開啟阿茲海默氏病之行為和心理症狀的鎖鑰：珍珠，串索與項鍊

The Key to Understanding the Behavioral and Psychological Symptoms of Alzheimer's Disease: Pearls, String, and the Necklace

10.6200/TCMJ.2015.12.2.01

詹金烈(Jin-Lieh Chan)；林志遠(Chih-Yuan Lin)；李黔芳(Chyan-Fang Lee)；詹麗琴(Li-Chen Chan)；林靜玉(Ching-Yu Lin)；蔡愛卿(Ai-Ching Tsai)；廖婉婷(Wang-Ting Liao)

自我認知 ； 自我 ； 阿茲海默氏病 ； autonoetic awareness ； ego ； Alzheimer's disease

北市醫學雜誌

12卷2期（2015 / 06 / 30）

1 - 6

繁體中文

個人的行為受過去的生活經驗與對未來的人生目標所影響；因此，對現況的闡釋，每個人都有屬於他自己的參考框架。Tulving將此自傳式的認識自己（autobiographic knowledge）叫作自我認知（autonoetic awareness）。自我認知結合了過去、現在與可能的未來，使得個人的行為有了時間上的聯貫性，有如將含有記憶元素的珍珠串連成具有自我認知內涵的項鍊一般，而時間正是扮演這「串索」的角色。自我（ego），依佛洛依德學派的觀念，它遵行「現實法則」（reality principle），周旋於原始慾望的原我（id）、完美主義的超我（super-ego）與現實（reality）之間，以圖個體的安全。本文嘗試闡明阿茲海默氏病之行為和心理症狀來自「自我認知」的無法與時更新及逐漸崩解，導致「自我」的「現實法則」失靈，安全感喪失，行為逐漸依「原我」的「快樂法則」（pleasure principle）退縮（regression），最後陷入慢性混亂狀態（chronic confusional state），與社會隔絕（social isolation）。

A person's behavior is under the influence of his own past experiences and future life goals. Therefore, everyone has a reference framework of his own to interpret the daily world. Tulving called this type of autobiographical knowledge ＂autonoetic awareness,＂ which binds the past, present and possible future together and forms one's behavior with continuous entity through time, like pearls with memory elements threaded to make a necklace of self awareness, and the time plays the role of thread. The ego (a sense of self), by Freudian concept, follows ＂reality principle.＂ It is driven by the id of primitive drives, confined by the super-ego aiming for perfection, and repulsed by reality. Its main concern is with the individual’s safety. This article attempts to delineate the behavioral and psychological symptoms of Alzheimer's disease by the impaired updating and gradual breakdown of self awareness, causing malfunction of the ＂reality principle＂ and loss of security, followed by gradual regression of behavior by the ＂pleasure principle＂ of id, and finally stepping into chronic confusional state and social isolation.