過去研究顯示，失智症患者語言能力在早期沒有表現出明顯的異常，但命名能力可能已經受損；另患者命名能力是否可以透過提示方式來提升，台灣在這一研究領域仍缺乏。本研究擬以華語30項波士頓命名測驗(the Chinese version of the 30-item Boston Naming Test)為測量工具，搜集一般正常人50名、輕度認知功能障礙患者(Mild Cognitive Impairment) 27名、阿茲海默症患者(Alzheimer's disease patients) 39名的測驗結果，根據受試者簡短智能測驗(Mini-Mental State Examination)測驗所得分數，依其認知功能由弱至強分組: M1(13-22分)、M2(23-26分)、M3(27-28分)、M4(29-30分)，分析不同程度認知功能受試者的命名能力、錯誤類型分布、語音提示效果以及語意加語音提示的效果來闡明此問題。
研究顯示多數受試者中，AD患者認知功能相對較弱、其次是MCI患者、其次是一般正常人。認知功能最弱的M1組(AD患者)命名能力最差、其次是M2組和M3組，M4組(一般正常人比例最高)在所有受試者中命名表現最佳。總體而言，認知功能弱的M1組(AD患者)和其他認知功能較強的組別相比，其命名能力較差，命名錯誤較多，需要語音提示及語意加語音提示的次數較¬¬¬¬¬¬多，而且難度低的題目被提示比例相對高。在自主回答狀況下M1、M2、M3組命名錯誤主要集中在「無回應」、「描述錯誤」、「同位錯誤」類型; M4組命名錯誤主要集中在「同位錯誤」、「描述錯誤」、「無關錯誤」類型。各組別間主要命名錯誤類型不僅有量的差異也有質的不同。
關於語音提示對命名表現影響方面，研究發現在語音提示前，各組的命名錯誤集中在「描述錯誤」，「同位錯誤」次之; 在語音提示後，M1、M2、M3組的主要回應類型為「正確」與「無回應」，M4組的主要回應類型為「正確」與「無關錯誤」。在語意加語音提示前，M1組、M2組、M3組主要錯誤類型為「無回應」，M4組主要錯誤類型為「無關錯誤」;在語意加語音提示後，各組主要回應類型為「正確」、「無回應」。語音提示、語意加語音提示後命名錯誤數量和錯誤類型均減少，兩種提示對認知功能弱的AD患者有效果，提示效果小於其他認知功能較強的組別。研究顯示語意知識逐漸退化可能是導致認知功能弱的AD患者命名能力下降的主因。
關鍵詞： 阿茲海默症、30項華語波士頓命名測驗、認知功能、語音提示效果、語意加語音提示效果

Past research has suggested that the language ability of patients with dementia do not show obvious abnormalities in the early stage, but the naming ability may have been impaired; and whether the naming ability of the patients can be improved through cueing technique. This area of research in Taiwan is still lacking. The present study aims to clarify this question by examining the naming ability of 116 participants with different degrees of cognitive function. The study adopts the Chinese version of the 30-item Boston Naming Test (BNT-30) as a measurement instrument to collect the Mini-Mental State Examination (MMSE) test scores of 50 average people, 27 patients with mild cognitive impairment, and 39 people with Alzheimer disease. Based on the MMSE test scores, the cognitive function was grouped from weak to strong: M1 (13-22 points), M2 (23-26 points), M3 (27-28 points), and the M4 (29-30 points). The study then carries out an in-depth analysis of the naming ability of the subjects with different degrees of cognitive function, the distribution of error types, the phonemic cueing effects, and the phonemic add semantic cueing effects.
The research results showed that the M1 group (AD patients) with the weakest cognitive function had the worst naming ability, followed by the M2 group, then the M3 group, while the M4 group (with the highest proportion of the average person) attained the best naming ability of all participants. The research outcome suggests, in general, the weaker the cognitive function, the poorer naming ability, and the more naming errors were committed, and more times were required for phonemic cues and semantics add phonemic cues.
The research outcomes also indicate that, in the spontaneous naming situation, the naming errors of M1, M2, and M3 group tend to concentrate on the types of "no response", " circumlocutory errors," and " coordinate errors," while M4 group naming errors are focused primarily in the "coordinate errors", "circumlocutory errors," and "unrelated errors." The result implies that the main naming error types between groups were not only quantitative but also qualitatively different.
Regarding the impact of phonemic cueing on naming performance, the study found that before providing the phonemic cueing, the naming errors of each group were concentrated in "circumlocutory errors" and "coordinate errors." After phonemic cueing was present, the main response types of M1, M2, M3 groups were "correct" and "no response," while the main response types of the M4 group were "correct" and "unrelated errors." The experiment was carried out further to examine the impact semantic add phonemic cueing on naming performance. The study noticed that before presenting the semantic add phonemic cueing, the main error types of M1, M2, and M3 group were centered at “no response” while the main error type of M4 group was “unrelated errors”, after semantic add phonemic cueing was provided, the main response type of each group was "correct" and "no response". The finding reveals that the number of naming errors and the type of errors were reduced after the semantic cueing and semantic add phonemic cueing were presented. The effect of semantic cueing and semantic add phonemic cueing on AD patients (M1 group) appear not to be more pronounced than in other groups. The research result suggests that the degradation of semantic knowledge may be the main cause of the weakening naming ability of AD patients with weak cognitive function.
Keywords: Alzheimer's disease, Chinese version of the 30-item BNT, cognitive function, phonemic cueing effect, semantic add phonemic cueing effect

目 錄
中文摘要 i
Abstract ii
致謝辭 iii
目 錄 iv
表目錄 vii
圖目錄 ix
第一章緒論 1
1.1研究背景 1
1.2研究動機 6
1.3研究目的與問題 8
1.4論文結構 9
第二章文獻探討 10
2.1圖片命名 10
2.2命名問題及命名問題產生原因 14
2.2.1命名問題 14
2.2.2命名問題產生的原因 15
2.3命名錯誤類型探討 20
2.4語音與語意提示效果相關研究 21
2.5阿茲海默症患者命名與提示效果相關研究 23
第三章研究方法 27
3.1研究對象 27
3.1.1 輕度認知功能障礙患者與阿茲海默症患者 27
3.1.2 一般正常人 28
3.2研究工具 28
3.2.1臨床失智評估量表 28
3.2.2簡短智能測驗 29
3.2.3華語30項波士頓命名測驗 30
3.3研究流程 32
3.4資料處理與分析 33
3.4.1回應歷程分析 34
3.4.2 回應類型歸納與計分說明 35
3.4.3 資料分析 36
第四章結果與分析討論 38
4.1 各組命名錯誤分布 41
4.2 各組自主回應表現 47
4.2.1 各組自主正確回答表現 47
4.2.2 各組自主回應之錯誤類型分佈 51
4.3語音提示 61
4.3.1整體語音提示效果和各組語音提示效果 61
4.3.2各組語音提示前後回應類型 66
4.4語意加語音提示 75
4.4.1整體語意加語音提示效果和各組語意加語音提示效果 76
4.4.2各組語意加語音提示前後回應類型 80
4.5語音提示效果和語意加語音提示效果 90
第五章 結論 95
5.1研究發現 95
5.2研究貢獻 98
5.3研究限制與對未來研究之建議 99
參考文獻 100
英文文獻 100
中文文獻 105
網路資源 106



 

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