2017年2月底，我國老年人口首次超過幼年人口，人口老化速度快速。失智症盛行率，在65歲以上老年人口中，每增加5歲，呈現倍增趨勢，在所有失智症中，阿茲海默症 (Alzheimer’s disease, AD) 所佔比率最高。本研究的目的為使用波士頓失語症測驗 (Boston Diagnostic Aphasia Examination, BDAE)「看圖說故事-偷餅乾圖」，收集CDR1分阿茲海默症患者、CDR0.5分疑似阿茲海默症患者及正常老年人的語料，並將患者的嚴重度分別以CDR分數、MMSE分數區分，以主要概念分析法檢視前述兩種分數之受試者在看圖說故事的自發性主要概念級分次數、自發性主要概念分數、經提示後所增加的主要概念分數之表現，最後並比較CDR分數、MMSE分數與主要概念表現之關聯性。

本研究共收集28名CDR1分AD患者、26名CDR0.5分疑似AD患者及45名正常老年人，以主要概念分析法研究結果顯示，自發性主要概念級分次數部分，以患者CDR的分數分成不同的嚴重度，結果只能區分出正常與AD病患，但無法區分出不同嚴重度，以患者MMSE的分數分成不同的嚴重度，任兩組兩兩相比，皆達顯著差異；兩種分數的第三組有較多準確且完整概念 (3級分)、較少未提及概念 (0級分)，第一組有較少3級分概念，較多0級分概念。自發性主要概念分數部分，不論個別主要概念分數或主要概念總分，以患者CDR的分數分成不同的嚴重度，結果只能區分出正常與AD病患，但無法區分出不同嚴重度，以患者MMSE的分數分成不同的嚴重度，主要概念總分任兩組兩兩相比，皆達顯著差異，8個主要概念中，有4個可以區分出低分組與中分組，2個可以區分出高分組與中分組；經提示後的表現，一般提示部分，不論以患者CDR的分數或MMSE的分數分成不同的嚴重度，都顯示只有第一組分數顯著高於第三組，具體提示部分，不論以患者CDR的分數或MMSE的分數分成不同的嚴重度，分析結果皆無顯著差異，經一般提示後增加的分數與自發性主要概念分數加總，主要概念總分的表現與自發性主要概念總分相同，顯示提示可以幫助AD增加更完整且準確的描述，但與正常老年人的表現仍有顯著差異。

看圖說故事的主要概念分析過程中，以患者CDR的分數分成不同的嚴重度，並以MMSE的分數分成不同的嚴重度，能觀察出同等級嚴重度的異質性，彌補嚴重度分級的不足處。

The purpose of this study was to employ the “cookie theft” picture (Goodglass & Kaplan, 1983), discriminate the severity of the patients with the CDR scores and the MMSE scores respectively, and adopt the main concept analysis to evaluate the spontaneous main concept grade frequency, spontaneous main concept scores, and the increased main concept scores on the cues among subjects with Alzheimer’s disease (AD) with CDR1, questionable AD with CDR0.5 and the normal elderly analyzed by the CDR scores and the MMSE scores respectively. The study also investigated the correlation of the main concept performance between the CDR scores and the MMSE scores.

Subjects were 28 adults with AD with CDR1, 26 adults with questionable AD with CDR0.5, and 45 normal elderly subjects. With regard to the main concept grade frequency, the CDR could only discriminate the normal from the AD patients, but could not discriminate AD with CDR1 from questionable AD with CDR0.5. As for the MMSE, the comparison among the 3 groups reached the significant difference. The third groups of these two scores had more accurate and complete concepts (grade 3), fewer absent concepts (grade 0); the first groups of the two scores had fewer grade 3 concepts and more grade 0 concepts. Regarding the main concept scores, for both the individual main concept socres and the total main concept scores, the CDR could only discriminate the normal from the AD patients, but could not discriminate AD with CDR1 from questionable AD with CDR0.5. As for the MMSE, the comparsion of the total main concept scores among the 3 groups reached the significant difference. Regarding the performance on the cues, for both the CDR and the MMSE, only the increased scores on the general cues of the first groups were significantly higher than those of the third groups. However, for the AD subjects, the main concept scores increased after the cues, so the cues could help the AD patients to describe more accurately and completely.

Through the main concept analysis of the picture description, by the way of discriminating the severity of the patients with the CDR and the MMSE respectively, the heterogeneity of the same severity could be observed, which could compensate for the insufficiency of the CDR severity rating system.

摘要 II
Abstract III
誌謝 IV
目錄 V
表目錄 VIII
圖目錄 XI
第1章 緒論 1
1.1 研究背景 1
1.2 研究動機 6
1.3 研究問題與目的 6
第2章 文獻回顧 9
2.1 詞彙提取之探討 9
2.1.1 名詞詞彙提取之探討 9
2.1.2 動詞詞彙提取之探討 11
2.2 空乏言談 (empty speech) 在語意記憶與工作記憶之探討 12
2.3 對話主題連貫性 (coherence) 之探討 17
2.4 語意概念探討 21
2.5 主要概念分析 26
第3章 研究方法 31
3.1 研究對象 31
3.1.1 CDR1分阿茲海默症患者與CDR0.5分疑似阿茲海默症患者 31
3.1.2 正常老年人 32
3.2 研究工具 32
3.2.1 波士頓失語症測驗 (Boston Diagnostic Aphasia Examination, BDAE)「看圖說故事-偷餅乾圖」 32
3.2.2 臨床失智評估量表 (Clinical Dementia Rating, CDR) 33
3.2.3 簡短智能測驗 (Mini-Mental State Examination, MMSE) 33
3.3 研究流程 34
3.4 提示流程 35
3.5 語料轉錄 36
3.6 資料處理及分析 37
3.6.1 主要概念表現分析 37
3.6.2 主要概念表現分析檢視流程 38
3.6.3 個別主要概念表現分析計分標準 39
第4章 研究結果與分析 41
4.1 CDR分數與主要概念表現關聯性之分析 41
4.1.1 自發性主要概念級分次數分析 43
4.1.2 自發性主要概念分數表現分析 45
4.1.3 經提示後的主要概念分數比較 51
4.2 MMSE分數與主要概念表現關聯性之分析 64
4.2.1 自發性主要概念級分次數分析 66
4.2.2 自發性主要概念分數表現分析 68
4.2.3 經提示後的主要概念分數比較 73
4.3 以CDR區分嚴重度、以MMSE區分嚴重度在主要概念表現之比較 86
4.3.1 自發性主要概念級分次數比較 86
4.3.2 自發性主要概念分數表現比較 87
4.3.3 經提示後的主要概念分數比較 91
第5章 結論 97
5.1 研究發現 97
5.2 研究貢獻 101
5.3 研究限制與未來展望 102
參考文獻 103
中文文獻 103
西文文獻 103
網路資料 109
附錄 阿茲海默症患者與正常老年人圖片描述樣本範例 110

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