「動手樂」活動作為主觀認知衰退患者執行功能訓練之療效：前導研究

Abstract

背景：預防及延緩失智症的發生是全球重要的公共衛生政策之一。失智症會帶來個人、家庭以及社會各方面的影響且目前並無有效的治療方式，因此於失智症發生前進行早期介入並開發有效的認知介入方案尤其重要。主觀認知衰退 (Subjective Cognitive Decline, SCD)被視為失智症最早期的症狀表現形式，患者可能有更高的認知衰退與失智症風險。儘管SCD患者在客觀認知測驗中表現正常，但SCD患者與認知功能正常者相比，除抱怨記憶力較差外，在某些認知領域如執行功能表現亦較差。執行功能包含一系列的認知過程，並透過自我控制及調節行為與想法，以幫助個人完成目標，包括工作記憶、抑制、認知彈性、計劃、問題解決和推理等。執行功能與日常生活功能相關，其衰退可能對個人生活品質造成負面影響。然而，目前針對維持或提升SCD患者執行功能的療效驗證文獻闕如。因此，本研究提出以「動手樂」活動作為提升SCD患者執行功能的介入方案。「動手樂」活動是一項強調問題解決、主動參與和開放性探索的認知活動，並挑戰執行功能。此外，過往文獻顯示「動手樂」活動對社區健康長者具不錯的療效。 目的：探討「動手樂」活動應於SCD患者之可行性及於執行功能之促進成效，並進一步瞭解活動於其他認知功能、工具性日常生活功能、創造力、情緒及自我效能感之效益。 方法：本研究為單一組別前後測實驗設計，並招募由社區篩檢之SCD患者。所有參與者將接受每週兩次，每次2小時，共6週之團體介入課程，並在介入前、後對所有參與者進行評估。主要成效指標為與執行功能相關之評估，包含河內塔測驗(Tower of Hanoi, TOH)、作業轉換典範(Task Switching Paradigm, TS)及彩色路徑描繪測驗-2(Color Trails Test-2, CTT-2)。次要成效指標包括工具性日常生活活動(Instrumental Activities of Daily Living, IADLs)表現、整體認知功能及其子領域如注意力及記憶力表現、創造力測驗表現、焦慮和憂鬱程度與自我效能感。組內前後測之差異比較將使用威爾卡森符號檢定(Wilcoxon signed-rank test)進行分析，並計算效應值(Cohen's d)。 結果：「動手樂」活動於社區篩選之SCD患者可行性佳。共12位參與者完成介入並納入分析，其中參與者之活動出席率達94.44%。介入結束後，參與者於執行功能(p=0.013-0.041, d=0.56-0.77)、整體認知功能(p=0.026, d=0.54)、主觀認知功能(p=0.049, d=0.63)、創意性及發散性思考(p=0.023-0.045, d=0.30-0.55)、立即視覺記憶(p=0.037, d=0.73)、立即聽覺記憶(p=0.007, d=1.03)，降低憂鬱程度(p=0.008, d=0.77)等顯著改善。然而，於注意力、延遲記憶、聚合性思考、工具性日常生活功能、焦慮程度及自我效能感方面，則未顯著改善。 結論：本研究初步支持「動手樂」活動於社區篩選之SCD患者可行，且能於促進執行功能、創意性及發散性思考、主觀與客觀整體認知功能、立即聽覺與視覺記憶及降低憂鬱程度帶來效益。惟樣本數小，未來仍需更大型試驗以驗證介入成效。

Background：Given that preventing and delaying the onset of dementia is a crucial public health policy issues worldwide, it is essential to develop effective interventions and implement early interventions before the onset of dementia. Subjective Cognitive Decline (SCD) is considered the earliest manifestation of dementia and individuals with SCD may have a higher risk for future cognitive decline and dementia. Despite performing normally on objective cognitive tests, individuals with SCD have been found to exhibit worse performance on some cognitive domains, including executive functions, compared to those without SCD. Executive Functions (EFs) refer to a set of cognitive processes that include working memory, inhibition, cognitive flexibility, planning, problem solving and reasoning, enabling individuals to achieve goals by controlling and regulating thoughts and behaviors. EFs are important for our daily functioning and their decline can negatively impact an individual's quality of life. However, to our knowledge, there is limited research on maintaining or improving EFs in individuals with SCD. Tinkering Activity (TA) is a hands-on cognitive activity that emphasizes process of problem-solving, active engagement and open-ended exploration, which challenges EFs. In addition, previous research has shown the benefits of TA for community-dwelling older adults. Objectives: The purpose of this study is to explore the feasibility of a TA-based cognitive intervention for individuals with SCD and to examine the efficacy in enhancing EFs and other cognitive functions, instrumental activities of daily living (IADLs), creativity, self-efficacy, as well as in reducing the levels of anxiety and depression. Method：This study was a one-group pretest–posttest design. Twelve individuals with SCD were recruited from the communities. All participants received 12 intervention sessions, each lasting 2 hours, with two sessions per week for 6 weeks. All participants were assessed before and after the intervention. Executive functions were assessed using the Tower of Hanoi test (TOH), Task Switching Paradigm (TS), Color Trails Test-2 (CTT-2) as primary outcome measures. The secondary outcomes were the performance of instrumental activities of daily living (IADLs), global cognitive function and cognitive domains of attention, memory, creativity, self-efficacy, levels of anxiety and depression. Wilcoxon signed-rank test will be used for statistical analysis and effect size (Cohen’s d) will be reported for all results. Results: Tinkering Activity was feasible for individuals with SCD. Twelve participants completed the intervention and were included in the analysis. The attendance rate was 94.44%. Results showed significant improvement in executive functions (p=0.013-0.041, d=0.56-0.77), global objective cognitive performance (p=0.026, d=0.54), global subjective cognitive function (p=0.049, d=0.63), creativity and divergent thinking (p=0.023-0.045, d=0.30-0.55), immediate visual memory (p=0.037, d=0.73), and immediate auditory memory (p=0.007, d=1.03). Moreover, there was a significant reduction in the level of depression (p=0.008, d=0.77). In contrast, there were no significant improvements in convergent thinking, delayed memory, performance of IADLs, self-efficacy, or in reducing the level of anxiety. Conclusion: Preliminary findings suggest that Tinkering Activity is feasible for individuals with SCD, and may effectively improve executive functions, subjective and objective cognitive functions, divergent thinking and reduce symptoms of depression. However, due to the small sample size, further studies are needed to validate our findings.