31/03/2016

高齡的智慧:情緒、認知功能與營養(演講摘要)

中國醫藥大學 安南醫院副院長
精神醫學及神經科學教授 

(發布:2016/3/31;修改:2024/5/18)

老化沿伸出來生理、心理、家庭、社會、疾病等種種不同的問題,目前仍是人類所最面對的最大挑戰之一。臺灣1993年正式進入高齡化社會(65歲以上超過人口7%),2017年65歲以上人口將達14%,成為高齡社會(aged society), 到了2025年將超過20%,成為超高齡社會(hyper-aged society,內政部,2012)。世界各國由7%倍增到14%所經歷的時間,法國花了125年、美國65年、英國及德國為45年;而台灣需25年,快過日本的26年,居世界最快!然而,台灣社會因應老化的問題,是否也是世界最快?

「預防重於治療」的鐵律放諸四海皆準。為了「成功老化,遠離憂慮」,當前世界的趨勢已朝向整合性的保健、預防與治療,有很多很重要的方式,目前都有良好的醫學研究証實,例如:「多多動腦勤於學習」、「規律運動」、「健康飲食與均衡營養」、「正念冥想靜坐」、「節奏放緩性格放寬」、「維繫良好的家庭和伴侶支持」、「參與社會社交活動,積極充實自我價值」等。

首先,活躍的「心智活動」可以保護腦細胞的退化,其次「飲食及營養」已漸受主流高齡醫學、乃至於精神健康之重視,我們中國醫大的身心介面實驗中心,最近與國際友人成立了「國際營養與精神醫學研究學會」,旨在推動飲食在精神健康的功效。「運動」對老人家也非常重要,可以促進心肺血管功能、改善睡眠品質及體重過重、更可以減少憂鬱、焦慮及相關的身體症狀;老人家若有退化性關節問題,可以考慮「慢呼吸」合併「慢節奏」的伸展、靜坐、太極或游泳,同時也有很好的舒壓效果。

最後,老人認知退化及憂鬱並不容易查覺,有時已經相當嚴重,也僅以「查不到原因」的身體不適來表現,若有這類情況,應及早就診精神科尋求專業協助。然而,台灣目前在現行健保制度下,大多強調疾病的治療,而且偏向藥物的治療,常常無法提供高齡者真正的需求,面臨台灣進入高齡化的社會,學術界和衛生主管機構都應該努力推動「整合性、全面性」的保健、預防與治療模式,讓老化更成功。









在Science有一個很有趣的研究,研究者結合心理學上冒險、賭局、及後悔的心理測驗,加上fMRI的檢查,來探討心智健康老人、老發性憂鬱症老人及年輕人的差異。 圖 1(A)結合心理方法和引發後悔感的順序冒險任務的 80 次嘗試:在每輪試驗中,會呈現 8 個盒子,其中 7 個盒子包含收益(「金」),1 個盒子包含損失(「魔鬼」)。 盒子從左到右依次打開。受試者可以在任何階段選擇打開下一個盒子,或者停止並收取到目前為止本輪獲得的收益。打開隨機分配的「魔鬼」 將結束試驗,並且所有收益都將丟失。如果受試者決定停止並收取收益,則會揭示「魔鬼」 的位置,表明他們可以安全地繼續到多遠(「錯失的機會」)。圖 1(B)只有在年輕和年長的憂鬱症受試者中,獲勝試驗中「魔鬼」 的位置(錯失的機會)預測了下輪冒險風險 (P < 0.007)。 虧損試驗中「魔鬼」 的位置沒有觀察到這種影響 (P > 0.83),表明錯失的機會對未來選擇行為具有選擇性影響。這項研究調查了年輕和年長的憂鬱症患者在涉及後悔情緒的決策任務中的表現。結果表明,只有在年輕和年長的憂鬱症患者中,錯失的機會(即獲勝試驗中本可以獲得的更高收益)才會影響他們下一輪的冒險行為。這一發現表明,憂鬱症可能與對錯失機會的敏感性增加有關,並可能有助於解釋憂鬱症患者的某些決策模式。


1 comment:

  1. A sharper mind: tai chi can improve cognitive function (Harvard Medical School)

    https://www.health.harvard.edu/mind-and-mood/a-sharper-mind-tai-chi-can-improve-cognitive-function

    There are lots of jokes about forgetting where you put your keys, but as you get older, changes in your mental function are no laughing matter. Changes in your brain that start around age 50 can affect your memory, as well as other cognitive functions such as your ability to juggle multiple tasks, process information rapidly, and focus on details. By age 70, one in six people has mild cognitive impairment (which can progress to Alzheimer's disease).


    Get your copy of An Introduction to Tai Chi

    An Introduction to Tai Chi
    Mind-body exercises, such as tai chi and yoga, have been gaining popularity over the past few decades. This is not surprising, given the increasing number of studies on the positive effects of these gentler forms of exercise—everything from lowering blood pressure and managing depression to building strength and improving balance. There is even evidence that tai chi may help you live a longer, more vital life.

    Read More


    Up until about two decades ago, it was believed that your brain only produced new cells early in life. But research has shown that the brain has the ability to change throughout your entire life span, growing new cells, making new connections, and even increasing in size. These changes can improve cognitive function—and various forms of exercise, including tai chi, can help.

    In a meta-analysis of 20 studies on tai chi and cognition, tai chi appears to improve executive function—the ability to multitask, manage time, and make decisions—in people without any cognitive decline. In those with mild cognitive impairment, tai chi slowed the progression to dementia more than other types of exercise and improved their cognitive function in a comparable fashion to other types of exercise or cognitive training.

    In one study, researchers had nearly 400 Chinese men and women with some cognitive impairment perform either tai chi or a stretching and toning program three times a week. After a year, the tai chi group showed greater improvements, and only 2% of that group progressed to dementia, while 11% from the traditional exercise group did.

    In another study, tai chi outperformed walking. Following 40 weeks of either tai chi, walking, social interaction, or no intervention, researchers compared MRI images and discovered that brain volume increased the most in the tai chi group. In addition, that group also performed better on cognitive tests.

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