碩士 / 國立成功大學 / 行為醫學研究所 / 91 / The issues of whether patients in the early stage of dementia of the Alzheimer type (DAT) are unaware of deficits and whether unawareness in all DAT patients is in the general or specific domain have been controversial. Several reports suggested that establishing an objective and quantitative measure of unawareness is the essential step in resolving these issues. Before we explore the issue of unawareness, we need to know the features of DAT patients’ neuropsychological functions in terms of the course of the disease. The aims of this study were as follows: first, to examine whether the higher cortical function examination scale (HCFE) can reflect the deterioration of different neuropsychological functions in patients with DAT; second, to develop an awareness rating scale (ARS), which includes more deficit domains in patients with DAT and which has good reliability and validity; third, to use the ARS data to explore whether patients with mild DAT are unaware of their deficits and whether unawareness in all DAT patients is in the general or specific domain.
Sixty-one patients with DAT and 32 healthy controls matched for age and education were included in the study. All subjects received a short-form battery of neuropsychological tests, the HCFE, the neurobehavioral standard interview (NBI), and the ARS. Sixty-one primary caregivers of DAT patients received the NBI, ARS, Instrumental Daily Living Function questionnaire, and the Symptoms Checklist-90-Revised to evaluate patients’ function and neurobehavioral symptoms. A clinical psychologist completed the Neurobehavioral Rating Scale (NRS) and the Clinical Dementia Rating (CDR) to evaluate the patients’ neurobehavioral symptoms and the severity of dementia. In order to explore the DAT patients’ unawareness, we compared each patient’s rating in the ARS with his/her performance in the HCFE, the caregiver’s rating in the ARS, and the psychologist’s rating in the NBR and CDR.
Subjects were divided into healthy, mild dementia, and moderate-severe dementia groups according to their CDR score. The results revealed that, (1) the performance of patients with mild dementia on the tests of temporal orientation (TO), orientation to personal information (OPIP), recent and remote memory (RC & RM), verbal and nonverbal new learning (VL & NVL), semantic association of verbal fluency (VF), visual-spatial construction (VSC), reasoning, and manual dexterity with the right hand was significantly worse than that of healthy controls. The performance of patients with moderate-severe dementia on the tests of TO, OPIP, RC, RM, VL, NVL, digit repetition, auditory comprehension, calculation, reasoning, manual dexterity with both hands and bimanual coordination was worse than that of the healthy and mild dementia groups. The performance of the patients with moderate-severe dementia on the tasks of orientation to place and object naming was worse than that of healthy subjects. (2) The internal consistency, content validity, and criterion-related validity of the ARS were acceptable. There were ten factors, which could account for 78.91% variation, in the ARS. (3) On the basis of the results of the HCFE, the patients with mild dementia had no remarkable unawareness of their cognitive deficits. However, patients with moderate-severe dementia showed unawareness of deficits in the learning, short-term memory, remote memory, and spatial judgment domains. In non-cognitive functioning, on the basis of caregiver and psychologist evaluation, patients with mild dementia showed unawareness of deficits in the self-care domain, while patients with moderate-severe dementia showed unawareness of deficits in the self-care and daily-living function domains.
On the basis of these results showing that with the CDR, the neuropsychological assessment could reflect the deterioration of different neuropsychological functions in patients with DAT in terms of the course of the disease, we suggest that combining the CDR and neuropsychological assessment results could provide more complete information for rehabilitation and care. The Awareness Rating Scale seems to be useful for future study. However, some defects in the ARS should be revised. For example, some domains in the ARS cover fewer items, and some domains in the ARS have low criterion-related validity. Since our DAT patients in the middle-late stage had unawareness in general domains, but our DAT patients in the early stage were only evident of unawareness in the self-care functioning domain, it appears that these results partially support Frederiks (1985), and Joynt and Shoulson’s (1985) observations of patients with the early stage of DAT being unaware of their deficits. Finally, the results revealed that in using the ARS, there was bias, not only in patients’ self-reports but also in caregivers’ reports. In order to improve the accuracy in future research on unawareness, we suggest using the neuropsychological examination as the basis of the cognitive component, and using the caregiver and clinician’s evaluation as the basis of the non-cognitive component.
| Identifer | oai:union.ndltd.org:TW/091NCKU5666003 |
| Date | January 2003 |
| Creators | Chia-Yu Wang, 王佳玉 |
| Contributors | Mau-Sun Hua, Huei-Chen Ko, 花茂棽, 柯慧貞 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | zh-TW |
| Detected Language | English |
| Type | 學位論文 ; thesis |
| Format | 97 |
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