| 摘要: | 隨著醫療與社會的進步，台灣人口結構逐漸成為高齡化社會，老年人口所佔總人口比例也持續增加。在人類老化的過程中，我們的腦部無法避免地也容易發生退化的情形，最常見的一種狀況是Dementia，中文學名為失智症俗稱癡呆症。是一種腦部疾病，會導致記憶力、思考能力退化，進而影響到日常生活的自我照料。
由於老化是人類的必經路程，世界各國在Dementia的療效研究未曾間斷過。因此，本研究的目的就是蒐集Dementia療效相關的論文，並彙整其使用的治療方式等因素，進行統合迴歸分析。期望能藉由探討Dementia療效相關問題，嘗試找出現今足以影響Dementia療效的可能因素。
在診斷量表方面，本研究將所用檢測量表分為三種類型，分別為：簡易智能評估(Mini-Mental State Examination，MMSE)、嚴重失能綜合測試(Severe Impairment Battery，SIB)及阿茲海默症評估量表-認知部分(Alzheimer''s Disease Assessment Scale- Cognitive Subscale，ADCS-Cog)。在治療方法中，本研究將治療方式歸納後分成五大類，分別為：中樞神經系統用藥、血液系統用藥、行為治療(Behavior Therapy)、中草藥等輔助療法(Chinese Herbal Medicine Adjunctive Therapy)與其他。
我們由所收集到的255篇發表之文獻中，整理出可使用的影響變項有: 發表年份、治療時間、診斷量表、研究類型與治療方法。經由統合迴歸分析後發現，治療方法中以中樞神經系統用藥作為參考組，綜合每份統合迴歸中，除了行為治療在調整治療時間效應後，未達統計顯著之外，其餘統合迴歸中治療方法皆達統計上顯著，且另外四種方法其療效之效益值皆比中樞神經系統用藥高。
更值得深入討論的是，在統合迴歸分析中，中草藥等輔助療法是這五種方法中最佳的，且均達統
計上之顯著性。顯示西藥類型的藥物治療，已經不是唯一治療Dementia的方法了，但實際結果仍要更進一步的臨床實驗探討與驗證。
Along medical and social progress, the population structure of Taiwan has gradually become an aging society. The proportion of the elderly population also continues to increase. In the process of human aging, our brain can not avoid the situation of prone degeneration. The most common situation is Dementia, named “失智症” in Chinese. It''s one of the brain diseases which will cause not only the degeneration of memory and thinking but also affect the capability of selfcare of daily life.
Since aging is unavoidable in human being, the studies in the treatment of Dementia are never stop in the whole world. Therefore, the purpose of this study is to collect all published papers that related to the treatment effects of Dementia and to aggregrate the information of influential factors, such as the treatment methods. We expect to be able to explore the problem of treatment effect of Dementia and try to find the influential factors of the treatment effects of Dementia.
Accordingly, in this study, there were three evaluation scales for treatment effect, named Mini-Mental State Examination(MMSE), Severe Impairment Battery(SIB) and Alzheimer''s Disease Assessment Scale- Cognitive Subscale(ADAS-Cog), and five treatment methods, named Central Nervous System Drugs, Blood System Drugs, Behavior Therapy, Chinese Herbal Medicine Adjunctive Therapy and Others.
Within those 255 collected papers, the available potentially influential variables are publication year, treatment duration, evaluation scales, type of study and treatment methodology. The results of meta-regression showed that, using Central Nervous System Drugs as the reference group, the treatment effects of all other four treatment methods were significantly better than the Central Nervous System Drugs, after adjusting for other factors’ effects (Except the Behavior Therapy after adjustment for treatment time effect).
Based on the results of meta-regression, it is worth to mention that the Chinese Herbal Medicine Adjunctive Therapy is the treatment with best treatment effect among those five treatment methods. Accordingly, the conventional medication (mainly western medicine) might not be the only effective treatment for Dementia. A further larger clinical trial to verify the possible results is highly recommended. |
