阿茲海默症與健康長者在幽默理解之差異-以執行功能及心智理論為中介變項

Abstract

失智症是一項嚴峻的健康照護挑戰，其中阿茲海默症為最常見的類型，各國紛紛從政策面、醫療面及研究面上著手，期待能夠及早發現與治療，以提升患者生活品質、減緩退化速度和減輕照顧者身心壓力。過去研究指出幽默與歡笑能改善病患生活品質和舒緩壓力，然而也發現阿茲海默症個案在患病前後出現幽默感轉變的情形。目前缺少相關研究探討阿茲海默症造成認知功能退化是否影響幽默理解能力。本研究旨在根據陳學志等人（2001）提出「反向—合意模式」幽默理解認知歷程，探討輕度阿茲海默症長者與健康長者在幽默理解能力之差異以及執行功能與心智理論對於此差異的中介效果。本研究採用測驗工具調查法進行量化研究，一共納入62位參與者，其中32位為輕度阿茲海默症長者、30位為健康長者。使用「幽默理解與幽默創造能力測驗之幽默理解能力分測驗」、「台灣版額葉評估量表」和「中文版心智理論量表」做為研究工具，使用統計軟體IBM SPSS Statistics 23和PROCESS v3.4，將所得的資料進行統計分析。研究結果發現輕度阿茲海默症長者的幽默理解能力、執行功能及心智理論皆顯著低於健康長者；執行功能與幽默理解能力呈顯著正相關；語言心智理論與幽默理解能力呈顯著正相關；語言心智理論對是否失智與幽默理解能力具有顯著中介效果，亦即是否失智經由文字推理他人意圖和信念的能力下降而影響幽默理解能力之表現。根據以上研究結果加以討論，並提供失智症早期發現、後續照護與非藥物介入應用及未來研究的建議。

Dementia is a serious challenge for health care and Alzheimer’s disease is the most common type. Countries all over the world have been trying to improve their patients’ quality of life, slow down disease progression and ease caregivers’ pressure through political, medical and research effort in detecting any sign and giving medical treatment as soon as possible. In past researches, humor and laughing can improve patients’ quality of life and decrease pressure. However, there were also mentioned that altered sense of humor happened in Alzheimer’s disease. There has been few studies discuss whether decline cognitive functions in Alzheimer’s disease affect humor comprehension. This study aims to explore the difference between mild Alzheimer’s disease and healthy elders’ humor comprehension and its mechanism by using executive functions and theory of mind as mediators according to the opposition-coherence theory of humor. 32 patient of mild Alzheimer’s disease (mild AD) and 30 healthy elders were recruited from Taoyuan City and hospital, and both groups were assessed with three batteries including humor comprehension test, Frontal Assessment Battery Taiwanese version, and Theory of Mind test. The study has shown that mild AD group performed significantly worse than the healthy group in humor comprehension, executive functions, and theory of mind; there are significant correlations between humor comprehension, executive functions and verbal theory of mind. We also find that verbal theory of mind have significantly mediating influence on the effects of dementia status on humor comprehension. It means dementia may affect the performance of humor comprehension through impulse verbal theory of mind. Finally, based on the research results, implications for dementia health care and directions for future research are discussed.