職能參與對老年人的健康效益之神經生理證據

Abstract

背景及目的：近年，隨著人口老化議題，如何促進老年者的健康已成為重要議題。雖然已有相關理論提出參與有意義的職能活動可對老年者的身、心理功能有正向影響，但過去文獻多重於探討老年者的生活型態或活動參與對其健康之影響，仍缺乏將活動對個體的意義程度納入考量並探討其與老年者健康程度之關係，針對相關之神經生理機制的研究亦較缺乏。因此，本研究目的在於結合靜息態功能性磁振造影 (resting-state functional magnetic resonance imaging) 探討老年人有意義的職能參與和大腦網絡連結性的關係為何。 方法：本研究共納入四十六位無神經或精神相關疾病診斷之六十~八十九歲之社區老年人，進行問卷調查及靜息態功能性磁振造影掃描。我們利用台灣版有意義的活動參與量表來評估老年者過去三個月內的有意義職能參與程度，包含個體客觀的參與頻率及其主觀評分活動之意義，此外，我們亦利用蒙特利爾認知評估台灣版、簡短形老人憂鬱量表、UCLA孤寂感量表來評估老年者的整體認知功能、憂鬱及孤寂程度。在大腦網絡連結性的部分，我們利用靜息態功能性磁振造影獲得息靜狀態大腦的功能性連結(resting-state functional connectivity)，並進一步分析職能參與程度是否可在靜息態大腦的功能性連結及健康程度的關係中扮演中介者的角色。 結果：(一) 老年人有意義的職能參與程度與其憂鬱程度與孤寂程度呈顯著負相關，但未與整體認知功能達顯著相關。(二) 雙側海馬迴與多數腦區間的靜息態大腦功能性聯結與受試者的職能參與程度呈顯著正相關，與憂鬱及孤寂程度則呈顯著負相關。(三) 職能參與程度在海馬迴與部份邊陲系統區域之靜息態大腦功能性聯結與憂鬱或孤寂程度的相關中扮演中介者的角色。 結論：本研究不同於以往的貢獻在於不只納入個體客觀的參與頻率，更將個體對活動意義的主觀評分納入考量以探討有意義的職能參與對老年者健康之影響。我們的結果顯示，部分腦區的大腦功能性連結可以反映個體的部份心理健康狀態，而這層關係，似乎是透過有意義的職能參與程度而影響之。

Background Population aging is a critical issue in Taiwan. How to promote the health of older adults has become an important topic. To our knowledge, despite some theories and studies have investigated the relationship between activity participation and health status in elderly. Rarely have studies address both the objective and subjective aspects of occupational participation in elderly and investigate their relationship with health-related outcomes. There is also lack of the neurophysiological mechanism underlying the contribution of the occupational participation in older adults. Hence, we want to examine the relationships between the level of occupational participation and health-related outcomes and incorporate the resting-state functional magnetic resonance imaging (resting-state fMRI) to investigate the neural mechanism of individual occupational participation in older adults. Methods We recruited 46 healthy older adults without medical history or diagnosis of neurological or psychological disorders. All participants completed the questionnaires and scanning of resting-state fMRI. We used MAPA to access the level of occupational participation during the past 3 months of older adults, including frequency of participation and subjective meaningfulness of the activity that the individual perceived. We also used MoCA, GDS-15, UCLA-LS to access global cognitive function, the level of depression and loneliness. On the other hand, we used the correlation and mediation analyses to investigate the interrelationship between occupational participation, resting-state functional connectivity and health-related outcomes. Results There were several findings in the current study. First, higher level of occupational participation was associated with better psychological well-beings but not with global cognitive function. Second, results from behavioral connectivity analyses showed that bilateral hippocampus seems to be an important hub that reflects meaningful occupational participation and psychological well-beings. Third, the level of meaningful occupational participation serves as a significant mediator in the correlation between psychological well-beings and the resting-state functional connectivity between hippocampus and several limbic areas. Conclusion In summary, different from previous studies, we incorporated both the frequency of participation and subjective meaningfulness of the activity that an individual perceived to investigate the relationship between occupational participation and health-related outcomes. Our results suggest that the level of occupational participation play as a significant mediator in the correlation between psychological well-beings and the resting-state functional connectivity between hippocampus and several limbic areas. To our knowledge, this is the first study that provides a neural-based evidence underlying the health facilitation effect of occupational participation in older adults.