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題名:阿茲海默氏失智症患者語言使用能力之研究
作者:柯怡姍
作者(外文):YI-SHAN KO
校院名稱:國立新竹教育大學
系所名稱:臺灣語言與語文教育研究所
指導教授:呂菁菁
學位類別:博士
出版日期:2016
主題關鍵詞:失智症聽覺理解口語表達閱讀理解書寫表達長篇敘事能力Dementiaspontaneous speechspeech productionreadingwritingnarrativesauditory comprehension
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從研究回顧中,我們發現失智症盛行率逐年提高,但以失智症的語言表現為主題的研究,多以非漢語為主,同時,有關於失智症患者聽覺及閱讀理解能力的研究較少,因此,本論文採用波士頓失語症測驗華語版 (呂菁菁等,2016) 以及梨子的故事 (Chafe, 1980) 為量測工具,試圖了解患者失智症在交談能力、聽覺理解能力、口語表達能力、閱讀理解能力、書寫表達能力,和長篇敘事能力的表現。
本研究共招募13名阿茲海默氏症失智症患者 (平均年齡75.31歲,教育程度平均8.23年),以及 14名非失智症之老年人作為對照組 (平均年齡73.07歲,教育程度平均8.29年)。研究結果顯示病例組在聽覺理解方面與對照組呈現顯著差異,達顯著差異之測驗包含「語詞理解」、「身體指認理解」、「指令理解」及「概念理解」;在口語表達、閱讀理解及書寫表達能力方面與對照組有顯著差異之測驗分別為口語表達中的「名稱答覆」、「句子覆誦」、「列舉動物名稱」、「圖片命名」,交談能力中的「看圖說故事」,以及閱讀理解中的「發音類似之語詞辨認」、「字圖配對」、「句子短文閱讀」,和書寫表達中的「筆畫組合」、「書寫語詞」、「書寫句子短文」;在長篇敘事能力方面,病例組所使用的主題數量顯著低於對照組。
基於以上的研究結果,本研究推論可能的解釋為:當患者面對只能經由語義系統來執行語言運作的情況時,語言運作上則會顯露出缺失;此外,病例組在口語表達中的命名表現較對照組差,以及在言談中的主題無法連貫,則可能是因抑制能力不足所致。
本研究最後對於語言運作領域的研究設計,以及在語境效應及語義系統的處理方面,也提出相關建議,以供未來進行語言研究做參考。
There has been a wealth of researches on the language ability of dementia; however, the studies on Chinese-speaking patients with dementia, specifically on their auditory and reading comprehension, can rarely be founded. Thus, this study tried to probe into the abilities of using language in patients with dementia of Alzheimer's type, with the research tools of Mandarin Version of Boston Diagnostic Aphasia Examination (Lu, et al.,2016) and Pear story (Chafe, 1980).
Data for the study came from a survey of 13 patients with AD and 14 age- and education-matched controls in six language domains: spontaneous speech, auditory comprehension, speech production, reading, writing and narratives. The results indicated that the performance of the AD patients showed significant differences in all the subtests of auditory comprehension than the control participants, including word discrimination, body-part identification, commands, and complex ideational materials. The AD patients were impaired in some subtests of speech production, reading and writing, including responsive naming, repeating phrases, animal naming, picture naming in oral expression, cookie-theft picture description in conversational and expository speech, word recognition, word-picture matching ,reading sentence and paragraphs in reading, and mechanics of writing, serial writing, complex-level dictation, written confrontation naming, narrative writing, and sentence written to dictation in writing. In addition, the AD patients used significantly less numbers of topics in narratives.
Finally, the language performance of difficulties related to the semantic system, and specifically inhibition problems were discussed. And based on our analyses, we also made recommendations concerning context effects and semantic systems for further researches.
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