.,Roberti, M. F.,Salvi, M.,Zucchini, I.,Pelà, G.,Maggio, M.(2020).Comprehensive model for physical and cognitive frailty: Current organization and unmet needs.Frontiers in Psychology,11,Article 569629.
15. Lee, W.-J.,Peng, L.-N.,Loh, C.-H.,Lin, G.-Z.,Lee, S.,Shimada, H.,Arai, H.,Chen, L.-K.(2020).Development and validation of the NCGG-FAT Chinese version for community-dwelling older Taiwanese.Geriatric & Gerontology International,20(12),1171-1176.
16. Makizako, H.,Shimada, H.,Park, H.,Doi, T.,Yoshida, D.,Uemura, K.,Tsutsumimoto, K.,Suzuki, T.(2013).Evaluation of multidimensional neurocognitive function using a tablet personal computer: Test-retest reliability and validity in community-dwelling older adults.Geriatric & Gerontology International,13(4),860-866.
17. Mantovani, E.,Zucchella, C.,Schena, F.,Romanelli, M. G.,Venturelli, M.,Tamburin, S.(2020).Towards a redefinition of cognitive frailty.Journal of Alzheimer’s Disease,76(3),831-843.
18. Mitchell, A. J.(2009).A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment.Journal of Psychiatric Research,43(4),411-431.
19. Panza, F.,D’Introno, A.,Colacicco, A. M.,Capurso, C.,Parigi, A. D.,Capurso, S. A.,Caselli, R. J.,Pilotto, A.,Scafato, E.,Capurso, A.,Solfrizzi, V.(2006).Cognitive frailty: Predementia syndrome and vascular risk factors.Neurobiology of Aging,27(7),933-940.
20. Rockwood, K.,Mitnitski, A.(2007).Frailty in relation to the accumulation of deficits.The Journals of Gerontology: Series A,62(7),722-727.
21. Ruan, Q.,Yu, Z.,Chen, M.,Bao, Z.,Li, J.,He, W.(2015).Cognitive frailty, a novel target for the prevention of elderly dependency.Ageing Research Reviews,20,1-10.
22. Sanford, A. M.(2017).Mild cognitive impairment.Clinics in Geriatric Medicine,33(3),325-337.
23. Sargent, L.,Brown, R.(2017).Assessing the current state of cognitive frailty: Measurement properties.The Journal of Nutrition, Health & Aging,21(2),152-160.
24. Shimada, H.,Makizako, H.,Park, H.,Doi, T.,Lee, S.(2017).Validity of the national center for geriatrics and gerontology-functional assessment tool and mini-mental state examination for detecting the incidence of dementia in older Japanese adults.Geriatrics & Gerontology International,17(12),2383-2388.
25. Song, X.,Mitnitski, A.,Rockwood, K.(2011).Nontraditional risk factors combine to predict Alzheimer disease and dementia.Neurology,77(3),227-234.
26. Tariq, S. H.,Tumosa, N.,Chibnall, J. T.,Perry, M. H., 3rd.,Morley, J. E.(2006).Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neuro-cognitive disorder--A pilot study.The American Journal of Geriatric Psychiatry,14(11),900-910.
27. van Oostrom, S. H.,van der A, D. L.,Rietman, M. L.,Picavet, H. S. J.,Lette, M.,Verschuren, W. M. M.,de Bruin, S. R.,Spijkerman, A. M. W.(2017).A four-domain approach of frailty explored in the Doetinchem Cohort Study.BMC Geriatrics,17(1),Article 196.
28. Walker, L. O.,Avant, K. C.(2019).Strategies for theory construction in nursing.Prentice Hall.
29. Yang, Y. P.,Huang, Y. C.,Chen, C. S.,Yang, Y. C.,Wang, J. J.(2021).Sensitivity and specificity of the Saint Louis University mental status examination to detect mild cognitive impairment and dementia in Chinese population.Gerontology,67(2),152-159.
30. 國家發展委員會（2020，8月），中華民國人口推估（2020至2070年）。https://bit.ly/33k8Xvj [National Development Council. (2020, August). Population projections for the R.O.C (Taiwan): 2020∼2070. https://bit.ly/33k8Xvj]
31. 教育部（無日期-a）．虛弱．於國語辭典簡編本．2021年2月17日取自http://dict.concised.moe.edu.tw/cgi-bin/jbdic/gsweb.cgi?o=djbdic&searchid=Z00000035564 [Ministry of Education, Taiwan, ROC. (n.d.-a). Frailty. In Concised Mandarin Chinese dictionary. Retrieved February 17, 2021, from http://dict.concised.moe.edu.tw/cgi-bin/jbdic/gsweb.cgi?o=djbdic&searchid=Z00000035564]
32. 教育部（無日期-b）．認知．於國語辭典簡編本．2021年2月17日取自http://dict.concised.moe.edu.tw/cgi-bin/jbdic/gsweb.cgi?o=djbdic&searchid=Z00000036252 [Ministry of Education, Taiwan, ROC. (n.d.-b). Cognitive. In Concised Mandarin Chinese dictionary. Retrieved February 17, 2021, from http://dict.concised.moe.edu.tw/cgi-bin/jbdic/gsweb.cgi?o=djbdic&searchid=Z00000036252]
33. 郭乃文, N.-W.,劉秀枝, H.-C.,王佩芳, P.-F.,廖光淦, K.-K.,甄瑞興, S.-H.,林恭平, K.-P.,陳祖裕, C.-Y.,徐道昌, T.-C.(1988)。「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，16，52-59。