老年人的正向精神醫學及認知介入

Positive Psychiatry and Cognitive Interventions for the Elderly

正向精神醫學 (positive psychiatry) 是一種企圖了解並促進病人安適感 (well-being) 的精神 科學與實踐。對於老年人的正向精神醫學，主要聚焦於成功的老年化，並在心理社會與行為 層面，利用認知介入強化其正向特質，且預防認知功能的退化。所謂成功的老年化，包括了 安適感及高認知功能，或是能維持認知儲備 (cognitive reserve)。當老年人為了他們的身體或 心理疾患來求助時，臨床醫師也應該留心他們的優勢能力，尤其是其認知儲備。有許多不同 的認知介入適用於一般的老年人，例如記憶訓練、及對推理及處理速度的訓練等；同時，對 於輕型認知障礙及上至阿茲海默症的病人，也應該接受許多認知介入的方法，而這些方法必 須依據不同病人加以調整，諸如認知刺激、認知訓練、認知復健及多元模式的認知介入治 療。在本篇綜說中，作者嘗試整理了所有增進老年人、以及輕型認知障礙與阿茲海默症的病 人之認知功能的認知介入方法。雖然腦部的病理退化難以避免，維持近似早前的認知功能或 保留認知儲備仍然可行。認知刺激的活動已被認為是認知儲備的主要影響因素之一，並與許 多其他因素彼此影響，最終達到成功的老年化。

Positive psychiatry is the science and practice of psychiatry that, seeks to understand and promote the well-being of patients. For the elderly, positive psychiatry is to focus on successful aging, psychosocial and behavioral aspects, including cognitive interventions to enhance positive attributes, and this prevention is also an important area of the process. Components of successful aging include wellbeing and a high cognitive function, or maintaining cognitive reserve. When the elderly come to seek help for their physical, or mental illnesses, clinicians should also look for their positive strengths, particularly their cognitive reserve. There are various cognitive interventions for normal elder individuals such as memory training, training in reasoning and the speed of procession. Meanwhile, for mild cognitive impairment (MCI) up to Alzheimer’s disease (AD), many approaches of cognitive interventions should be implemented. Those approaches should be designed for each particular patient, and include cognitive stimulation, cognitive training, cognitive rehabilitation, and multicomponent cognitive intervention. In this overview, the authors attempted to review all kinds of cognitive interventions to enhance cognitive function in the elderly, along with patients with MCI or AD. Although pathological degenerative in brain, or the brain reserve is hard to avoid, maintaining cognitive functions or retaining cognitive reserve as close to the previous level may be possible. Cognitive stimulating activities have been suggested as one of the major contributing factors for cognitive reserve, which interacts with several other factors, and eventually leads to successful aging.