運動訓練對巴金森氏病個案注意力及工作記憶之改善成效——前趨研究

Exercise Training on Improvement of Attention and working MemoIyamong Patients with Parkinson Disease - A Pilot Study

巴金森氏病患者不論在病程之早期或晚期，特別是接受長期左多巴治療者，都會併發程度不同之認知障礙。過去研究顯示，運動訓練能顯著改善巴金森氏病患者的步態功能，但攸關運動訓練對巴金森氏病患者認知功能成效的研究仍相當有限。因此，本研究目的在探討十二週運動訓練對巴金森氏病患者注意力及，工作記憶之改善成效。本研究採一組個案前後測設計，以立意取樣法，共收集20位符合收案條件：（1）至少符合巴金森氏病三個主要的運動障礙症狀（即，靜止性震顫、動作遲緩、以及肌肉僵硬）中的兩項；（2）穩定服用左多巴治療3個月，因病情控制已趨穩定，不會出現不可預期的「來電-斷電」現象的波動；（3）疾病嚴重度在輕度與中度間（Hoehn & Yahr stage I & II）（Hoehn & Yahr， 1967），因無平衡困難且可以獨立行走於跑步機；（4）未有規律運動，以免干擾結果；（5）臨床失智評量表（clinical dementia rating， CDR）≦0.5，使其能獨立完成注意力及工作記憶的測試。排除條件為巴金森氏病以外的其他神經退化性疾病或骨骼肌肉系統病變者，以認知心理測試軟體（TAP 2.0）評量個案之注意力及工作記憶兩部分。注意力依單一視、聽及雙重視、聽覺刺激順序測試注意力表現。以SPSS 17.0版進行資料建檔及分析，應用Spearman's correlation 及Mann-Whitney U test分析基本屬性與注意力和工作記憶之相關或差異，以Wilcoxon signed ranks test檢定運動前後注意力和工作記憶之改善成效。研究結果顯示，經十二週運動訓練，患者對單一視覺刺激的平均反應時間顯著下降（z＝-2.415， p=0.016），單一聽覺刺激（z＝-2.351， p=0.019）和雙重刺激下之聽覺平均反應正確率（z＝-2.654， p＝0.008）顯著增加。工作記憶雖顯示有獲改善之趨勢，但均未達統計上之顯著差異。本研究結果部分支持規律運動訓練可改善巴金森氏病患者注意力。Different degrees of cognitive impairment occur in patients with Parkinson's disease (PD), no matter in the early or late stage, especially those receiving long-term levodopa treatment. Prior studies have demonstrated that exercise training could effectively improve the gait function in patients with PD. However, researches concerning the effect of exercise training on improving the cognition function in PD patients are few. Hence, the purpose of this study was to test the effect of a 12-week exercise training program on cognition function in patients with PD. One-group pretest-posttest design with purposive sampling method was used in this study, and twenty PD patients who met the selection criteria were recruited. Criteria were patients who (1) had been diagnosed with idiopathic PD at least two items in three cardinal symptoms (resting tremor, bradykinesia and rigidity); (2) had taken levodopa stably at least for 3 months, as the disease condition has become stable and would not appear the unexpected 'on-off' phenomenon fluctuation; (3) disease severity was between Hoehn &Yahr stage I and II, as they had no balanced difficulty and could walk independently on treadmill machine; (4) had no frank dementia (clinical dementia rating scale≦0.5) to complete both attention and working memory tests independently. The Test Battery for Attention Performance (TAP; version 2.0) was applied for the assessment of attention and working memory. SPSS 17.0 for Windows was used for statistical analysis. Comparisons of the improvement between baseline and after exercise training were evaluated by Wilcoxon signed ranks test within group. The results revealed that through the 12-week exercise training program, the average reaction time from single stimulus of visual decreased significantly (z=-2.415, p=0.016). In addition, average accurate response rates from single auditory stimulus (z=-2.351, p=0.019) and from the double auditory stimuli (z=-2.654, p=0.008) increase significantly. Although the trend of improvement on working memory was demonstrated, there was no statistically significant difference. These findings partly support that exercise training improves the attention performance among PD patients.