Study on the Effects of Individualized Learning Therapy on Cognitive Function and Behavioral and Psychological Symptoms of Dementia in the Institutionalized Older Adults

個別式學習療法對改善機構失智老人認知及行為精神症狀之成效探討

10.1097/jnr.0000000000000118

陳曉梅(Hsiao-Mei Chen)；蔡麗珍(Li-Jane Tsai)；趙淑員(Shu-Yuan Chao)；Mary Jo Clark

個別式學習療法 ； 失智長者 ； 認知功能 ； 神經精神症狀 ； individualized learning therapy ； cognitive function ； dementia among the elderly ； neuropsychiatric symptoms

The Journal of Nursing Research

24卷4期（2016 / 12 / 01）

300 - 310

英文

背景 隨著失智長者人口數的增加，失智症照護在台灣已備受關切，特別是對於行為症狀的處理，以及認知功能的促進。目的 本研究旨在檢視個別學習療法對失智症長者提升認知功能與改善神經精神症之成效。方法 採類實驗前後測研究設計，中部僅有的二所失智專科病房，隨機分派為實驗組與比較組，參與的長者分別為23 與21位。實驗組施以個別學習療法，每週兩次，每次30 分鐘，連續施行三個月。比較組僅一般的常規活動，無學習療法。於活動前及12週之後，以簡易式認知功能評量表（MMSE）評量認知情形；另以中文版神經精神病徵評量表（CNPI）每週評量長者的神經精神病徵。以獨立t檢定（或曼－惠特尼U考驗法）、卡方檢定（或費雪精確性檢定）及廣義估計方程式（GEE）進行資料分析。結果 經12 週的處置後，實驗組較比較組在認知功能得分顯著提昇（p ＜ .001），神經精神症狀總分顯著減少（p ＜ .001）；而在幻聽、奇異行為、憂鬱、表情淡漠、不安、睡眠障礙等症狀在第7 週時，表現顯著改善。結論／實務應用 個別學習療法對提升失智長者的認知功能與改善神經精神症狀有相當之成效，值得未來應用。

Background: The increasing number of elderly people affected by dementia in Taiwan hasmade dementia care a crucial issue of concern. This issue is particularly important in terms of the proper management of behavioral symptoms and improvement of the cognitive functions of those affected by this disease. Purpose: This study examined the effects of individualized learning therapy on cognition and neuropsychiatric symptoms among elderly people with dementia. Methods: A quasi-experimental, pretest-posttest research de-sign was adopted. We recruited elderly people with dementia at the only two institutions for elderly patients with dementia in Central Taiwan. These institutions were assigned randomly as the experimental or control group, with totals of 23 and 21 participants, respectively. The participants in the experimental group received individualized learning therapy for 30 minutes twice weekly for 3 months. The comparison group received usual care only. The cognitive function and neuropsychiatric symptoms of all participants were measured using the Mini-Mental Status Examination (MMSE) before the start of and immediately after the 12-week intervention and the Chinese version of the Neuropsychiatric Inventory (CNPI), which was administered once per week during the intervention. Independent t tests (or Mann- Whitney U tests), chi-square tests (or Fisher's exact tests), paired t test, and generalized estimating equations were used for data analysis. Results: Participants in the experimental group had significantly higher MMSE scores (p ＜ .01) and lower CNPI scores (p ＜ .01) than their comparison group peers after the intervention. Furthermore, the neuropsychiatric symptoms in the experimental group such as hallucinations, bizarre behavior, depression, apathetic expression, irritability, and sleep disorder had significantly improved by the seventh week. Conclusions/Implications for Practice: Individualized learning therapy may be an effective approach to improve cognitive function and reduce neuropsychiatric symptoms among older people with dementia. Therefore, future clinical application is warranted.

1. Taiwan Alzheimer's Disease Association. (2012). World Health Organization(WHO) published a global dementia report in Taiwan. Retrieved from http://www.Tada-2002.org.tw/tada_event_detail.aspx?pk=188 (Original work published in Chinese)
2. Chen, Y. Z.、Dai, Y. S.、Yang, Q. C.、Wang, C. Q.、Chang, Y. X.(1995)。Assembly of Functional assessment scales for long-term care service。Taipei Ministry of Health and Welfare，33，7-10。
3. Farina, E.,Mantovani, F.,Fioravanti, R.,Pignatti, R.,Chiavari, L.,Imbornone, E.,Nemni, R.(2006).Evaluating two group programmes of cognitive training in mild-to-moderate AD: Is there any difference between a "global" stimulation and a "cognitive-specific" one?.Aging & Mental Health,10(3),211-218.
4. Gates, N. J.,Sachdev, P. S.,Fiatarone Singh, M. A.,Valenzuela, M.(2011).Cognitive and memory training in adults at risk of dementia:A systematic review.BMC Geriatrics,11,55.
5. Guo, N. W.、,Liu, H. C.、Wang, P. F.、Liao, K. K.、Yan, S. H.、Lin, K. P.、Hsu, T. C.(1988)。Chinese version and norms of theMini-Mental State Examination。Journal of Rehabilitation Medicine Association，16，52-59。
6. Hoe, J.,Thompson, R.(2010).Promoting positive approaches to demnetia care in nursing.Nursing Standard,25(4),47-56.
7. Hopper, T.,Bourgeois, M.,Pimentel, J.,Qualls, C. D.,Hickey, E.,Frymark, T.,Schooling, T.(2013).An evidence-based systematic review on cognitive interventions for individuals with dementia.American Journal of Speech-Language Pathology,22(1),126-145.
8. Hulme, C.,Wright, J.,Crocker, T.,Oluboyede, Y.,House, A.(2010).Non-pharmacological approaches for dementia that informal carers might try or access: A systematic review.International Journal of Geriatric Psychiatry,25(7),756-763.
9. Hung, Y. S.、Wu, W. S.、Huang, Y. C.、Chang, C. L.、Lin, J. C.、Hsu, H. P.、Chou, W. C.(2010)。Palliative care in hospitalized dementia Patients: Experiences fromone community teaching hospital in Northern Taiwan。Taiwan Journal of Hospice Palliative Care，15(2)，161-170。
10. Kawashima, R.,Koizumi, H.(2003).Learning therapy.Sendai, Japan:Tohoku University.
11. Kverno, K. S.,Black, B. S.,Nolan, M. T.,Rabins, P. V.(2009).Research on treating neuropsychiatric symptomsof advanced dementia with non-pharmacological strategies, 1998-2008: A systematic literature review.International Psychogeriatrics,21(5),825-843.
12. Leung,V. P.,Lam, L. C.,Chiu, H. F.,Cummings, J. L.,Chen, Q. L.(2001).Validation study of the Chinese version of the neuropsychiatric inventory (CNPI).International Journal of Geriatric Psychiatry,16(8),789-793.
13. Lin, Y. T.、Hwang, T. J.、Chiang, H. L.、Sheu, Y. H.、Shan, J. C.(2009)。Quetiapine for patients with agitation or psychosis related to Alzheimer's disease and vascular dementia。Taiwan Geriatrics and Gerontology，4(1)，51-62。
14. Ministry of the Interior(2013)。MOI statistical bulletin，2013(4)
15. Murayama, N.,Iseki, E.,Endo, T.,Nagashima, K.,Yamamoto, R.,Ichimiya, Y.,Sato, K.(2009).Risk factors for delusion of theft in patients with Alzheimer's disease showingmild dementia in Japan.Aging & Mental Health,13(4),563-568.
16. Olazara´ n, J.,Reisberg, B.,Clare, L.,Cruz, I.,Pen˜ a-Casanova, J.,Del Ser, T.,Mun˜ iz, R.(2010).Nonpharmacological therapies in Alzheimer's disease: A systematic review of efficacy.Dementia and Geriatric Cognitive Disorders,30(2),161-178.
17. Orrell, M.,Spector, A.,Thorgrimsen, L.,Woods, B.(2005).A pilot study examining the effectiveness of maintenance cognitive stimulation therapy (MCST) for people with dementia.International Journal of Geriatric Psychiatry,20(5),446-451.
18. Prince, M.,Prina, M.,Guerchet, M.(2013).World Alzheimer Report 2013: Journey of caring:An analysis of long-term care for dementia.London, England:Alzheimer's Disease International.
19. Requena, C.,Maestú, F.,Campo, P.,Fernández, A.,Ortiz, T.(2006).Effects of cholinergic drugs and cognitive training on dementia: 2-year follow-up.Dementia and Geriatric Cognitive Disorders,22(4),339-345.
20. Spector, A.,Orrell, M.,Woods, B.(2010).Effects on different areas of cognitive function for peoplewith dementia.International Journal of Geriatric Psychiatry,25(12),1253-1258.
21. Spector, A.,Thorgrimsen, L.,Woods, B.,Royan, L.,Davies, S.,Butterworth, M.,Orrell, M.(2003).Efficacy of an evidencebased cognitive stimulation therapy programme for people with dementia: Randomized controlled trial.The British Journal of Psychiatry,183,248-254.
22. Stein-Parbury, J.,Chenoweth, L.,Jeon, Y. H.,Brodaty, H.,Haas, M.,Norman, R.(2012).Implementing person-centered care in residential dementia care.Clinical Gerontologist,35(5),404-424.
23. Wilson, R. S.,Barnes, L. L.,Aggarwal, N. T.,Boyle, P. A.,Hebert, L. E.,Mendes de Leon, C. F.,Evans, D. A.(2010).Cognitive activity and the cognitive morbidity of Alzheimer disease.Neurology,75(11),990-996.
24. Woods, B.,Aguirre, E.,Spector, A. E.,Orrell, M.(2012).Cognitive stimulation to improve cognitive functioning in people with dementia.The Cochrane Database of Systematic Reviews,2,CD005562.
25. Woods, B.,Thorgrimsen, L.,Spector, A.,Royan, L.,Orrell, M.(2006).Improved quality of life and cognitive stimulation therapy in dementia.Aging & Mental Health,10(3),219-226.
26. Yamagami, T.,Takayama, Y.,Maki, Y.,Yamaguchi, H.(2012).A randomized controlled trial of brain-activating rehabilitation for elderly participants with dementia in residential care homes.Dementia and Geriatric Cognitive Disorders Extra,2(1),372-380.
27. Yamaguchi, H.,Maki, Y.,Yamagami, T.(2010).Overview of nonpharmacological intervention for dementia and principles of brain-activating rehabilitation.Psychogeriatrics,10(4),206-213.
28. Yang, C. F.、Hsieh, C. J.、Hsiao, Y. L.、Liu, S. J.(2007)。Introduction to learning therapy-An evidenced-based therapy to activated brain。The Journal of Long-Term Care，11(2)，141-148。
29. Yuill, N.,Hollis, V.(2011).A systematic review of cognitive stimulation therapy for older adults with mild to moderate dementia: An occupational therapy perspective.Occupational Therapy International,18(4),163-186.

1. 葉啟斌,黃三原,曾念生,陳順益,陳俊延,張勳安,高譽誠,周雨青,李昆明,江瑋珊(2017).The Impact of Pharmacological Treatments on Cognitive Function and Severity of Behavioral Symptoms in Geriatric Elder Patients with Dementia.臺灣精神醫學,31(1),69-79+iii.