背景：
隨著老年人口的快速增長，認知功能衰退已成為人口老化下不容忽視的問題，然而認知衰退並不僅限於老年人，早發性失智症在65歲之前也可能發生，但研究顯示採取健康的生活方式可以降低失智症的風險，根據認知儲備（Cognitive reserve）理論，增加與認知相關的生活型態，例如參與社團活動，有助於延緩認知功能衰退，且不同類型的社團活動對認知的益處因性別而異。然而，過去的研究鮮少同時探討社團參與及認知軌跡，台灣的研究亦僅限於評估社團參與對認知分數的影響，未考慮認知功能隨時間的變化。因此，本研究旨在探討不同類型的社團活動以及參與波數對認知軌跡的影響。
目的：
本研究的目的有三， （一）瞭解台灣老年人在長期追蹤下，依性別、年齡分層之認知功能的軌跡變化情形； （二）探討參與社團活動與認知功能軌跡的相關性； （三）比較參與社團活動類型以及參與社團活動波數對認知軌跡組的影響。
方法：
採用「臺灣地區中老年身心社會生活狀況長期追蹤調查」（Taiwan Longitudinal Survey on Aging, TLSA）資料庫，以2003年年齡滿50歲以上之台灣中老年人為研究對象，共有5,377人，於2007、2011及2015年進行追蹤調查，並排除問卷代答者、認知功能遺漏超過一題者、2003年ADL有困難者、缺少2003年資料者、 未完成至少二次認知功能評估者，排除上述樣本後，最終納入3,963人進行分析。依變項認知功能以簡短式心智狀態問卷（SPMSQ）作為評估工具；自變項社團參與類型分為社區團體、服務性團體、宗教團體、工商會/政團/同鄉會四類，依是否有參與任一類社團評估有無社團參與，並計算四波調查中參與幾波的社團活動。利用群組化軌跡分析（Group-based Trajectory Model）識別依性別、年齡分層之認知功能軌跡，並以多元邏輯斯迴歸（Multinomial logistic regression）探討社團參與類型及參與波數對各認知軌跡組別間的影響。
結果：
首先，認知功能軌跡分析結果顯示，全體樣本可分為「維持高分」、「維持良好」、「快速下降」三組。若以性別來看，男性可分為「維持高分」、「維持良好」、「快速下降」三組；女性則為「維持高分」、「維持良好」、「高分緩慢下降」、「低分持續下降」四組。若依年齡來看，男性50-64歲分為兩組：「維持高分」、「維持良好」，而65歲以上則分為四組：「維持高分」、「維持良好」、「緩慢下降」、「快速下降」；女性50-64歲也是兩組：為「維持良好」、「緩慢下降」，而女性65歲以上則為「些微下降」、「高分緩慢下降」、「低分持續下降」三組。
在社團參與類型對認知軌跡之結果發現，全體樣本中，參與社區團體會促使維持良好和快速下降軌跡，參與工商會/政團/同鄉也會促使快速下降軌跡，而參與服務性團體則對快速下降軌跡有延緩作用。依性別分層後，男性參與社區團體易發展為維持良好的認知軌跡，而女性參與服務性團體對發展為認知衰退軌跡具有保護作用。經年齡分層後，僅女性參與工商會/政團/同鄉會增加發展為較差的認知功能軌跡。此外，男女性參與社團活動的波數越多對認知衰退具有保護作用，特別是65歲以上的族群。
結論：
本研究發現在不同的性別與年齡間存在多元的認知功能軌跡型態，其中以女性的認知表現較差，且自50歲開始即出現認知退化趨勢，可以藉由參與服務性團體防止認知衰退，而男性參與社區團體則會促使發展為維持良好的認知軌跡，建議未來政策可以針對不同的性別與年齡，規劃社團活動的參與策略，並設計參與誘因或內容以增加參與意願，促進大眾認知健康。

Cognitive decline has become an increasingly concerning issue due to population aging, and it can also affect individuals below the age of 65, leading to early-onset dementia. According to the cognitive reserve theory, engaging in cognitive-stimulating activities, such as social participation, can help delay cognitive decline. Therefore, the purpose of this study was to explore the effect of various types of social participation and the number of participation waves on cognitive trajectories.
The study used data from the "Taiwan Longitudinal Survey on Aging, TLSA" and focused on 3,963 Taiwanese middle-aged and elderly individuals aged 50 and above from 2003 to 2015. The dependent variable was Cognitive function trajectory. The independent variable, social participation, was categorized into four types, and the number of survey waves in which they engaged in social activities was calculated.
Results showed that cognitive function was divided into three trajectory groups in the sample, three trajectories for males and four for females. Regarding age, males and females aged 50-64 were divided into two trajectory groups. However, males aged 65 and above were divided into four trajectory groups, while females were divided into three trajectory groups. Moreover, it was found that males participating in community groups were associated with an increased likelihood of a maintaining well in cognitive trajectory. For females, participating in service-based groups was protective against cognitive decline trajectories. When considering age stratification, participation in a chamber of commerce and industry/political groups/townspeople associations contribute to developing poorer cognitive functioning trajectories. Furthermore, more wave participation in social groups had a protective effect against cognitive decline, especially for those aged 65 and above.

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