睡眠品質對於認知功能表現以及大腦結構改變在台灣老年族群 ...

睡眠品質對於認知功能表現以及大腦結構改變在台灣老年族群相關性之探討 · The associations of sleep quality with cognitive functions and brain structures among older ... 資料載入處理中... 網站地圖| 首頁| 本站說明| 聯絡我們| 圖書館首頁| 常見問題| 台聯大論文系統| 操作說明 | English 簡易查詢 進階查詢 論文瀏覽 熱門排行 我的研究室 上傳論文 建檔說明 下載區 相關連結 帳號：guest(188.166.176.73)          離開系統 字體大小：       詳目顯示 第1筆/ 共1筆  /1頁 以作者查詢圖書館館藏、以作者查詢臺灣博碩士、以作者查詢全國書目、勘誤回報 論文基本資料 摘要 外文摘要 目次 參考文獻 電子全文 作者:邱侶婷作者(外文):Lu-TingChiu論文名稱:睡眠品質對於認知功能表現以及大腦結構改變在台灣老年族群相關性之探討論文名稱(外文):TheassociationsofsleepqualitywithcognitivefunctionsandbrainstructuresamongolderadultinTaiwan指導教授:莊宜芳指導教授(外文):Yi-FangChuang學位類別:碩士系所名稱:公共衛生研究所學號:30607014出版年:108畢業學年度:107語文別:中文論文頁數:67中文關鍵詞:睡眠品質、認知功能、大腦結構、老年人外文關鍵詞:sleepquality、cognitivefunction、brainstructure、olderadults相關次數: 推薦:0點閱:37評分:下載:8收藏:0 摘要目的：睡眠問題在老年族群的盛行率高。

睡眠障礙亦為認知衰退與失智症可改變的危險因子之一，因此提升老年睡眠問題的認識與重視程度，對失智症之預防甚為重要。

本研究目的為在台灣社區老年人(1)探討睡眠品質與不同面向的認知功能表現之間的相關性與(2)探討睡眠品質與不同區域的大腦體積之間的相關性。

方法：本研究的資料來源為2017年9至2019年1月之台灣輕度認知功能障礙流行病學研究資料，以居住於新北市、65歲以上、未失智且能獨立生活之老年人為研究族群，共納入317位受試者。

研究的自變項為睡眠品質，使用匹茲堡睡眠品質量表做量測，探討之睡眠面向包含睡眠遲滯期、睡眠效率、睡眠干擾以及睡眠藥物使用；依變項為認知功能表現以及大腦區域體積，使用多項神經心理學測驗測量記憶力、注意力以及執行功能，並透過腦部核磁造影取得腦影像，使用Freesurfer腦影像分析軟體取得大腦區域體積，探討之腦區包含總大腦體積、腦室、灰質、白質、海馬迴、額葉以及顳葉體積。

資料分析方式使用複線性迴歸模型分析睡眠品質對於認知功能以及大腦區域體積的相關性。

結果：老年人睡眠品質差約佔50%，睡眠品質差的組別年齡較高、女性比例較高、教育程度較低、罹患高血脂及心臟血管疾病比例較高以及憂鬱程度較高。

認知功能表現部分，在校正干擾因子之後，睡眠干擾頻率愈高與注意力表現愈差達顯著相關(p=0.004)，並與三項測量注意力之神經理學測驗分數達顯著相關；在大腦區域體積部分，在整體睡眠品質以及不同睡眠面向中，與各大腦區域體積皆未達顯著相關性。

結論：在台灣老年族群中，睡眠干擾頻率愈高與注意力表現愈差有顯著相關性，睡眠品質與大腦區域體積則未觀察到顯著相關性。

AbstractBackground:Theprevalenceofsleepproblemisincreasingintheelderly.Poorsleepqualityisalsooneofmodifiableriskfactorsforcognitivedeclineanddementiainolderadults.Itisofpublichealthimportancetoincreaserecognitionandmanagementofsleepproblemsinolderadultsforpreventionofdementia.Thepresentstudyaimsto(i)exploretheassociationbetweensleepqualityanddifferentcognitivedomain,andto(ii)exploretheassociationbetweensleepqualityanddifferentareaofbrainvolumesamongcommunity-dwellingolderadultsinTaiwan.Method:ThedatasourceofthisstudywastheMildCognitiveImpairmentstudyinTaiwanbetweenSeptember2017andJanuary2019.Therewere317independently-livingandnon-dementedolderadultswithage>65inNewTaipeiCity.SleepqualitywasmeasuredbyPittsburghSleepQualityIndex,andsleepcomponentscontainedsleeplatency,sleepefficiency,sleepdisturbanceandsleepmedication.Cognitivefunctionwasmeasuredbyabatteryofneuropsychologicaltestsassessingthreecognitivedomains:memory,attentionandexecutivefunction.BrainvolumewasmeasuredbymagneticresonanceimagingandanalyzedusingFreesurfer.Regionalbrainvolumesincludedtotalcerebral,ventricular,graymatter,whitematter,hippocampal,frontallobeandtemporallobevolume.Theassociationsofsleepqualitywithcognitivefunctionsandbrainstructureswereanalyzedusingmultiplelinearregressionmodel.Result:About50%ofolderadultsreportedpoorsleepquality.Participantswithpoorsleepqualitywereolder,mostlyfemale,lesseducated,hadhigherratesofhyperlipidemiaandcardiovasculardisease,andhadhigherdegreeofdepression.Afteradjustingfortheconfounders,higherfrequencyofsleepdisturbancewassignificantlyassociatedwithpoorerperformanceinattention(p=0.004),andwasalsosignificantlyassociatedinthreeneuropsychologicaltestsofattention.Therewerenoassociationsbetweensleepqualityandregionalbrainvolumes.Conclusion:InTaiwanesecommunity-dwellingolderadults,higherfrequencyofsleepdisturbancewasassociatedwithpoorerperformanceinattentionwhiletherewasnosignificantassociationbetweensleepqualityandregionalbrainvolumes.Keyword:sleepquality;cognitivefunction;brainstructure;olderadults 目錄致謝i摘要iiAbstractiii圖表目錄vii附表目錄viii第一章前言1第一節研究背景1第二節研究動機、研究目的與研究假說4第二章文獻回顧5第一節睡眠品質與認知功能之量測5第二節老年族群睡眠品質與認知功能探討7第三節老年族群睡眠品質與大腦區域體積探討10第四節台灣相關研究12第三章研究方法13第一節資料來源與研究設計13第二節研究對象13第三節自變項之量測14第四節依變項之量測15第五節共變項之量測20第六節資料分析方法22第四章研究結果25第一節共變項在睡眠品質好壞的分布情形25第二節睡眠品質與認知功能之相關性26第三節睡眠品質與大腦區域體積之相關性29第五章討論與結論31第一節主要研究結果31第二節研究結果討論31第三節研究優勢與研究限制39第四節結論與未來研究建議41參考文獻42附錄60圖表目錄表1研究樣本描述性統計分析48表2.1整體睡眠品質與神經心理學測驗表現之相關性49表2.2特定睡眠面向與神經心理學測驗表現之相關性50表2.3整體睡眠品質與認知功能表現之相關性52表2.4特定睡眠面向與認知功能表現之相關性53表3.1整體睡眠品質與大腦區域體積之相關性54表3.2特定睡眠面向與大腦區域體積之相關性55圖1研究資料處理流程圖57圖2大腦區域體積示意圖58圖3睡眠對於大腦結構萎縮與認知功能障礙的作用機制59附表目錄附表1整體睡眠品質與認知表現之相關性在認知正常組與輕度認知功能障礙組分布61附表2特定睡眠面向與認知功能之相關性在認知正常組與輕度認知功能障礙組分布62附表3整體睡眠品質與大腦區域體積之相關性在認知正常組與輕度認知功能障礙組分布63附表4特定睡眠面向與大腦區域體積之相關性在認知正常組與輕度認知功能障礙組分布64附表5實際睡眠長度與認知功能表現之相關性分布66附表6主觀睡眠品質與認知功能表現之相關性分布67 參考文獻1.Patterson,C.,WorldAlzheimerReport2018—Thestateoftheartofdementiaresearch:Newfrontiers."Alzheimer’sDiseaseInternational(ADI):London,UK.2018.2.N.E.Carlson,P.,etal.,Trajectoriesofbrainlossinagingandthedevelopmentofcognitiveimpairment.Neurology,2007.70(11):p.828-833.3.Cloutier,S.,etal.,PatternsofCognitiveDeclinePriortoDementiainPersonswithMildCognitiveImpairment.JAlzheimersDis,2015.47(4):p.901-13.4.Harada,C.N.,M.C.NatelsonLove,andK.L.Triebel,Normalcognitiveaging.ClinGeriatrMed,2013.29(4):p.737-752.5.Geda,Y.E.,Mildcognitiveimpairmentinolderadults.CurrPsychiatryRep,2012.14(4):p.320-7.6.Fox,N.,etal.,CorrelationbetweenratesofbrainatrophyandcognitivedeclineinAD.Neurology,1999.52(8):p.1687-1687.7.Apostolova,L.G.andP.M.Thompson,MappingprogressivebrainstructuralchangesinearlyAlzheimer'sdiseaseandmildcognitiveimpairment.Neuropsychologia,2008.46(6):p.1597-612.8.Henneman,W.J.P.,etal.,HippocampalatrophyratesinAlzheimerdisease.Neurology,2009.72(11):p.999-1007.9.Neikrug,A.B.andS.Ancoli-Israel,Sleepdisordersintheolderadult:amini-review.Gerontology,2010.56(2):p.181-9.10.Krystal,A.D.,Psychiatricdisordersandsleep.NeurolClin,2012.30(4):p.1389-413.11.Anderson,K.N.andA.J.Bradley,Sleepdisturbanceinmentalhealthproblemsandneurodegenerativedisease.NatSciSleep,2013.5:p.61-75.12.Novak,M.andC.M.Shapiro,druginducedsleepdisturbance.PharmacoepidemiologyandDrugSafety,1997.16(2):p.133-149.13.Knutson,K.L.,etal.,Roleofsleepdurationandqualityintheriskandseverityoftype2diabetesmellitus.Archivesofinternalmedicine,2006.166(16):p.1768-1774.14.Kasasbeh,E.,D.S.Chi,andKrishnaswamy,Inflammatoryaspectsofsleepapneaandtheircardiovascularconsequences.SOUTHERNMEDICALJOURNAL-BIRMINGHAMALABAMA,2006.99(1):p.58.15.Taheri,S.,Thelinkbetweenshortsleepdurationandobesity:weshouldrecommendmoresleeptopreventobesity.JArchivesofdiseaseinchildhood,2006.91(11):p.881-884.16.Hartmann,E.,The90-MinuteSleep-DreamCycle.ArchivesofGeneralPsychiatry,1968.18(3):p.280-286.17.Carskadon,M.A.andW.C.Dement,Normalhumansleep:anoverview.Principlesandpracticeofsleepmedicine,2005.4:p.13-23.18.Espiritu,J.R.,Aging-relatedsleepchanges.ClinGeriatrMed,2008.24(1):p.1-14,v.19.Martin,J.L.andA.D.Hakim,Wristactigraphy.Chest,2011.139(6):p.1514-1527.20.Krystal,A.D.andJ.D.Edinger,Measuringsleepquality.SleepMedicine,2008.9:p.S10-S17.21.Buysse,D.J.,etal.,ThePittsburghSleepQualityIndex:anewinstrumentforpsychiatricpracticeandresearch.Psychiatryresearch1989.28(2):p.193-213.22.Kushida.,C.A.,etal.,PracticeParametersfortheIndicationsforPolysomnographyandRelatedprocedure.sleep,2005.28(4):p.499-521.23.Folstein,M.F.,S.E.Folstein,andP.R.J.J.o.p.r.McHugh,“Mini-mentalstate”:apracticalmethodforgradingthecognitivestateofpatientsfortheclinician.1975.12(3):p.189-198.24.Nasreddine,Z.S.,etal.,TheMontrealCognitiveAssessment,MoCA:abriefscreeningtoolformildcognitiveimpairment.JournaloftheAmericanGeriatricsSociety2005.53(4):p.695-699.25.Teng,E.L.,etal.,TheCognitiveAbilitiesScreeningInstrument(CASI):apracticaltestforcross-culturalepidemiologicalstudiesofdementia.Internationalpsychogeriatrics,1994.6(1):p.45-58.26.Knopman,D.S.andS.J.A.o.n.Ryberg,AverbalmemorytestwithhighpredictiveaccuracyfordementiaoftheAlzheimertype.1989.46(2):p.141-145.27.McLeod,D.R.,etal.,Anautomatedversionofthedigitsymbolsubstitutiontest(DSST).BehaviorResearchMethods&Instrumentation,1982.14(5):p.463-466.28.Reitan,R.M.,ValidityoftheTrailMakingTestasanindicatoroforganicbraindamage.Perceptualandmotorskills,1958.8(3):p.271-276.29.Golden,C.J.andS.M.Freshwater,Stroopcolorandwordtest.1978.30.Bliwise,D.L.,SleepdisordersinAlzheimer'sdiseaseandotherdementia.Clinicalcornerstone,2004.6(1):p.S16-S28.31.Ju,Y.E.,B.P.Lucey,andD.M.Holtzman,SleepandAlzheimerdiseasepathology--abidirectionalrelationship.NatRevNeurol,2014.10(2):p.115-9.32.Devore,E.E.,F.Grodstein,andE.S.Schernhammer,SleepDurationinRelationtoCognitiveFunctionamongOlderAdults:ASystematicReviewofObservationalStudies.Neuroepidemiology,2016.46(1):p.57-78.33.Blackwell,T.,etal.,Poorsleepisassociatedwithimpairedcognitivefunctioninolderwomen.JournalofGerontology,2006.61(4):p.405-410.34.Potvin,O.,etal.,Sleepqualityand1-yearincidentcognitiveimpairmentincommunity-dwellingolderadults.Sleep,2012.35(4):p.491-9.35.Ramos,A.R.,etal.,Associationbetweensleepdurationandthemini-mentalscore:theNorthernManhattanstudy.JClinSleepMed,2013.9(7):p.669-73.36.Auyeung,T.W.,etal.,Cognitivedeficitisassociatedwithphaseadvanceofsleep-wakerhythm,dailynapping,andprolongedsleepduration--across-sectionalstudyin2,947community-dwellingolderadults.Age2013.35(2):p.479-86.37.Franco-Marina,F.,etal.,TheMini-mentalStateExaminationrevisited:ceilingandflooreffectsafterscoreadjustmentforeducationallevelinanagingMexicanpopulation.JInternationalpsychogeriatrics,2010.22(1):p.72-81.38.Spira,A.P.,etal.,ActigraphicSleepDurationandFragmentationinOlderWomen:AssociationsWithPerformanceAcrossCognitiveDomains.Sleep,2017.40(8).39.Blackwell,T.,etal.,Associationsofobjectivelyandsubjectivelymeasuredsleepqualitywithsubsequentcognitivedeclineinoldercommunity-dwellingmen:theMrOSsleepstudy.Sleep,2014.37(4):p.655-63.40.Miyata,S.,etal.,Poorsleepqualityimpairscognitiveperformanceinolderadults.JSleepRes,2013.22(5):p.535-41.41.Xu,L.,etal.,SleepdurationandmemoryintheelderlyChinese:longitudinalanalysisoftheGuangzhouBiobankCohortStudy.Sleep,2014.37(11):p.1737-44.42.Regen,W.,etal.,Perfectionistictendenciesininsomniapatients'behaviorduringpsychometrictesting.Behavioralsleepmedicine,2015.13(5):p.387-394.43.SaintMartin,M.,etal.,Doessubjectivesleepaffectcognitivefunctioninhealthyelderlysubjects?TheProofcohort.SleepMed,2012.13(9):p.1146-52.44.Gildner,T.E.,etal.,Associationsbetweensleepduration,sleepquality,andcognitivetestperformanceamongolderadultsfromsixmiddleincomecountries:resultsfromtheStudyonGlobalAgeingandAdultHealth(SAGE).JClinSleepMed,2014.10(6):p.613-21.45.Lo,J.C.,etal.,Sleepdurationandage-relatedchangesinbrainstructureandcognitiveperformance.Sleep,2014.37(7):p.1171-8.46.Seelye,A.,etal.,Theimpactofsleeponneuropsychologicalperformanceincognitivelyintactolderadultsusinganovelin-homesensor-basedsleepassessmentapproach.ClinNeuropsychol,2015.29(1):p.53-66.47.Lo,J.C.,etal.,Self-reportedsleepdurationandcognitiveperformanceinolderadults:asystematicreviewandmeta-analysis.SleepMed,2016.17:p.87-98.48.Lezak,M.D.,etal.,Neuropsychologicalassessment.2004:OxfordUniversityPress,USA.49.Cabeza,R.,L.Nyberg,andD.C.Park,Cognitiveneuroscienceofaging:Linkingcognitiveandcerebralaging.2016:OxfordUniversityPress.50.Joo,E.Y.,etal.,BrainGrayMatterDeficitsinPatientswithChronicPrimaryInsomnia.Sleep,2013.36(7):p.999-1007.51.Altena,E.,etal.,Reducedorbitofrontalandparietalgraymatterinchronicinsomnia:avoxel-basedmorphometricstudy.BiolPsychiatry,2010.67(2):p.182-5.52.Joo,E.Y.,etal.,Hippocampalsubstructuralvulnerabilitytosleepdisturbanceandcognitiveimpairmentinpatientswithchronicprimaryinsomnia:magneticresonanceimagingmorphometry.Sleep,2014.37(7):p.1189-98.53.Riemann,D.,etal.,ChronicinsomniaandMRI-measuredhippocampalvolumes:apilotstudy.2007.30(8):p.955-958.54.Andre,C.,etal.,Brainandcognitivecorrelatesofsleepfragmentationinelderlysubjectswithandwithoutcognitivedeficits.AlzheimersDementia,2019.11:p.142-150.55.Chang,W.P.,etal.,Sleepapneaandtheriskofdementia:apopulation-based5-yearfollow-upstudyinTaiwan.PLoSOne,2013.8(10):p.e78655.56.Chen,P.L.,etal.,Riskofdementiainpatientswithinsomniaandlong-termuseofhypnotics:apopulation-basedretrospectivecohortstudy.PLoSOne,2012.7(11):p.e49113.57.Chiu,H.Y.,etal.,DifferencesBetweenMenandWomenAged65andOlderintheRelationshipBetweenSelf-ReportedSleepandCognitiveImpairment:ANationwideSurveyinTaiwan.JAmGeriatrSoc,2016.64(10):p.2051-2058.58.Backhaus,J.,etal.,Test–retestreliabilityandvalidityofthePittsburghSleepQualityIndexinprimaryinsomnia.Journalofpsychosomaticresearch,2002.53(3):p.737-740.59.花茂棽,etal.,魏氏記憶量表第三版(WMSIII)中文版.台北:中國行為科學社股份有限公司2005.60.陳榮華and陳心怡,魏氏成人智力量表第三版(WAIS-III)中文版.台北:中國行為科學社股份有限公司,2004.61.Fischl,B.,FreeSurfer.Neuroimage,2012.62(2):p.774-781.62.Sheikh,J.I.andJ.A.Yesavage,GeriatricDepressionScale(GDS):recentevidenceanddevelopmentofashorterversion.TheJournalofAgingMentalHealth1986.63.Nebes,R.D.,etal.,Self-ReportedSleepQualityPredictsPoorCognitiveperformanceinolderadult.TheJournalsofGerontology,2009.64(2):p.180-187.64.Tworoger,S.S.,etal.,TheAssociationofSelf-ReportedSleepDuration,DifficultySleeping,andSnoringWithCognitiveFunctioninOlderWomen..AlzheimerDisease&AssociatedDisorders,2006.20(1):p.41-48.65.Niu,J.,etal.,SleepqualityandcognitivedeclineinacommunityofolderadultsinDaqingCity,China.SleepMed,2016.17:p.69-74.66.Blackwell,T.,etal.,AssociationofSleepCharacteristicsandCognitioninOlderCommunityDwelling.SLEEP,2011.34(10):p.1347-1356.67.YaffeK,etal.,Preclinicalcognitivedeclineandsubsequentsleepdisturbanceinolderwomen.Neurology,2007.69(3):p.237-242.68.Gamaldo,A.A.,etal.,TheAssociationbetweenSubjectiveMemoryComplaintsandSleepwithinOlderAfricanAmericanAdults.JGerontolBPsycholSciSocSci,2019.74(2):p.202-211.69.Blackwell,T.,etal.,Poorsleepisassociatedwithimpairedcognitivefunctioninolderwomen.TheJournalsofGerontology2006.61(4):p.405-410.70.Palmer,K.,etal.,SleepDisturbanceinMildCognitiveImpairmentandAssociationWithCognitiveFunctioning.ACase-ControlStudy.FrontAgingNeurosci,2018.10:p.360.71.Godbolt,A.K.,etal.,Systematicreviewoftheriskofdementiaandchroniccognitiveimpairmentaftermildtraumaticbraininjury:resultsoftheInternationalCollaborationonMildTraumaticBrainInjuryPrognosis.Archivesofphysicalmedicineandrehabilitation,2014.95(3):p.S245-S256.72.Horne,J.,Primaryinsomnia:Adisorderofsleep,orprimarilyoneofwakefulness?Sleepmedicinereviews,2010.14(1):p.3-7.73.Kyle,S.D.,etal.,Sleepandcognitiveperformance:cross-sectionalassociationsintheUKBiobank.SleepMed,2017.38:p.85-91.74.Jansson‐Fröjmark,M.andS.J.Linton,Isperfectionismrelatedtopre‐existingandfutureinsomnia?Aprospectivestudy.Britishjournalofclinicalpsychology,2007.46(1):p.119-124.75.Lim,A.S.,etal.,RegionalNeocorticalGrayMatterStructureandSleepFragmentationinOlderAdults.Sleep,2016.39(1):p.227-35.76.Sexton,C.E.,etal.,Poorsleepqualityisassociatedwithincreasedcorticalatrophyincommunitydewellingadult.Neurology,2014.83(11):p.967-973.77.Tapiola,T.,etal.,Cerebrospinalfluidβ-amyloid42andtauproteinsasbiomarkersofAlzheimer-typepathologicchangesinthebrain.2009.66(3):p.382-389.78.Bloom,G.S.,Amyloid-βandtau:thetriggerandbulletinAlzheimerdiseasepathogenesis.JAMAneurology,2014.71(4):p.505-508.79.Nilsonne,G.,etal.,Intrinsicbrainconnectivityafterpartialsleepdeprivationinyoungandolderadults:resultsfromtheStockholmSleepyBrainstudy.SciRep,2017.7(1):p.9422.80.Liu,Y.R.,etal.,Sleep-relatedbrainatrophyanddisruptedfunctionalconnectivityinolderadults.BehavBrainRes,2018.347:p.292-299.81.Ju,Y.E.,etal.,SleepqualityandpreclinicalAlzheimerdisease.JAMANeurol,2013.70(5):p.587-93.82.Fang,H.,etal.,AcutehypoxiapromotethephosphorylationoftauviaERKpathway.NeurosciLett,2010.474(3):p.173-177.83.Lim,D.C.andA.I.Pack,Obstructivesleepapneaandcognitiveimpairment:addressingtheblood-brainbarrier.SleepMedRev,2014.18(1):p.35-48.84.Spiegelhalder,K.,etal.,Insomniadoesnotappeartobeassociatedwithsubstantialstructuralbrainchanges.Sleep,2013.36(5):p.731-7.85.Jack,C.R.,etal.,HypotheticalmodelofdynamicbiomarkersoftheAlzheimer'spathologicalcascade.TheLancetNeurology,2010.9(1):p.119-128. 電子全文 推文 推薦 評分 引用網址 轉寄         top 相關論文 1. 探討老年慢性腎臟病患健康素養之預測因子 2. 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