南台灣社區失智症老人日常生活功能之表現

Activities of Daily Living in Different Types of Dementia patients in Southern Taiwan

本研究之目的係以日常活動能力量表來評估不同類別失智老人在執行各項身體性及工具性日常活動之依賴程度及應協助事項。本研究以64 位阿茲海默氏症、21 位血管性失智症、8 位混合型失智症及其他類型失智症，係由多段隨機抽樣取自高高屏3931 位65 歲以上社區老人。診斷採CMMSE、失智評分量表、神經心理測驗、腦缺血失智評估、國際疾病分類、精神疾病統計資料手冊、AD及VaD 診斷標準等。研究結果顯示：AD 患者在PADLs 以自行走路、盥洗為最困難，IADLs 以準備三餐、處理金錢及家務最困難。VaD 患者以盥洗及洗澡、準備三餐、處理家務及上街購物為最困難。研究結果也顯示PADLs 及IADLs 與失智症之類別相關（P＜0.05），且與失智症嚴重度有明顯負相關（P＜0.001）。多數患者在PADLs 及IADLs 表現不一，應給予個別化之協助。

This study investigated the functional status of ADLs in different types of dementia, by using PADL (Physical Activities of Daily Living) and IADL (Instrumental Activities of Daily Living)measures, and to understand the degree of dependency and the needs for assistance in performing activities of daily living. The subjects comprised 64 Alzheimer’s disease(AD), 21 vascular dementia (VaD), 8 Mixed AD and VaD, and other disorders who were recruited from two epidermiologic studies of dementia with a total of 3,931 community residents aged 65 years and above in southern Taiwan. The measures included rates of dementia types, using Chinese Mini Mental Status Examination(CMMSE), Blessed Dementia Rating Scale(BDRS), CERAD(the Consortium to Establish a Registry of Alzheimer’s Disease), Hachinski Ischemia scale, ICD-10NA,DSM-Ⅲ-R criteria for dementia, NINCDS-ADRDA guidelines for Alzheimer’s disease(AD) and NINDS-AIREN criteria for vascular dementia (VaD), Clinical Dementia Rating (CDR) for dementia severity, PADLs and IADLs for assessing functional status. The results showed that 67.2% of all AD patients were female, and 61.9% of all VaD patients were male. For the AD patients, walking and grooming were the most difficut items on PADLs, whereas preparing meals, handling money, and doing housework were the most difficult items on IADLs. For VaD patients, as grooming and bathing were the most difficult PADLs items, whereas preparing meals and doing housework and going shopping were the most difficult IADLs items. VaD patients showed poorer responses, and were more dependent than AD patients on all PADLs and IADLs functional items. The PADLs and IADLs functional status scores were significantly associated with the types of dementia (P＜.05) and with the CDR of dementia patients (P＜.001). In conclusion, most dementia patients are dependent in daily activities, different types and severity of dementia lead to different disability profiles; individualized care is, therefore, most appropriate.