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| 教 育 專 題 深 入 報 導《2004-07-23》 |
| 本期內容 | |
| ◎ 國際專題:你去哪裡了？ | |
| 國際專題:你去哪裡了？ | |
| 策劃、編譯■成怡夏 | |
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當你所愛的人記憶一點一滴流失，要怎麼找到彼此情感的聯繫？面對至親面無表情的容顏，要怎麼撐過「找不到原來的那個人」的難堪和失落，和身心俱疲的無助感？照顧阿茲海默症病患充滿了辛酸的故事，它顛覆了人對身份的認同，也挑戰了人對另一個人的感情，更讓人發現自己對於大腦複雜的結構是那麼無知。 一般最常見的老人癡呆有兩種，一種是因為腦血管阻塞，引起腦中風；另一種是腦細胞壞死，引起腦部萎縮的阿茲海默症。台灣目前罹患失智症的人數約為4到8萬，其中半數罹患阿茲海默症，患者會出現認知功能障礙，包括記憶力變差、反覆詢問同一問題等；此外，患者還可能伴隨著異常行為與心理精神症狀，例如妄想、幻覺、攻擊行為、性情大變、情緒不穩及失眠等。 由於阿茲海默症初期症狀不明顯，經常錯失早期發現的契機，很多人以為老人家年紀大了，自然會忘東忘西；有時會有老人家疑神疑鬼，懷疑兒孫拿走自己的東西的情況，遭來兒孫的指責與憤怒，造成家庭關係緊張，渾然不知這並非老糊塗了，而是老人家生病了。 許多長期照顧阿茲海默症病人的家屬都非常需要各方面的支持，試想，你所照顧的人對你的付出可能不但沒有任何情感上的回饋，反而無動於衷；但是他的無助與孱弱，卻召喚著你強烈的同情，這時你這單方面緊抓的記憶火花顯得多餘與沉重，接受現實反倒是一條輕捷的道路。南茜在雷根過世後嘆息道：「他根本不知道我是誰！」那麼照顧下去的動力究竟是什麼？道義？記憶？還是同樣身為人對於共同命運的承擔？ 雖然阿茲海默症目前仍被視為無法治癒的疾病，但若能早期診斷，可透過適當的藥物治療及非藥物治療，達到改善症狀、延緩退化速度的效果。 2015年美國醫療經費將成長3倍 研究者指出，美國聯邦政府花費在阿茲海默症（老年癡呆症）的經費，隨著人口老化在2015年將成長3倍，也增加老人健康醫療保險上的壓力。即到了2015年，將會花費1,890億美元健康保險於阿茲海默症上，比2000年的620億美元高出許多。 報導中也強調，現行的醫療保險花費在阿茲海默症的病人身上，3倍於一般平均的受益者，也佔聯邦計劃中老年病患的34％。「阿茲海默症的治療比一般疾病的治療貴多了。」阿茲海默症協會發言人史蒂芬‧麥克可內爾表示。 他在訪談中還補充說：「我們看到阿茲海默症的病患正在暴增。」估計有450萬的美國人罹患此病，而這個數目將會隨著嬰兒潮的那一代逐漸老化，在2050年高達1千6百萬人。 麥克可內爾說，阿茲海默症的研究者在督促聯邦政府增加研究預算，從現在的6億8千萬美元提高到10億美元，以支付更多的實驗方法和描圖科技，讓醫生可以做出更快速精確的診斷。 雷根促成國會通過一項法案，將阿茲海默症研究經費加倍至14億美元。為紀念已在6月因該病去世的前總統雷根，這項法案，在參議院有63位議員共同提案。目前醫療保險用在治療阿茲海默症病人，平均每年的費用是13,207美元，高於其餘平均受益者的4,454美元，麥克可內爾說。 藥物治療如愛憶欣（Aricept）可延遲阿茲海默症直到老年再發病，麥克可內爾在一場阿茲海默症的會議中表示。他補充，這項藥物平均可以延遲發病6年，將會減少150萬的病患數目，也可以節省高達510億美元的醫療資源。「可以晚一點才生病，更少人進入進一步的病程。」他說。 Federal spending on Alzheimer's disease could triple by 2015 as the population ages, putting increasing strain on the Medicare health program for the elderly, researchers said on Monday. The study for the Alzheimer's Association projects that Medicare spending on people with the disease will rise to $189 billion by 2015 from $62 billion in 2000. Current Medicare spending on Alzheimer's patients is three times as high as for the average beneficiary and currently accounts for 34 percent of total costs in the federal program for elderly patients, the report said. "The presence of Alzheimer's makes it much more expensive to treat people who often have other illnesses," said Alzheimer's Association spokesman Stephen McConnell. "And we're looking at a demographic explosion of Alzheimer's patients," McConnell added in an interview. An estimated 4.5 million Americans have the disease and that number is expected to balloon as high as 16 million by 2050 as the baby boom generation ages. McConnell said Alzheimer's researchers are urging the federal government to increase funding for research into the disease to $1 billion from the current $680 million, to pay for more trials and more imaging technology that allows doctors to make quick assessments of a patient's brain. 減肥、保持活動 阿茲海默症免上身 減肥、吃更多水果和蔬菜，多動腦和身體，聽起來像是預防心血管疾病的公式，但是這也是用於阿茲海默症的預防。專家指出，中年肥胖、高膽固醇和高血壓顯然影響腦部。 「人們可以透過很多種生活型態的因素，降低心智衰退的風險。」阿茲海默症協會醫學與科學會議主席馬里蘭‧阿拉伯表示。「人類的腦部比我們想像的更容易受影響。」 阿拉伯補充說：「腦部有很多空間可以去更新和重生，我們必須告訴人們，大家應該像重視身體上的健康一樣，重視心智上的健康。」 「愈早愈好，」她說，「阿茲海默症在病理學上發展超過10年，或許更長，人們應該愈早開始注意它愈好。」 一項在芬蘭研究1千5百位老年人的研究發現，有中年肥胖的人在老年痴呆的機會是正常體重者的兩倍。中年就有高膽固醇和高血壓疾病的人，老年痴呆的比率則高於正常人6倍。 另一項針對1萬3千位女性做的研究發現，中年常吃像萵苣、菠菜、花椰菜和豆芽菜等蔬菜的人，在70歲的時候比少吃蔬菜的女性有更好的心智能力。另一項研究也顯示，休閒時間從事的活動若結合社交、心靈與身體的活動，也可以防止痴呆。心靈活動包括閱讀、做縱橫字謎、玩賓果遊戲等等，可以幫助預防心智衰退，阿拉伯說：「應該有什麼可以推著人，去做些不是例行性的事情。」 Losing weight, eating more fruits and vegetables and exercising your brain and body sounds like a formula to prevent heart disease, but it is also a way to prevent Alzheimer's, researchers said on Monday. Midlife obesity, high cholesterol and high blood pressure appear to affect the brain as well as the heart, they said. "There are a variety of lifestyle factors that people can engage in that will reduce their risk of cognitive decline," said Dr. Marilyn Albert, chair of the Alzheimer's Association's medical and scientific council. "The brain is much more plastic than we thought," Albert added in an interview. "It has more capacity to renew and regenerate. ... We have to tell people that they need to think about their cognitive health in a way that they typically thought about their physical health." Early is better, she added. "The pathology of Alzheimer's disease develops over 10 years, possibly longer. People should start as early in life as possible." Several studies presented to a meeting sponsored by the Alzheimer's Association in Philadelphia this week support the contention. A study in Finland of 1,500 elderly people found that those who were obese in middle age were twice as likely to develop dementia when they got old as those who were of normal weight. For those who also had high cholesterol and high blood pressure in middle age, the risk of dementia was six times higher than those who were not affected. Another study, of 13,000 women, found that those who ate vegetables such as iceberg lettuce, spinach, broccoli and Brussels sprouts in middle age preserved more of their cognitive abilities as they entered their 70s than women who ate few vegetables. "Women with the highest average intake of those vegetables appear to experience less cognitive decline," Dr. Jae Hee Kang of Harvard Medical School, told a news conference. Another study suggested that leisure activities that combine social, mental and physical activity are the most likely to prevent dementia. Each activity is less important than all of them together, said Laura Fratiglioni of Sweden's Karolinska Institute. Mental activities such as reading books, doing crossword puzzles or playing bingo can help to prevent mental decline, Albert said. "It should be anything that will push people to encounter something that isn't routine." An estimated 4.5 million Americans currently have Alzheimer's, and that number is expected to balloon as high as 16 million by 2050 as the baby boom generation ages. 簡易心智狀態問卷調查表（SPMSQ） 請依下表所列的問題，詢問長輩並將結果紀錄下來，（如果長輩家中沒有電話，可將4-1題改為4-2題），答錯的問題請記錄下來。 1.今天是幾號？ 2.今天是星期幾？ 3.這是什麼地方？ 4.您的電話號碼是幾號？住在什麼地方？（二選一） 5.您幾歲了？ 6.您的出生年月日？ 7.現任的總統是誰？（姓氏正確即可） 8.前任的總統是誰？（姓氏正確即可） 9.您媽媽叫什麼名字？ 10.從20減3開始算，一直減3減下去。 失智症初步評估參考標準 ˙心智功能完整：錯0～2題 ˙輕度心智功能障礙：錯3～4題 ˙中度心智功能障礙：錯5～7題 ˙重度心智功能障礙：錯8～0題 如長輩只有小學程度，可多錯一題；若長輩有高中以上程度，則需少錯一題。若長輩答錯3題以上（含），請立即帶他（她）前往各大醫院神經科或精神科，做進一步的失智症檢查。以求及早發現，及早治療，減緩失智症繼續惡化！ 當您使用簡易心智狀態問卷調查表（SPMSQ），發現長輩出現疑似失智症之症狀時，您應該如何處理？ ＊撥打諮詢專線，尋求專業人員提供協助。 台北：02-2332-0992 免付費專線：0800-228-585 ＊就近前往各大醫院神經科或精神科做失智症檢查。 ＊連絡下列機構： 天主教失智老人基金會 http://www.cfad.org.tw，02-2304-6715 台灣失智症協會 http://www.tada2002.org.tw/，02-2314-9690 天主教康泰醫療教育基金會 http://www.kungtai.org.tw/，02-2365-7780 (取自「如何與殘障朋友相處」一書，伊甸基金會提供) |
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