以事件相關電位為基礎研究探討六週動手樂活動對於主觀認知衰退患者之認知彈性成效

Abstract

背景：全球人口老化及相關疾病，如失智症，正成為重大挑戰。主觀認知衰退(Subjective Cognitive Decline, SCD)為臨床前失智症階段，患者失智風險較高，且SCD患者於各認知功能之衰退程度亦較非SCD患者來得更高，其中也包含執行功能，可能進一步影響個人之日常生活功能，又認知彈性為執行功能中，與日常生活功能最具相關之認知歷程，故早期認知促進及認知彈性介入對延緩失智至關重要，然現今較少針對SCD患者之執行功能及認知彈性介入方案，動手樂活動(Tinkering Activities)為以主動推理訓練核心的認知介入，其於健康長者及SCD患者之可行性及療效皆已初步驗證。惟因SCD患者於神經心理測試無異常，行為學變化或較難偵測，故本研究結合事件相關電位(Event-Related Potentials, ERP)瞭解SCD患者參與動手樂活動後之大腦活動變化及其機轉，作為支持介入成效的神經生理學依據。 目的：結合事件相關電位及神經心理學測驗，探討動手樂活動對SCD患者認知彈性之介入成效，並進一步評估其對其他認知功能(如創意性思考、記憶力與注意力)及工具性日常生活功能的效益。 方法：本研究採單一組別前後測實驗設計，招募由台灣北部社區篩檢之SCD患者預計24人。參與者將接受每週2次，每次2小時，共6週之團體介入課程，於介入前、後進行腦電圖及行為測驗評估。腦電圖評估使用32孔電極帽進行電訊號接收，並於各電極注入導電膠降低電阻。主要成效指標為認知彈性，以行為學及神經生理學指標分別進行量測，反應性認知彈性(reactive cognitive flexibility)以ERP成分分析及交替任務測驗(Task Switching Task, TS)評量；自發性認知彈性(simultaneous cognitive flexibility)以用途替代測驗(Alternative Uses Test)評量。本篇分析之ERP成分含與任務激活相關之frontal P2，涉及反應抑制及衝突處理之frontal N2，及涉及工作記憶、認知資源的分配之parietal P3b。次要成效指標包括執行功能、工具性日常生活活動表現、整體認知功能、注意力及記憶力表現、聚合性及發散性思考表現。組內前後測之差異比較以Wilcoxon signed-rank test進行分析，效果量以Cohen's d呈現，ERP成效指標與行為測驗之相關性以斯皮爾曼等級相關係數(Spearman Rank Correlation)進行分析。 結果：共21位受試者完成EEG及行為測驗，反應性認知彈性方面，轉換任務錯誤率顯著下降(p=.031，d=.36)，具正向效益；神經生理學指標方面，P2之峰值振幅出現增加趨勢(p=.322，d=.24)，P2之specific switch effect出現增加趨勢(p=.434，d=.24)，，P3b於頂葉區域之specific switch effect出現增加趨勢(p=.149，d=.25)，P2與N2之波潛伏期出現潛在提早趨勢(p=.550-590，d=.24-27)。次要成效指標：執行功能(p=.001-.003，d=.72-94)、記憶力(p=.001-.046，d=.40-.89)等方面顯著改善；相關性探索部分，於認知彈性方面，P2之波潛伏期變化量與轉換任務錯誤率變化量呈顯著正相關(rₛ=.611；p=.003)，顯示特定ERP成份與行為學評量之相關性。 結論：本研究結果顯示，為期六週之動手樂活動對主觀認知衰退者之反應性認知彈性及部分神經生理學指標具潛在正向影響，並於多元認知面向（如記憶力、執行功能與工具性日常生活功能）中呈現轉移效果。此外，事件相關電位成分與行為表現間之顯著相關性，亦支持神經指標作為介入效果之潛在參考依據。惟研究樣本數較小，設計上尚缺乏隨機與盲化，需保守詮釋並透過後續大型研究進一步驗證。

Background: With global population aging, dementia and related conditions have become significant public health challenges. Subjective Cognitive Decline (SCD), considered a preclinical stage of dementia, is associated with increased risk of progression and greater cognitive decline—particularly in executive functions—compared to non-SCD individuals. Such impairments may further affect instrumental activities of daily living (IADLs). Among executive functions, cognitive flexibility is most closely related to everyday functioning. Therefore, early cognitive enhancement interventions targeting cognitive flexibility are crucial for dementia prevention. However, existing intervention programs focusing on executive functions and cognitive flexibility in SCD populations remain limited. Tinkering activities, which emphasize active inference and problem-solving, have shown initial feasibility and efficacy among healthy older adults and individuals with SCD. Given the subtle behavioral manifestations in SCD and often normal neuropsychological profiles, this study integrated event-related potentials (ERPs) to investigate underlying neural mechanisms and provide physiological support for intervention effects. Objective: This study aimed to evaluate the effects of a tinkering-based intervention on cognitive flexibility in individuals with SCD by integrating ERP and neuropsychological assessments. It further explored transfer effects on other cognitive domains (e.g., creative thinking, memory, attention) and IADL functioning. Methods: A one-group pretest–posttest design was adopted. A total of 24 community-dwelling older adults with SCD from northern Taiwan were recruited. Participants received a group-based intervention twice per week, two hours per session, for six weeks. Behavioral and EEG assessments were conducted pre- and post-intervention. Primary outcome measures included reactive cognitive flexibility—indexed by ERP components and the Task Switching Task (TST)—and spontaneous cognitive flexibility—assessed using the Alternative Uses Test (AUT). ERP components analyzed included frontal P2 (task-set activation), frontal N2 (response inhibition and conflict monitoring), and parietal P3b (working memory updating and resource allocation). Secondary outcomes included executive function, IADLs, global cognition, attention, memory, and convergent/divergent thinking. Wilcoxon signed-rank tests were used for within-group comparisons, with effect sizes (Cohen’s d) reported. Correlations between ERP changes and behavioral performance were analyzed using Spearman rank correlation. Results: A total of 21 participants completed both EEG and behavioral assessments. Regarding reactive cognitive flexibility, a significant decrease was found in switch trial error rate (p = .031, d = .36), indicating a positive intervention effect. For neurophysiological indicators, the peak amplitude of P2 showed an increasing trend (p = .322, d = .24), as did the specific switch effect of P2 (p = .434, d = .24). Additionally, the specific switch effect of P3b in the parietal regionshowed a trend toward increase (p = .149, d = .25). Both P2 and N2 latencies demonstrated potential shortening trends (p= .550–.590, d = .24–.27). Significant improvements were also observed in executive function (p = .001–.003, d = .72–.94), and memory (p = .001–.046, d = .40–.89). In the correlational analysis, changes in P2 latency were significantly positively correlated with changes in switch trial error rate(rₛ=.611；p=.003), indicating relevance to cognitive flexibility, suggesting associations between specific ERP components and behavioral performance. Conclusion: The results suggest that the six-week tinkering-based intervention may have a potentially positive effect on reactive cognitive flexibility and certain neurophysiological markers in individuals with subjective cognitive decline (SCD). Transfer effects were also observed in broader cognitive domains, including memory, executive function, and instrumental activities of daily living. Furthermore, the significant correlations between ERP components and behavioral performance support the use of neurophysiological indicators as potential markers of intervention efficacy. However, given the small sample size and lack of randomization and blinding, the findings should be interpreted with caution and validated through future large-scale studies.