中医药研究论丛

231.5 耳穴磁珠疗法改善失智患者精神症状并提高认 知促进活动叁与度-中医复能照护先驱性研究
TJ TCM.23(1) : 57-70, 2020
DOI : 10.6516/TJTCM.202003_23(1).0005
耳穴磁珠疗法改善失智患者精神症状并提高认
知促进活动叁与度-中医复能照护先驱性研究
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
王品轩1,2 陈安履1 周晖哲1 谢旭东1 林舜谷1,3,4*
1 台北市立联合医院仁爱院区中医科,台北,台湾
2 中国医药大学中医学系,台中,台湾
3 国立阳明大学公共卫生研究所,台北,台湾
4 台北市立大学通识教育中心,台北,台湾
【摘要】
前言:中医对於复能照护的叁与仍然不多,且并未有临床研究验证其疗效。在本研究中,我们将以耳穴治疗进行失智症患者的中医复能照护,并检验对於患者之精神症状和日照中心叁与度之效果。方法:本研究采用回溯性世代追踪研究(Retrospective Cohort Study)法,於2016 年6 月至2018 年5 月间纳入31 位接受耳穴治疗之失智症患者与32位对照组,耳穴治疗以磁力强度为100 高斯之磁珠,贴於耳部之神门穴、心点、交感点、皮质下点等四个穴位。藉由简易心智量表(Mini-Mental StateExamination(MMSE))来衡量认知功能,并以日常生活活动功能(Activitiesof daily living(ADL)) 评估患者的生活自理能力, 用神经精神量表(Neuropsychiatric Inventory Questionnaire,NPI-Q)评估精神及行为症状。至於患者叁加认知促进课程积极度,则以老年痴呆症照顾图谱(DementiaCare Mapping,DCM)评估。结果:经过四个礼拜的治疗後,接受耳穴治疗患者的神经精神量表分数显着的下降,总分平均下降12.3±2.8 分,而对照组平均总分增加4.9±2.7 分,两组以学生t 检定(Student’s t-test)检测达到统计上显着的差异。显示患者精神症状在耳穴治疗後有显着的改善,细项分析发现改善最明显的症状依次为、忧郁及情绪低落(depression or dysphoria)、妄想(delusions)、容易激动或有攻击性(agitation or aggression)与幻觉(hallucinations)。患者的情绪及投入评估值(Mood/Engagement value)在耳穴治疗後平均上升2.8±1.0 分,对照组则仅上升0.2±1.6 分,亦达到统计显着上的意义。相比於治疗前的情形,本研究显示耳穴治疗的治疗效果在四个礼拜最为显着,後续的追踪可以观察到缓慢下降,但以配对样本t 检定(Pair-Sample t test)检验差距并未达到显着。结论:本研究发现耳穴治疗可以减缓失智症患者的忧郁、妄想、激动、幻觉等精神症状,并能提升患者认知培训课程的叁与度,建议未来可在失智症临床照护上推广使用。
【关键词】复能照护、中医、耳穴治疗、长期照护、失智症、精神与行为症状
Pin-Hsuan Wang1,2 Andy Chern1 Hui-Zhe Zhou1 Hsu-Tung Hsieh1
Shun-Ku Lin1,3,4*
1Department of Chinese Medicine, Taipei City Hospital, Taipei, Ren-Ai Branch. Department
of Health, Taipei City Government, Taipei, Taiwan
2School of Chinese Medicine, China Medical University, Taichung, Taiwan
3Institute of Public Health, National Yangming University, Taipei, Taiwan
4School of General Education Center, University of Taipei, Taipei, Taiwan
【Summary】
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 only
relieved 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.
Keywordsreablement care, traditional chinese medicine, ear acupoint application therapy, long-term care, dementia, behavior and psychological symptom of dementia