主動推理導向之「動手樂活動」促進社區長者認知彈性之效益：事件相關電位研究

Abstract

背景 延緩老化造成的認知退化，是快速老年化社會中需要持續面對的課題，特別是高齡者因認知彈性功能退化，影響其對於日常生活的適應能力。認知彈性係指能夠轉換不同角度的看法、思維、或是執行任務的行為模式以適應環境的變化。認知彈性不佳時會造成高齡者的生活功能獨立性下降，生活品質下降。然少有文獻針對高齡者的認知彈性做深度探討或是提出維持、提升能力的方案。因此，本研究將創新應用動手樂活動(首創於舊金山探索館)作為提升認知彈性的介入途徑。在動手樂活動中，參與者會透過主動推理及操作中學習的過程，大量嘗試製作創意物件，挑戰參與者的認知彈性功能。本研究目的為探討著重主動推理過程的動手樂活動方案，相較於缺少主動推理過程的手工藝控制組，是否更有助於提升認知彈性。 方法 本研究採對照研究設計，自台灣北部地區招募二十二位健康長者(平均年齡 70.51歲、女性12名)，動手樂活動組12人以及控制組10人。介入共十次，一周兩次，每次二小時。參與者在介入前與介入後兩周內完成評估。認知彈性表現將會透過作業轉換典範 (Task-switching Paradigm) 呈現，其中包含：(一) 轉換成本相關的反應時間 － “Specific Switch Cost” 以及 “Control Switch Cost”、(二)轉換相關P3b事件相關電位 (ERP, Event-Related Potential)。轉換成本即是新舊任務交替間所增加的認知消耗。因此，轉換成本的降低意指認知彈性之進步。 結果 行為結果顯示動手樂活動組以及控制組皆在 “Specific Switch Cost” 中呈現下降的趨勢，意指後測相對於前測下規則轉換 (Switch) 題目的反應時間下降而轉換前 (Pre-Switch)題目的反應時間不變。然而，僅有在動手樂活動組中觀察到 “Control Switch Cost” 的下降趨勢，意指後測相對於前測下規則轉換 (Switch) 題目的反應時間下降而單一任務題目的反應時間不變。在事件相關電位結果中，僅有動手樂活動組在介入前後呈現P3b事件相關電位之平均振幅的下降，意指參與者以較少的認知消耗轉換至新任務。相反地，介入後控制組呈現P3b事件相關電位之平均振幅的上升以及較大的標準差，意味參與者有更高的認知消耗以及較不穩定的任務轉換反應。 結論 此初步結果指出著重主動推理過程的動手樂活動介入方案相較於控制組更能夠提升高齡者的認知彈性能力。然而受限於樣本數較小，未來尚需增加樣本數，並規劃劑量更高之動手樂活動為基礎的介入方案，以驗證此介入的成效。

Backgrounds Slowing down aging-related cognitive decline has been a great challenge in rapidly aging societies. In particular, the adaptability of daily lives in older adults is largely influenced by the decline of Cognitive Flexibility (CF), which refers to the ability to flexibly switch between thoughts, perspectives, or behavior styles in response to ever-changing environments. Such negative influences may lead to poor quality of life in older adults while increasing their dependency on caregivers. However, there is minimal literature that examines or proposes what will be an effective way to maintain or even improve the capacity of cognitive flexibility in older adults. Therefore, this study aimed to examine the effectiveness of a novel application of Tinkering Activities (TA, originated from Exploratorium, San Francisco) as an intervention approach to promote the capacity of CF. In TA, participants will heavily experience making creative products through active inference and the learning-by-doing process, which forms a challenge to their cognitive flexibility. Specifically, we tested whether cognitive flexibility can be promoted through a TA-based program that emphasizes the active inference process compared to a control training program of manual-based crafting that incorporates only the passive inference process. Methods The current study adopted a case-control design in which 22 healthy older adults (mean age = 70.51, Females =12) were recruited from local communities in the north of Taiwan and allocated into the TA group and the control groups. Both intervention groups lasted for five weeks, with 2 sessions per week and 2 hours per session. The participants' outcomes of cognitive flexibility performance within two weeks before and after the intervention were evaluated by (1) the switch-cost related reaction times – Specific Switch Cost and Control Switch Cost, and (2) the switch-related P3b event-related potential (ERP) during Task-Switching Paradigm. Switch-cost is defined as the degree of extra cognitive efforts spent to make a switch from performing an old task to a new task. Thus, a reduction of switch-cost indicates an improvement in cognitive flexibility. Results First, behavioral results showed that both the TA group and the control group demonstrated a reduction in the 'Specific Switch Cost' (decreased reaction times to rule switch trials as compared to trials before the switch). However, only the TA group showed a reduction in the 'Control Switch Cost' (decreased reaction times to rule switch trials as compared to single task trials). Second, in terms of ERP results, only the TA group demonstrated a trend toward a reduction of the mean amplitude of switch-related P3b component in the post-intervention than in the pre-intervention, implying that participants were able to switch to a new task with less effort. In contrast, after the intervention, the control group showed an increase in the mean amplitude of switch-related P3b component with greater standard deviations, indicating more effortful and less stable responses to the task switch in these participants. Conclusions In conclusion, the preliminary results suggest that the TA-based training program seems to be more effective in promoting the capacity of cognitive flexibility in older adults than the control program. However, the results are not conclusive due to the limited sample size. Future studies with a larger sample size and a higher training dosage are needed to further verify the training effect of the TA-based training program.