研究目的：全腦放射治療對癌症腦轉移的患者是一種重要的治療方式，部分研究指出全腦放射治療可能會使全面性心智功能、記憶力和執行功能下降。臨床觀察發現部分患者有注意力功能下降之抱怨，但目前少有研究探究全腦放射治療對注意力功能造成之影響進行檢視。此外，臨床觀察發現部分患者在接受全腦放射治療短期內就出現明顯的認知功能下降現象，但目前少有研究探討全腦放射治療在治療初期對認知功能造成的影響。故本研究試圖探討腦轉移患者接受為期2~3週的全腦放射治療過程中，不同時間點其全面性心智功能與注意力功能的變化，並探討臨床衡鑑之運用方式。

研究方法：研究樣本病人組立意取樣於南部某教學醫院，經病理診斷為癌症且轉移到腦部需要接受全腦放射治療之病患；對照組為人口學變項配對之一般健康受試者。收案病人組21人，對照組22人。以簡短心智狀態檢查表 (Mini-Mental State Examination, MMSE)、魏氏智力測驗–記憶廣度分測驗 (WAIS–III Digit span)、廣泛性非語文注意力測驗(Comprehensive Non-verbal Attention Test Battery, CNAT) 於病人接受全腦放射治療前 (T0)、治療開始第三～四天 (T1)、治療結束後一週內 (T2)進行評估。

結果：(1) 不同組別和不同追蹤時間點對MMSE之交互作用達顯著，病人組於後測的MMSE分數顯著低於對照組。病人組於治療前後的MMSE變化未達到顯著差異，但於T1有上昇趨勢，於T2呈現下降的趨勢；對照組於治療前後MMSE變化達顯著差異，後測分數明顯較前測高。病人組在不同MMSE功能向度上的表現於不同追蹤時間上無顯著差異，但其中「注意與計算」和「登錄與記憶」後測分數比前測分數低，而「定向感」和 「語言」於後測則呈現進步。(2) 不同組別和不同追蹤時間點對搜尋性注意力反應時間之交互作用達顯著，病人組於前測反應時間較快，於後測則反應較慢，但組別和追蹤時間點之單純主要效果均未達顯著。由趨勢圖顯示病人組的集中注意力、搜尋性注意力，和抑制性注意力的反應時間表現於後測呈下降趨勢；集中注意力的錯誤數表現於後測也呈現下降趨勢。(3) MMSE和注意力測驗表現之間的相關分析顯示，病人組與社區組後測的相關均變多，而病人組前後測的相關一致性較少，顯示其前後測的功能變化形態不同。
結論：病人組於MMSE後測顯著低於對照組，但病人組於治療前後2~3週的短期時間內變化僅呈現分數下降趨勢但無達到顯著差異。病人組在搜尋性注意力反義時間於T2表現較長，其他注意力功能於2~3週的短期時間內無顯著差異變化。建議在衡鑑工具的運用上，使用國內增加「反向追蹤」題之總分38分版本，以初步預估病人其注意力功能之可能變化。

Past researches indicate that patients who were treated with WBRT may have declined mental functions, such as memory, or executive function. But as for the attention disturbance is seldom studied in previous researches. This study investigates the mental function and attentional function of patient with brain metastases during the 2~3weeks WBRT, and the application of the neuropsychological assessment were discussed. 21 patients treated with WBRT and 22 normal controls were assessed Mini-Mental State Examination (MMSE), WAIS-III Digit Span, Comprehensive Non-verbal Attention Test Battery (CNAT) at different time-points: before WBRT (T0), after three to four days (T1), within a week after WBRT (T2). The results of the present study have revealed that, patients’ total score of MMSE were significantly lower than normal controls in T2. The patients’ total score of MMSE during the 2~3weeks WBRT were not significantly changed. As for attention, patient took longer to finish trials of selective attention in T2, but other attentional functions remains the same after WBRT. The correlation between MMSE and CNAT showed that patients have more correlation agreement difference in T2, suggests the different pattern of functional change during the WBRT. We suggest use the extra item of MMSE-“reading backwards” to predict the possible attentional function change.

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