| 摘要: | 背景及目的：隨著老年人口的增加，人口老化的社會現象（≧65歲者佔人口比率11.8% 以上稱為老年人的社會）愈益嚴重。然而，主要影響老年人的功能障礙是失智症。如何正確且快速診斷出失智症，是個需予正視的課題。本研究目的係比較電腦化及傳統手工失智症的評估效益及其可行性。方法：研究對象係以南部某醫學中心臨床神經科醫師所開立之失智症檢查，以2013年4月至2013年10月所做的CDR為個案樣本，共計366個病人的失智評量表資料（含病人及家屬雙方）進行研究評估。利用電腦化6向度（即記憶、方向感、問題解決能力、社區活動、居家習慣、及自我照顧能力）、及分數加總等2個方法，對照傳統手工法之6向度失智分數，做複迥歸預測（以病人及家屬回答的失智症量表的結果預測6構面失智分數），再換算成0至5分的失智症程度（沒有、懷疑、輕度、中度、重度、深度、及末期，其中懷疑為0.5分）。以組內相關係數（ICC）、Kappa係數及其95%信賴度區間、卡方檢定來比較其與傳統手工作業方法失智程度的一致性及構面結構的相同性。另以尤登圖作為醫師對病人家屬解說失智症程度的對照視覺化圖示報表。 結果：研究顯示，電腦化法比分數加總法的失智症程度與傳統手工法的失智症程度有較高的Kappa係數（0.87, 95% CI=0.66, 1.00及0.66, 95% CI=0.46,0.87）、較高的ICC（0.98, 95% CI=0.94, 1.0及0.88, 95% CI=0.85, 0.90），及較小的卡方值（0.423及17.84）。利用尤登圖可以協助醫師對病人家屬解說失智症程度，提供更多有用的訊息。結論：電腦化法比分數加總法有較高的與傳統手工作業方法之失智程度一致性及構面結構相同性。作者設計的電腦化失智症評估法，結合尤登圖來評估病人的失智症，可推薦未來研究者進行更多的臨床檢測。
Background: With the increase in the elderly population, population aging society increasingly serious (≧65 years of age accounted for more than 11.8% population ratio called a “super-aged” society). However, the main impact of dysfunction in the elderly is dementia. How to correctly and quickly diagnose dementia, is a critical issue that needs to be addressed.Objectives: To compare the efficiency and feasibility of the computer-assisted and the traditional hand-plus-human-brain (THB) methods using a newly developed Clinical Dementia Rating (CDR) scale for assessing and diagnosing patients with symptoms of dementia.Methods: From 2013/4 to 2013/10 there were a total of 366 people with dementia in a Southern Medical Center. The Clinical Dementia Rating (CDR) scale questions were given to them and their families with a total of 732 people by the clinical neurologists for them to fill out. The computer-assisted and the THB methods across six dimensions (memory, directional sense, problem-solving skills, community activities, habits at home, and self-care ability), as well as a summing-all-items (SAI) score on two CDR scales separately responded to by patients and family members, were used with a multi-regression method to predict the CDR scores derived with the THB method. And then results were converted into dementia degree from 0 to 5(none, suspicious, mild, moderate, severe, depth, and terminal, where suspicious is 0.5 points). The intraclass correlation coefficient (ICC) and its 95% confidence interval, Kappa coefficient and its 95% confidence interval, and the chi-square test were used to compare the consistency and dimensional structure sameness between the two proposed methods and THB results. A Youden plot was used to visually present the CDR results to patients and their families to explain the degree of dementia by physicians.Results: Studies have shown that the degree of dementia of the computer-assisted method than the SAI method with the THB method has higher Kappa coefficient (0.87, 95% CI = 0.66, 1.00 and 0.66,95% CI = 0.46,0.87), higher the ICC (0.98, 95% CI = 0.94, 1.0 and 0.88, 95% CI = 0.85, 0.90), and a smaller chi-square value(0.423 and17.84). Using a Youden plot offered much more useful information than did other types of analytical presentations.Conclusions: The computer-assisted method with the THB method than the SAI method with the THB method has a higher degree of consistency and dimensional structure sameness. The computer-assisted method combined with a Youden plot to assess the extent of dementia of elderly patients is recommended for clinical use. |
