耳穴磁珠療法改善失智患者精神症狀並提高認知促進活動參與度──中醫復能照護先驅性研究

Ear Acupoint Application Therapy not only Relieves Behavioral and Psychological Symptoms of Dementia But Also Improves Their Participation of Cognitive Promotion Course-the Pilot Study on Reablement Care of Traditional Chinese Medicine

前言：中醫對於復能照護的參與仍然不多，且並未有臨床研究驗證其療效。在本研究中，我們將以耳穴治療進行失智症患者的中醫復能照護，並檢驗對於患者之精神症狀和日照中心參與度之效果。方法：本研究採用回溯性世代追蹤研究（Retrospective Cohort Study）法，於2016年6月至2018年5月間納入31位接受耳穴治療之失智症患者與32位對照組，耳穴治療以磁力強度為100高斯之磁珠，貼於耳部之神門穴、心點、交感點、皮質下點等四個穴位。藉由簡易心智量表（Mini-Mental State Examination（MMSE））來衡量認知功能，並以日常生活活動功能（Activities of daily living（ADL））評估患者的生活自理能力，用神經精神量表（Neuropsychiatric Inventory Questionnaire，NPI-Q）評估精神及行為症狀。至於患者參加認知促進課程積極度，則以老年痴呆症照顧圖譜（Dementia Care Mapping，DCM）評估。結果：經過四個禮拜的治療後，接受耳穴治療患者的神經精神量表分數顯著的下降，總分平均下降12.3±2.8分，而對照組平均總分增加4.9±2.7分，兩組以學生t檢定（Student's t-test）檢測達到統計上顯著的差異。顯示患者精神症狀在耳穴治療後有顯著的改善，細項分析發現改善最明顯的症狀依次為、憂鬱及情緒低落（depression or dysphoria）、妄想（delusions）、容易激動或有攻擊性（agitation or aggression）與幻覺（hallucinations）。患者的情緒及投入評估值（Mood／Engagement value）在耳穴治療後平均上升2.8±1.0分，對照組則僅上升0.2±1.6分，亦達到統計顯著上的意義。相比於治療前的情形，本研究顯示耳穴治療的治療效果在四個禮拜最為顯著，後續的追蹤可以觀察到緩慢下降，但以配對樣本t檢定（Pair-Sample t test）檢驗差距並未達到顯著。結論：本研究發現耳穴治療可以減緩失智症患者的憂鬱、妄想、激動、幻覺等精神症狀，並能提升患者認知培訓課程的參與度，建議未來可在失智症臨床照護上推廣使用。

Introduction: Up to date, Traditional Chinese Medicine has not participated in the reablement care to an appreciable extent. Furthermore, there is no clinical study to confirm the efficacy of Traditional Chinese Medicine in this field. In this study, we apply the ear acupoint application therapy to the reablement care of dementia. The primary goal was to gain a fundamental understanding of the effects of Traditional Chinese Medicine therapy and the degree of participation of Day Care Centers on the behavior and psychological symptom of dementia. Method: The method adopted in this study is based on the Retrospective Cohort Study. In this work conducted from June 2016 to May 2018, 31 Dementia patients who received ear acupoint application therapy and the control group comprising 32 people without the therapy were chosen. The magnetic intensity of therapy was set at 100 gauss and the ear acupoints included Ear Shenmen, Heart point, Sympathetic nervous point and Subcortical point. Mini-Mental State Examination (MMSE) was used to evaluate congetive function, and Activities of daily living (ADL) used to evaluate the living skills of the patient. As to the participation score of cognitive promotion course, it was evaluated by Dementia Care Mapping (DCM). Results: For those dementia patients who had been treated over a period of 4 weeks, the Neuropsychological Inventory Questionnaire scores were significantly reduced; the average score decreased by -12.3±2.8. By contrast, the total average score increased by 4.9±2.7 in the control group. This result showed a statistically significant difference between the two groups based on Student's t-test. It was then concluded that Behavioral and psychological symptoms of dementia (BPSD) of the patients was improved significantly after the ear acupoint application therapy. In addition, the detailed analysis showed that the most improved symptoms in decreasing order is: depression or dysphoria > delusions > agitation or aggression > hallucinations. It is noteworthy that, on the average, the Mood/Engagement value of the patients increased by 2.8±1.0, whereas only an insignificant increase (0.2±1.6) was observed in the control group. This result is statistically significant. This study also revealed that the most significant efficacy was achieved over a period of 4 weeks ear acupoint application therapy. Following up the patients showed that the efficacy declined slowly, but there was no statistical significance by Pair-Sample t test.Conclusion: This study revealed that ear acupoint application therapy not onlyrelieved the BPSD of the patient (such as depression or dysphoria, delusions,agitation or aggression and hallucinations) but also enhanced the participation of cognitive promotion course. Thus, the ear acupoint application therapy is recommended for the clinical care of dementia in the future.