台灣正常中老年人 語意流暢度測驗之北部地區常模研究

Abstract

語意流暢度測驗（SVF）由於指導語簡單易懂、施測快速、不需受測者具備讀寫能力，測驗內容貼近日常熟悉事物，且對腦功能異常高度敏感，因此為廣泛使用於執行功能評估的工具之一。台灣臨床上最常使用包括水果、魚類以及蔬菜等三項內容的語意流暢度測驗，然而至今尚未系統性建立該測驗常模及心理計量資料。本研究目的在增訂3項非生物類別語意流暢度測驗、評估SVF於台灣北部地區中老年人使用上之心理計量特性、探討人口學變項與該測驗表現之關係，進一步建立台灣北部中老年人SVF的常模資料。本研究一共收集了台灣北部地區220名45歲至85歲、教育程度0年至18年的健康中老年人於SVF的常模資料，同時收集尼爾森修訂版卡片分類測驗、彩色路徑描繪測驗、定速聽覺系列加法測驗、詞彙分測驗等資料來檢驗SVF之效度。其中30名受測者於四個月後進行再測，以檢驗SVF之再測信度。研究結果顯示：1.項目分析方面，個別SVF彼此具有高項目同質與高鑑別度；2.人口學變項中，整體而言，年齡與教育程度為SVF最重要的預測變項。年齡與SVF呈現負相關；教育程度與SVF呈現正相關；性別只與蔬菜類別有顯著相關。然而就合併類別SVF或個別SVF而言，人口學變項對不同SVF的影響不同。隨著個別語意類別之不同，不識字組、國小教育程度組以及國中教育程度組組間差異也有所不同; 3.信效度方面，合併類別SVF具有高內部一致性及.85-.90的再測信度；合併類別SVF與個別SVF皆具有良好效度 ; 4.常模建立方面，本研究以迴歸分析的方式建立校正公式，排除人口學變項對測驗表現的影響，並分別建立合併6項全類別SVF、合併3項生物向度SVF、合併3項非生物向度SVF以及個別SVF之百分等級對照表以供參照。綜合上述研究結果，說明SVF於45歲至85歲的北部地區健康中老年人使用上有良好的心理計量特性，以及臨床應用上之適切性，而本研究提供的常模資料具有代表性與適切性。未來擬以臨床病人為對象，配合神經影像學資料加以佐證，探討SVF在臨床使用上敏感度與特異性之議題，並訂定適當切截點。

Semantic Association of Verbal Fluency task (SVF) is commonly used in neuropsychological assessment since it is easy to administer, sensitive to brain damage and cognitive deterioration. Besides, SVF is a relatively simple test used to assess frontal lobe function. SVF also has been applied in the investigation of illiterate and other low-level education groups as it does not require reading or writing skills. The SVF with a composite of fruit, fish and vegetable categories is the most popular criterion in Taiwanese clinical practice. However, related studies on the SVF and the normative data for the tests are scarce in Taiwan. Therefore, the objectives of this study were to expand the SVF test including the nonliving domain, to evaluate its psychometric properties, and to collect the normative data in healthy older adults in North Taiwan, as well as to examine the relationship between the test performance and demographic variables. The SVF were administered to 220 healthy individuals aged 45 to 85 years, with education level varied from 0 to 18 years. The Nelson’s Modified Card Sorting Test, the Color Trail Test, the Paced Auditory Serial Addition Test, and the Vocabulary subtest from the WAIS-Ⅲ (Chinese version) were also administered to examine the validity of the SVF. Thirty of these 220 participants were retested 4 months later to examine the reliability of the SVF. The results revealed that both the item homogeneity and item discrimination were high. The SVF performances were negatively correlated with age, but positively correlated with education. The advantage performance of female subjects on the vegetable fluency task was also noted. Overall, age and education were the most important predictors of the SVF performances. However, the influence of demographic variables on SVF performances varied as different domains and individual category were concerned, justifying the necessity of establishing the norms for composite scores of SVF and each single SVF score individually. Stability coefficients of the composite scores of SVF ranged from .85 to .90, and the correlations between the SVF and the criterion validity tests were significant. Regression coefficients derived from demographic variables were used to adjust raw scores, and percentile rank norms for these adjusted scores were established. In conclusion, the SVF showed good test-retest reliability and validity, and the local normative data are applicable for the healthy individuals aged from 45 to 85 years. The composite scores of living domain SVF are particularly suitable for evaluating illiterates or people with low education level. For the effective use of the SVF in clinical settings, further studies of specific clinical populations are required.