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| Title: | 纖維肌痛症患者主觀認知抱怨、客觀認知功能與生活品質之關聯性研究
The relationship between subjective cognitive complaints, objective cognitive functions and quality of life in patients with fibromyalgia |
| Authors: | 姜欣萍
Keung, Yan-Ping |
| Contributors: | 楊啟正
Yang, Chi-Cheng
姜欣萍
Keung, Yan-Ping |
| Keywords: | 纖維肌痛症
主觀認知抱怨
客觀認知功能
生活品質
Fibromyalgia
Subjective cognitive complaints
Objective cognitive functions
Quality of life |
| Date: | 2025 |
| Issue Date: | 2025-07-01 14:11:30 (UTC+8) |
| Abstract: | 背景：纖維肌痛症（Fibromyalgia , FM）是一種以廣泛性疼痛為特徵的慢性疾患。主觀認知功能抱怨是FM的常見症狀，83%的患者報告有主觀認知問題，且50%至80%的患者在注意力、記憶力與執行功能上表現下降。然而，主觀認知抱怨不一定與客觀認知功能缺損一致，且過往研究多聚焦於特定的認知領域，難以全面理解兩者間的關聯。有鑑於此，本研究旨在全面評估FM患者的主觀認知抱怨與客觀認知功能表現，並探討兩者間的差異與相關性；同時進一步分析疼痛程度、情緒狀態、主觀認知抱怨及客觀認知表現，對生活品質的預測效果。
方法：本研究納入40名FM患者作為實驗組，及20名健康受試者作為對照
組。所有受試者皆評估其疼痛、憂鬱、焦慮與主觀認知退化程度，同時接受神經心理功能測驗，包括整體性認知功能、注意力、記憶力、工作記憶、處理速度、執行功能、概念形成能力、心理轉換能力、語言流暢度及語言生產能力等面向，以測量其客觀認知表現。除此之外，亦評估受試者在生理、心理、社會關係、環境與整體層面的生活品質。本研究採用獨立樣本t檢定，比較兩組在疼痛程度、情緒狀態與生活品質的差異；以變異數分析與共變數分析檢視兩組在主觀認知抱怨與客觀認知表現的差異，另以Hedges' g計算效果量，進一步評估兩組在主觀與客觀認知指標上的差異幅度。同時根據主客觀認知表現，將FM患者劃分為四個組別，進一步分析各組在整體、執行功能與記憶力三個認知領域的表現，並透過克拉斯卡－瓦立斯檢定探討不同認知分組與心理健康狀況之間的差異。接續以皮爾森相關分析評估FM患者在不同心理健康與認知變項和疼痛程度與生活品質之關聯，最後採用多元線性迴歸分析與階層迴歸分析心理健康與認知變項和疼痛程度與生活品質之預測力。
結果：本研究結果顯示，在心理健康指標方面，包括疼痛程度、情緒狀態與生活品質，FM組皆比對照組顯著更差。在主觀認知抱怨方面，FM組在定向感/執行功能、記憶功能、語言功能與整體主觀認知功能退化程度上得分亦顯著較高；在客觀認知表現方面，FM組在整體性認知功能、部分注意力指標、記憶再認、工作記憶、處理速度、概念形成、心理轉換、語言流暢度與語言生產能力等多項指標上表現顯著低於對照組；進一步分析則顯示，FM組的主觀抱怨總平均效果量大於客觀表現的總平均效果量。以主客觀記憶力的分組發現與疼痛、憂鬱和焦慮具有顯著關聯。相關分析顯示所有心理健康變項和處理速度與疼痛程度顯著相關，而所有心理健康和部分客觀認知變項與特定生活品質面向呈現顯著相關。最後，多元線性迴歸分析顯示憂鬱、主觀認知與PSI表現對疼痛程度有顯著的預測力，且焦慮與半數生活品質面向有顯著的預測力。
結論：FM組相較對照組在疼痛、情緒與生活品質等方面表現較差，並同時呈現主觀與客觀認知功能的下降。主觀認知抱怨整體幅度高於實際缺損，且與心理困擾密切相關。憂鬱、主觀認知抱怨與處理速度可預測疼痛程度，焦慮則顯著預測生活品質。依記憶功能進行分組可區辨FM患者在生心理困擾程度之差異，臨床應用上，納入記憶主觀評估將有助於及早發現需要額外心理介入之高風險族群。
Background: Fibromyalgia (FM) is a chronic disorder characterized by widespread pain. Subjective cognitive complaints are common among individuals with FM, with
83% of patients reporting cognitive difficulties, and 50% to 80% showing impairments in attention, memory, and executive functions. However, subjective cognitive complaints do not always correspond with objective cognitive deficits, and
previous studies have primarily focused on specific cognitive domains, limiting a comprehensive understanding of the relationship between the two. Accordingly, this study aimed to comprehensively evaluate both subjective cognitive complaints and objective cognitive performance in FM patients, to explore the differences and associations. Additionally, the study examined the predictive effects of pain intensity, emotional status, subjective cognitive complaints, and objective cognitive performance on quality of life.
Methods: The study recruited 40 FM patients as the experimental group and 20 healthy control participants as the comparison group. All participants completed self report questionnaires assessing pain severity, depression, anxiety, and perceived cognitive decline. Additionally, neuropsychological assessments were measured to evaluate objective cognitive performance across multiple domains, including brief global cognition, attention, memory, working memory, processing speed, executive function, concept formation, mental flexibility, verbal fluency and verbal productivity. Quality of life was assessed across physical health, psychological, social relationships, environmental, and overall domains. Independent samples t-tests were
used to compare the two groups in terms of pain severity, emotional status, and quality of life. Analyses of variance (ANOVA) and analyses of covariance (ANCOVA) were conducted to examine group differences in subjective cognitive
complaints and objective cognitive performance. Hedges' g effect sizes were calculated to further evaluate the magnitude of differences between the groups on both subjective and objective cognitive measures. FM patients were classified into four groups based on subjective and objective cognitive performance. Kruskal-Wallis tests were used to assess differences among the cognitive subgroups and associations with psychological indicators. Pearson correlation analyses were subsequently conducted to examine the associations between psychological indicators, cognitive
performance , pain severity, and quality of life in FM patients. Finally, multiple linear regression and hierarchical regression analyses were employed to assess the predictive power of psychological indicators and cognitive performance on pain severity and quality of life.
Results: The results revealed significant differences between the FM group and the comparison group across psychological indicators, including pain severity, emotional
status and quality of life, with the FM group showing significantly poorer outcomes in all aspects. Regarding subjective cognitive complaints—covering
orientation/executive function, memory function, language function, and overall perceived cognitive decline—the FM group reported significantly higher levels of impairment than the comparison group. In terms of objective cognitive performance, the FM group showed significantly lower scores compared to the comparison group across multiple domains, including brief global cognition, partial attention indices,
recognition memory, working memory, processing speed, concept formation, mental flexibility, verbal fluency and verbal productivity. Further effect size analysis
indicated the magnitude of subjective cognitive differences is considerably greater than that of objective performance. A significant association was found between the subjective and objective memory groupings and psychological indicators, including pain, depression, and anxiety. Correlation analyses revealed that all psychological indicators and processing speed were significantly associated with pain severity, while all psychological indicators and certain objective cognitive variables showed significant associations with specific domains of quality of life. Finally, multiple linear regression analyses indicated depression, subjective cognitive complaints, and processing speed significantly predicted pain severity, while anxiety significantly predicted half of the quality of life domains.
Conclusions: Compared to the comparison group, the FM group demonstrated poorer outcomes in pain, emotional and quality of life, along with declines in both subjective and objective cognitive functioning. Subjective cognitive complaints were greater in magnitude than the actual deficits observed and were closely associated with psychological indicators. Depression, subjective cognitive complaints, and processing speed significantly predicted pain severity, while anxiety was a significant predictor
of quality of life. Grouping based on memory function differentiated the levels of psychological distress among FM patients. Clinically, incorporating subjective and
objective memory assessments may facilitate early identification of high-risk individuals who require additional psychological interventions. |
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| Description: | 碩士
國立政治大學
心理學系
107752022 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0107752022 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
|
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