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研究生: 顏慧詩
See, Hooi
論文名稱: 輕度阿茲海默症合併妄想症狀有無與心智理論功能之相關探討
'Theory of Mind' of Mild Alzheimer's Disease Patients with and without Delusions
指導教授: 郭乃文
Guo, Nai-wen
學位類別: 碩士
Master
系所名稱: 醫學院 - 行為醫學研究所
Institute of Behavioral Medicine
論文出版年: 2009
畢業學年度: 97
語文別: 英文
論文頁數: 113
中文關鍵詞: 妄想阿茲海默症心智理論認知功能
外文關鍵詞: Theory of Mind, Cognitive functions, Alzheimer's disease, Delusions
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  • 研究背景與目的:阿茲海默症(Alzheimer’s disease, AD)患者伴隨妄想症狀的比例相當高,它們會讓個案產生更多的不適感,也是照顧者壓力的主要來源。故阿茲海默症之妄想症狀值得關注。「妄想」是一種固著、堅信而無法撼動的錯誤想法。「心智理論」(Theory of Mind, ToM) 是一種可理解、表徵他人的心理狀態,解釋、預測他人行為的能力,包含初級錯誤信念 (First-order false belief) -了解他人與自己有不同信念以及次級錯誤信念 (Second-order false belief) - 正確了解A對B的想法,能考量他人如何看待第三者。此能力的缺損就會造成推論或歸因的偏差。Frith在1992年的研究指出:有妄想症狀的精神分裂症患者較無妄想症狀的患者在心智理論能力上有明顯缺陷。雖然許多研究已經都已普遍支持精神分裂症、失智症、阿茲海默症等疾病的患者確有明顯的心智理論缺陷。到目前為止,妄想症狀與心智理論能力特定的關聯,尚未得到一致的結果。因此,本研究的目的在了解輕度阿茲海默智症患者的妄想症狀有無與心智理論之間的關係。研究假設患有妄想症狀的患者,其心智理論能力也較無妄想症狀的患者來得差。另外,有的學者認為心智理論能力與認知功能有關,有的則認為二者是屬獨立的系統而沒有關聯,因此本研究的另一個目的在了解輕度阿茲海默症患者的心智理論能力表現與認知功能之間的關聯。
    研究方法:本研究選取共29名輕度失智未合併妄想症狀的阿茲海默症患者、30名輕度失智的阿茲海默症合併妄想症狀患者、29名健康老年人,比較三組心智理論能力 (包含初級錯誤信念及次級錯誤信念) 以及認知功能 (包含語文工作記憶、非語文工作記憶以及執行功能) 的表現。
    結果:三組受試者在初級錯誤信念表現沒有顯著差異。合併妄想症狀的輕度阿茲海默症患者的次級錯誤信念測驗表現顯著較未合併妄想症狀患者差,二組表現都顯著比正常組差。妄想組與非妄想組在部分認知功能作業上達顯著差異。二組不同的心智理論能力分作業也分別與不同的認知功能作業有其特定的相關。
    討論:本研究支持輕度阿茲海默症患者的妄想症狀與心智理論能力的缺陷有顯著的關係,此能力的缺損造成推論或歸因的偏差,可能與妄想症狀有關。另外,合併妄想症狀及未合併妄想症狀的輕度阿茲海默症患者,其心智理論能力與認知功能之間有不同型態的相關聯。主要的學術貢獻是提供病因機制探討的新觀點,希望未來可以臨床上作為治療的理論基礎。

    Background: For a number of years now, symptoms such as delusions have been known to occur in Alzheimer’s disease patients (AD). However, they have received much less attention than the cognitive impairment of AD. Behavioral changes, such as delusions, cause the greatest stress to the patients and their caregivers yet are often treatable. They indicate subtypes of AD, and shed light on the neuropathology of the disease and its symptoms. Theory of Mind (ToM) involves a person’s ability to infer what another person knows, thus taking his or her perspective. Frith (1992) proposed a theory concerning a specific relationship between impaired theory of mind and paranoid delusions. Initial evidence has been presented for a theory of mind impairment in individuals with schizophrenia, AD and some other forms of dementia. Specific correlations between impaired theory of mind and delusions has been demonstrated in schizophrenic patients. However, theory of mind has not been investigated in AD patients with delusional conditions. The specific relationship between impaired theory of mind and AD with delusions has not yet been demonstrated. The purpose of present research is to examine the relationship between ability of theory of mind in mild AD patients with and without delusions. And additionally, whether cognitive functions are related to theory of mind deficits.
    Methods: First and second-order false belief tasks were examined in 30 delusional AD patients, 29 non-delusional AD patients and 30 healthy controls. Extensive neuropsychological assessments were also conducted.
    Results: Mild AD patients that suffer from delusions performed significantly poorer than those patients without delusions and the healthy elderly subjects (in second-order false belief tasks), retrieval and ineffective reminder subscores in verbal and nonverbal working memory tasks, as well as correctness, perseverative responses and perseverative errors in WCST-64. Different patterns of correlation between ToM and cognitive function tasks were also observed.
    Discussion: Current study has presented some evidence for a specific theory of mind impairment in AD participants with delusions. The confirmation of the association among working memory, executive function and theory of mind ability is also demonstrated. This may provide a greater insight into the abilities of social cognition, and may answer whether delusional symptoms frequently found in AD patients are related to deficits in theory of mind. It may reflect a new perspective of the pathology of delusion symptoms in AD.

    1.INTRODUCTION...1 1-1 Delusions in Alzheimer’s disease...1 A.Classifications of delusions...2 B.Etiologies of delusions...6 C.Cognitive functions of delusional Alzheimer’s disease patients...12 1-2 Theory of Mind...14 A.Definition of ‘Theory of Mind’...14 B.Theory of mind impairments...15 C.Theoretical approaches of ‘Theory of Mind’...19 D.‘Theory of Mind’ assessments...24 1-3 ‘Theory of Mind’ of Alzheimer’s Disease and Delusional Disorders Patients...29 A.‘Theory of Mind’ of Alzheimer’s disease patients...29 B.‘Theory of Mind’ of delusional disorder patients...32 1-4 Study Purposes...36 2. METHODS...37 2-1 Participants...37 A.Alzheimer’s participants...37 B.Control participants...38 2-2 Materials...29 A.Two Factor Index of Social Position...39 B.Chinese Form of Mini-Mental State Examination...40 C.Cognitive Abilities Screening Instrument-Chinese Version...40 D.Clinical Dementia Rating-Chinese Version...41 E.Cornell Scale for Depression in Dementia...42 F.Dementia Delusional Scale...43 G.Tasks for Assessing Ability of ‘Theory of Mind’...45 H.Knox Cube Imitation Test...47 I.Fuld Object Memory Evaluation...48 J.Wechsler Adult Intelligence Scale Digit Span Subtest...49 K.Guo’s Verbal Working Memory Test...50 L.Wisconsin Card Sorting Test-64 Card Version...51 M.Questionnaires of Executive Behaviors in Daily Life...52 2-3 Procedures...53 3. RESULTS...54 3-1 Data Analysis...54 3-2 Demographic, ToM Tasks, Working Memory and Executive Function of All Elderly Participants...55 3-3 ToM Tasks and Neuropsychological Performances for Non-delusional AD Group...61 3-4 ToM tasks and Neuropsychological Performances for Delusional AD Group...64 4. CONCLUSIONS & DISCUSSIONS...67 4-1 ‘Theory of Mind’Impairment in Delusional AD Participants...67 4-2 Cognitive Impairment of Delusional and Non-delusional AD Patients...70 4-3 Coincidence of Cognitive Impairment with Specific Theory of Mind Impairment...71 4-4 Research Contribution and Limitations...73 REFERENCES...77 TABLES...90 APPENDICES...102

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