研究背景與目的：隨台灣邁入高齡化社會，高齡者的心理健康議題變得相當重要。執行功能是一組主要由大腦前額葉皮層控制的高層次認知功能，其涵蓋的認知歷程與面向相當廣泛，且評估工具與策略相當多元。由於前導研究發現與執行功能息息相關的「工具性日常生活活動功能」和「自覺健康情形」分別可解釋22%與10%的老年憂鬱量表(Chinese Version of Geriatric Depression Scale-Short Form, GDS-S)分數變化，故本研究推測高齡者之執行功能應會對其心理健康產生影響力，並以兩種不同狀態的高齡族群為對象，探討執行功能對心理健康之影響。
研究方法：研究一是針對整體認知功能正常的高齡慢性病患者進行討論，研究對象為128位老年糖尿病患者；研究以第一年的社會人口學資料(年齡、性別、教育年數)、身體健康與用藥狀況(Glycated Hemoglobin (HbA1c)、Body Mass Index (BMI)、藥物數量、疼痛嚴重度)、認知功能評估結果(Chinese Version of Mini-Mental State Examination (MMSE-C)分數、執行功能量表分數)、生活功能表現(疼痛干擾程度、Barthel Index (BI)分數、Lawton Instrumental Activities of Daily Living (IADL)分數、Hierarchy of Care Required-Cognition and Emotion (HCR-C&E)分數為獨變項，以三年的生活品質量表(World Health Organization Quality of Life Scale Brief Version, WHOQOL-BREF)分數與GDS-S分數為依變項，進行相關分析與迴歸分析，並以Cohen’s ƒ2 計算效果量(effect size，ES)。研究二是針對整體認知功能缺損的高齡者進行討論，研究對象為29位輕度認知障礙(Mild Cognitive Impairment，MCI)患者、29位輕度失智症(mild dementia，MD)病患、和32位65歲以上社區健康民眾(older healthy controls，OHCs)，研究評估所有研究對象的執行工作記憶(Neuropsychological Measure of Executive Working Memory, NPM-EWM)，並依能否通過NPM-EWM評估將整體認知功能缺損的研究對象分為通過組與失敗組，進一步分析通過組與失敗組的差異。
研究結果：研究一發現執行功能量表分數對三年WHOQOL-BREF總分與GDS-S總分都具最大貢獻，其中對第一、二年WHOQOL-BREF總分的貢獻屬大效果量(ES=0.46、0.57)，對第三年WHOQOL-BREF總分和第一、二年GDS-S總分的貢獻屬中到大效果量(ES=0.30、0.15、0.21)，對第三年GDS-S總分的貢獻屬小到中效果量(ES=0.13)。研究二發現全部社區健康民眾、超過50%的MCI病患與25%以下的MD患者通過NPM-EWM，而MCI失敗組在Hierarchy of Care Required- Instrumental Activities of Daily Living (HCR-IADL)的表現顯著低於MCI通過組(ES=1.252)、MD通過組在Hamilton Depression Rating Scale (HDRS)量表的表現顯著低於MD失敗組(ES=0.884)。
討論與總結：研究一結果顯示，執行功能量表分數可解釋整體認知功能正常之高齡慢性病患者三年的心理健康狀態。研究二結果顯示，探討整體認知功能缺損之高齡者的執行工作記憶，將有助了解影響其心理健康變化之內在機制。綜合以上兩個研究，可見高齡者之執行功能的確會對其心理健康產生影響力，只是針對不同狀態之高齡族群，宜著重不同執行功能面向並採取適切的評估策略。建議未來可將執行功能評估導入高齡長者健康照護的常規流程，以便能依個別需求規劃精準的介入措施。

Background and Aims：Taiwan has transitioned from an "aging society" to an "aged society" in 2018. Hence, the mental health of older adults has become an extremely important issue in Taiwan. Executive function (EF) is an umbrella term for a set of neurocognitive constructs and processes dominated by the prefrontal cortex. It can be evaluated by applying various assessment instruments and techniques. Since the pilot study found that EF-related variables, including the Instrumental Activities of Daily Living (IADL) score and the self-rated health score, can explain 22% and 10% of the variance of the score of Chinese Version of Geriatric Depression Scale-Short Form (GDS-S), the present study hypothesized that the EF of older adults would affect their mental health. Therefore, the present took 2 groups of older adults with different conditions as examples to explore the impact of EF on mental health.
Methods：Participants in the first sub-study are cognitively normal older adults with chronic illness. This sub-study recruited 128 older adults with diabetes aged ≥ 60 years old. The demographic variables (age, gender, and years of education), health and medical conditions (Glycated Hemoglobin (HbA1c), Body Mass Index (BMI), number of medications, and pain severity), cognitive function (Chinese Version of Mini-Mental State Examination (MMSE-C) and Executive Function Scale-Short Version (EFS-S)), and life function (pain interference, Barthel Index (BI), IADL, Hierarchy of Care Required-Cognition and Emotion (HCR-C&E)) collected in the 1st year were considered independent variables. The World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and the GDS-S collected in the 1st year as well as in the 2nd and 3rd year follow-up were considered dependent variables. Pearson's correlation coefficient analysis and stepwise multiple linear regression analysis were performed to explore the relationship between the independent and dependent variables. Cohen’s ƒ2 was applied to calculate the effect size (ES). Participants in the second sub-study are cognitively impaired older adults. This sub-study recruited 32 older healthy controls (OHCs), 29 mild neurocognitive disorder (NCD) patients, and 29 major NCD patients. All participants administered a neuropsychological measure of executive working memory (NPM-EWM). Based on the results of the NPM-EWM, the mild and major NCD patients were regrouped into the passed-group (including mild NCD-passed and major NCD-passed subgroups) and the failed-group (including mild NCD-failed and major NCD-failed subgroups). The differences in the NPM-EWM between the OHC group and all the mild and major NCD subgroups were then analyzed using one-way ANOVA and LSD post hoc test. χ2 and two-tailed t tests were used to examine the differences between the participants of the mild and major NCD group who passed or failed the NPM-EWM.
Results：The result of the first sub-study showed the EFS-S score is the strongest predictor for all the overall WHOQOL-BREF scores and the GDS-S scores at the 3 time points. It contributed 31.5% of the variability of the overall WHOQOL-BREF score at the 1st year (ES = 0.46), 36.2% of the variability at the 2nd follow-up (ES = 0.57), and 23.0% of the variability at the 3rd year follow-up (ES = 0.30). It also contributed 13.2% of the variability of the GDS-S score at the 1st year (ES = 0.15), 17.1% of the variability at the 2nd follow-up (ES = 0.21), and 11.1% of the variability at the 3rd year follow-up (ES = 0.13). The result of the second sub-study showed all OCHs, more than half mild NCD patients, and less than a quarter of major NCD patients passed the NPM-EWM. The mild NCD-passed subgroup revealed significantly less level (p = 0.003) of Hierarchy of Care Required- Instrumental Activities of Daily Living (HCR-IADL) than did the mild NCD-failed subgroup, and the effect size was large (Cohen’s d = 1.252). The major NCD-passed subgroup had a significantly higher Hamilton Depression Rating Scale (HDRS) score (p = 0.05) than did the major NCD-failed subgroup, and the effect size was also large (Cohen’s d = 0.884).
Discussion and Conclusion：The findings of the first sub-study demonstrated that the EF was the most predictive factor for the quality of life (QoL) and negative emotion (NE) of cognitively normal older adults with chronic illness. The findings of the second sub-study showed examining the executive working memory (EWM) will help to understand the internal mechanisms of the alteration of mental health among cognitively impaired older adults. Based on the findings from the 2 sub-studies conducted on older adults with different conditions, the present study recommended that EF does have a contribution to the mental health of older adults. Nevertheless, specific aspects of EF should be emphasized, and different assessment approaches should be adopted while evaluating the EF of older adults with diverse conditions. The present study recommends including the evaluation of EF into the routine process of geriatric healthcare delivery services so that healthcare professionals can design precise interventions according to individual needs.

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