ᐔ ᚑ 㧞 㧢 ᐕ ᐲ⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦ ࠃ ࠆ ⎇ ⓥ ႎ ๔ ᦠᐔᚑ㧞㧢ᐕᐲ

⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ ᣉ⸳ߦ߅ߌࠆ⹺⍮∝㜞㦂⠪ߩ 31. ะ਄ߩߚ߼ߩᄙర⊛ࠕࡊࡠ࡯࠴࡮
࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦߦ㑐ߔࠆ⎇ⓥ੐ᬺ> ␠ળ⑔␩ᴺੱ ੳ⥋ળ⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯⋡   ᰴᐔᚑ  ᐕᐲ⎇ⓥᚑᨐ㧕㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞ࠍ↪޿ߚ⹺⍮∝㜞㦂⠪ߩ੺⼔ߣ࡝ࡂࡆ࡝ߦ㑐ߔࠆ⎇ⓥ ஜᐽ㜞㦂⠪߅ࠃ߮⧯ᐕ⠪ߩ㖸ჿ⹺⍮ߩ․ᓽߩᬌ⸛́ ࡮࡮࡮࡮࡮࡮࡮
ਥછ⎇ⓥ⠪ ዊ㐳⼱㓁ሶ㧔⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯ ⎇ⓥㇱ㧕ಽᜂ⎇ⓥ⠪ ਛ᧛ ᤘ▸㧔࿖┙㐳ኼක≮⎇ⓥ࠮ࡦ࠲࡯ ⣖ᯏ⢻↹௝⸻ᢿ㐿⊒ㇱ㧕⎇ⓥදജ⠪ 㥱⮮ ජ᥏㧔⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯ ⎇ⓥㇱ㧕ᬌᩏදജ⠪ ጊਅ ⧷⟤㧔ห਄‫ޔ‬ᗲ⍮ක≮ቇ㒮⍴ᦼᄢቇ㧕      ᳓㊁ ⚐ᐔ㧔⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯ ⎇ⓥㇱ㧕㧕⹺⍮∝㜞㦂⠪ߣߩࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦߣ QoL ⛽ᜬߩߚ߼ߩ࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦ੺౉

ߦ㑐ߔࠆ⎇ⓥ੐ᬺ ࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮࡮17


ਥછ⎇ⓥ⠪

ዊ㐳⼱ 㓁ሶ㧔⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯⎇ⓥㇱ㧕ಽᜂ⎇ⓥ⠪

ኴ⃨ጊ ⒤㧔ฬฎደᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼࡮ᢎ᝼࡮␹⚻ౝ⑼㧕

⎇ⓥදജ⠪਄᧛ ⚐৻㧔ฬฎደᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼࡮ഥᢎ࡮૞ᬺ≮ᴺ჻㧕
ၔ᫪ ᴰ㧔ฬฎደᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼࡮ቴຬ⎇ⓥຬ࡮㖸ᭉ≮ᴺ჻㧕ਛᎹ ਈ྾㇢㧔ਛㇱᄢቇ↢๮ஜᐽ⑼ቇㇱ࡮ഥᢎ࡮૞ᬺ≮ᴺ჻㧕⼱೑ ⟤♿㧔ਛㇱᄢቇ↢๮ஜᐽ⑼ቇㇱ࡮ഥᚻ࡮૞ᬺ≮ᴺ჻㧕↰ਛ ዁⵨㧔ฬฎደᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼࡮૞ᬺ≮ᴺ჻㧕
᳓㊁ ⚐ᐔ㧔ฬฎደᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼࡮૞ᬺ≮ᴺ჻㧕Ꮉፒ ߼ߋߺ㧔ฬฎደᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼࡮૞ᬺ≮ᴺ჻㧕ᄢ᫪ ㆐਽㧔ฬฎደᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼࡮૞ᬺ≮ᴺ჻㧕㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞ࠍ↪޿ߚ⹺⍮∝㜞㦂⠪ߩ੺⼔ߣ࡝ࡂࡆ࡝ߦ㑐ߔࠆ⎇ⓥ- ஜᐽ㜞㦂⠪߅ࠃ߮⧯ᐕ⠪ߩ㖸ჿ⹺⍮ߩ․ᓽߩᬌ⸛́
ਥછ⎇ⓥ⠪ ዊ㐳⼱㓁ሶ㧔⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯ ⎇ⓥㇱ㧕ಽᜂ⎇ⓥ⠪ ਛ᧛ ᤘ▸㧔࿖┙㐳ኼක≮⎇ⓥ࠮ࡦ࠲࡯ ⣖ᯏ⢻↹௝⸻ᢿ㐿⊒ㇱ㧕⎇ⓥදജ⠪ 㥱⮮ ජ᥏㧔⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯ ⎇ⓥㇱ㧕ᬌᩏදജ⠪ ጊਅ ⧷⟤㧔 ห਄‫ޔ‬ᗲ⍮ක≮ቇ㒮⍴ᦼᄢቇ㧕      ᳓㊁ ⚐ᐔ㧔⹺⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯ ⎇ⓥㇱ㧕㧭. ⎇ⓥߩ⢛᥊෸߮⋡⊛ ⹺⍮∝ߩ∝⁁ㅴⴕߦ઻߁ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ㓚ኂߪ‫ޔ‬๟࿐ߩੱ‫ߩߣޘ‬੤ᵹࠍ㒖ኂߔࠆߛߌߢߥߊ‫ߩੱᧄޔ‬ਇ቟߿ቅ⁛ᗵࠍ㜞߼ߡ BPSD ಴⃻ߩ⢛᥊࿃ሶߣ߽ߥࠅ‫⹺ޔ‬⍮∝㜞㦂⠪ߩ QOL ߿੺⼔࡮⋴⼔ߦᓇ㗀ࠍਈ߃ࠆᄢ߈ߥⷐ࿃ߩ߭ߣߟߢ޽ࠆ‫ޕ‬ᓥߞߡ‫ޔ‬ࠤࠕߩታ〣႐㕙ߦ߅ߌࠆࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦߩ޽ࠅᣇߦߟ޿ߡ⠨߃ࠆߎߣߪ㊀ⷐߥ࠹࡯ࡑߢ޽ࠅ‫ߢࠬ࡯ࡌࠬࡦ࠺ࡆࠛࠍࠇߘޔ‬ឭ⸒ߒߡ޿ߊߎߣ߇ᧄ⎇ⓥࡊࡠࠫࠚࠢ࠻
ߩਥߚࠆ⋡⊛ߢ޽ࠆ‫ޕ‬ੱߩࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦߪ⸒⺆એᄖߦ‫ޔ‬㗻ߩ⴫ᖱ‫ߚߞ޿ߣ࡯ࡖ࠴ࠬࠚࠫޔ✢ⷞޔ‬㕖⸒⺆ᕈߩᖱႎࠍ੺ߒߡ߽ⴕࠊࠇߡ߅ࠅ‫ޟߩࠄࠇߎޔ‬㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ
ࠪࠣ࠽࡞(nonverbal communication: NC)‫⋧ޔߪޠ‬ᚻߩᔃߩ⁁ᘒࠍℂ⸃ߒ‫ޟ‬ᔃࠍㅢࠊߖ
ࠆ‫⺆⸒ߦ߼ߚޠ‬એ਄ߦᄢಾߥᓎഀࠍᨐߚߒߡ޿ࠆ‫ޕ‬ᚒ‫ޟߩߎߪޘ‬㕖⸒⺆ᕈࠪࠣ࠽࡞‫ޠ‬߇‫⹺ޔ‬⍮∝ߦ߅ߌࠆࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ໧㗴ࠍᡷༀߒ‫ޟޔ‬ᔃߩㅢߞߚࠤࠕ‫ࠍޠ‬ታ⃻ߔࠆߚ߼ߩࠠ࡯ࡐࠗࡦ࠻ߦߥࠆߣ⠨߃ߡ⎇ⓥࠍㅴ߼ߡ߈ߚ‫⎇ߩߢ߹ࠇߎޕ‬ⓥߢ‫ݘޔ‬⹺⍮∝߇ㅴⴕߒߡ߽‫⴫ޔ‬ᖱ࡮ⷞ✢࡮ࠫࠚࠬ࠴ࡗ࡯ߣ޿ߞߚ NC ߩ⹺⍮⢻ജ߿‫ីޔ‬ᚻ࡮᜿ᜦߣ޿ߞߚ␠ળ⊛ᘠ⠌ㆀⴕ⢻ജߪ‫ޔ‬Ყセ⊛ᱷሽߒ߿ߔ޿ߎߣ㨇1, 2㨉‫ޔ‬෸߮‫ݙޔ‬NC
ࠍⓍᭂ⊛ߦ↪޿ߚ࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦࡊࡠࠣ࡜ࡓ㧔ߦߎߦߎ࡝ࡂ㧕ߦࠃߞߡ‫⹺ޔ‬⍮∝㜞㦂⠪ߩࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ⢻ജࠍ᦭ᗧߦ㜞߼ࠆലᨐ߇޽ࠆߎߣࠍ᣿ࠄ߆ߦߒߚ
㨇3, 4㨉‫⎇ߩࠄࠇߎݚޔߦᦝޕ‬ⓥᚑᨐࠍ⹺⍮∝ߩ੺⼔࡮⋴⼔⃻႐ߢ௛ߊࠬ࠲࠶ࡈߦㆶ
రߒߡ޿ߊ⋡⊛ߢ‫ߩޠࡂ࡝ߎߦߎߦޟޔ‬ᗧ⟵߿ᣇᴺߦߟ޿ߡಽ߆ࠅ߿ߔߊ⸃⺑ߒߚᚻᒁᦠ㨇5㨉෸߮ DVD㨇6㨉ࠍ૞ᚑߒߡ᥉෸ߦขࠅ⚵ߺ‫ޔ‬ԛᄙᣉ⸳ߢߩ⃻႐ࠬ࠲࠶ࡈ
ߦࠃࠆታ〣ߦࠃߞߡ߽‫↪᦭ߩࡂ࡝ߎߦߎߦޔ‬ᕈࠍ␜ߒߚ㨇7, 8㨉‫ޕ‬ߎࠇࠄߩᚑᨐߪ NC ߩਛߢ߽ਥߦⷞⷡᖱႎߦὶὐࠍᒰߡߚ⎇ⓥߢ޽ࠆ߇‫ޔ‬NC ߦߪ⡬ⷡᕈߩ߽ߩ‫ߔ⹤ߜࠊߥߔޔ‬ჿߦㄟ߼ࠄࠇߚ༑ᔶຟᭉߩᗵᖱ߿ᛥ឴ߣ޿ߞߚᖱႎ߽
޽ࠅ‫ߩࡦ࡚ࠪ࡯ࠤ࠾ࡘࡒࠦޔ‬႐㕙ߢߪⷞⷡᖱႎߣห╬ߦ㊀ⷐߥᓎഀࠍᨐߚߒߡ޿ࠆ‫ޕ‬ᓥߞߡ⃻ⴕࡊࡠࠫࠚࠢ࠻ߪ‫⹺ޔ‬⍮∝㜞㦂⠪ߦ߅ߌࠆ⡬ⷡᕈ NC ߩ⹺⍮⢻ജ߿ߘߩ․ᓽ
ࠍ᣿ࠄ߆ߦߒߡ޿ߊߎߣߦࠃࠅ‫⼔੺ޔ‬⠪߇ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠍขࠆ㓙ߦ⇐ᗧߔߴ-1-߈‫ߌ߆ߒ⹤ޟ‬ᣇ‫ߢࠬ࡯ࡌࠬࡦ࠺ࡆࠛࠍޠ‬ឭ⸒ߒߡ޿ߊߎߣࠍ⋡ᮡߦߒߡขࠅ⚵ࠎߢ޿ࠆ‫ޕ‬೨ᐕᐲߪ‫⹺ޔ‬⍮∝㜞㦂⠪ 11 ฬࠍኻ⽎ߦ‫ޔ‬㖸ჿ㧔⹤ߒ⸒⪲㧕ߦㄟ߼ࠄࠇߚჿߩ
⴫ᖱࠍ⹺⍮ߔࠆ⢻ജ߿‫ޔ‬㖸ჿߩᗧ๧⊛ౝኈࠍ⹺⍮ߔࠆ⢻ജࠍ⹦⚦ߦᬌ⸛ߒ‫ޔ‬એਅߩ⚿ᨐ߇ᓧࠄࠇߚ㨇8㨉‫ޕ‬
1)⹺⍮∝㜞㦂⠪߇㖸ჿߩᗧ๧ࠍ⹺⍮ߔࠆ⢻ജߪ MMSE ߩૐਅߦ⋧㑐ߒߡૐਅߒߚ
߇‫ޔ‬ჿ߆ࠄ⊒⹤⠪ߩᗵᖱࠍ⹺⍮ߔࠆ⢻ജߪ MMSE ߣ⋧㑐߇ߥߊ‫⹺ޔ‬⍮∝ߩㅴⴕᦼߢᗧ๧⹺⍮⢻ജ߇ૐਅߒߡ߽‫ޔ‬㖸ჿߩ⴫ᖱࠍ⺒߻ജߪᲧセ⊛଻ߚࠇࠆน⢻ᕈ߇␜ߐࠇߚ‫ޕ‬2)⹺⍮∝㜞㦂⠪ߪ‫⹤⊒ޔ‬ᖱႎ߇㐳ߊⶄ㔀ߦߥࠆߣᗧ๧⊛ℂ⸃ᐲ߇ૐਅߔࠆ߇‫ޔ‬ㅒߦઁ⠪ߩᗵᖱࠍℂ⸃ߔࠆߩߦߪ‫ࠅࠃޔ‬㐳޿⊒⹤ᖱႎ߇ᔅⷐߢ޽ࠆߎߣ߇␜ߐࠇߚ‫ޕ‬

3)߶ߣࠎߤ㖸ჿߩᗧ๧⊛ౝኈ߇ℂ⸃࿎㔍ߥㅴⴕᦼ⹺⍮∝㜞㦂⠪ߦ߅޿ߡ߽‫ޟޔ‬ఝߒߊᔃࠍㄟ߼ߡ‫߫ࠇߌ߆ߒ⹤ޠ‬ᅢᗵࠍᜬߟ৻ᣇߢ‫ޟޔ‬ᔶߞߡ‫ޠߦ߁߷ࠄ߈ߞ߱ޟޠ‬‫ޟ‬ሶߤ߽ߦ⹤ߒ߆ߌࠆࠃ߁ߦ‫ߚߌ߆ߒ⹤ޠ‬႐วߪ‫ޔ‬ህᖡᗵࠍᜬߞߚ‫ޕ‬ߎࠇࠄߩ⚿ᨐ߆ࠄ‫⹺ޔ‬⍮∝㜞㦂⠪ߣળ⹤ߔࠆ਄ߢ‫⹤⊒ޔ‬⠪ߩჿߩ⴫ᖱ߇㊀ⷐߢ޽ࠆߎߣ߇␜ߐࠇߚ‫৻ޕ‬ᣇ‫ߩੱޔ‬㖸ჿࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦߦᓇ㗀ࠍਈ߃ࠆ࿃ሶߪ‫ޔ‬㖸ჿߦㄟ߼ࠄࠇߚᗵᖱએᄖߦ߽‫ޔ‬ᛥ឴‫⹤⊒ޔ‬ㅦᐲ‫⪲⸒ޔ‬㑆ߩ‫ޟ‬㑆‫ޠ‬㧔࡝࠭ࡓ㧕ߣ޿ߞߚ߽ߩ߽‫ޔ‬㊀ⷐߥࡈࠔࠢ࠲࡯ߢ޽ࠆߎߣ߇⍮ࠄࠇߡ޿ࠆ㨇9, 10, 11㨉‫⹺ޔߒ߆ߒޕ‬⍮∝㜞㦂⠪ߣߩ㖸ჿࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦߦ߅޿ߡߘࠇࠄߩࡈࠔࠢ࠲࡯߇ߤߩࠃ߁ߥᓇ
㗀ࠍਈ߃ࠆ߆‫ޔߜࠊߥߔޔ‬1. ߤߩࠃ߁ߥᛥ឴ߢ‫ޔ‬2. ߤߩߊࠄ޿ߩ⊒⹤ㅦᐲߢ‫ޔ‬3.ߤ
ߩߊࠄ޿ߩ‫ޟ‬㑆‫ߡߌ޽ࠍޠ‬ળ⹤ࠍߔࠆߩ߇ᦨ߽ㆡᒰ߆‫ࠊߤࠎߣ߶ޔߪߡ޿ߟߦ╬ޔ‬߆ߞߡ޿ߥ޿‫੹ߢߎߘޕ‬ᐕᐲߪ‫ߕ߹ޔ‬ஜᐽ㜞㦂⠪ߦߟ޿ߡ㖸ჿᗧ๧⹺⍮ߦߎࠇࠄߩ
ࡈࠔࠢ࠲࡯߇ߤߩࠃ߁ߥᓇ㗀ࠍਈ߃ࠆ߆ࠍᬌ⸛ߒ‫੹ޔ‬ᓟߩ⹺⍮∝㜞㦂⠪ߣߩᲧセߩߚ߼ߩၮ␆࠺࡯࠲ࠍ෼㓸ߒߚ‫ޔߚ߹ޕ‬ஜᐽ⧯ᐕᚑੱߣߩᲧセ߽ⴕ޿‫ޔ‬ട㦂ߩᓇ㗀ߦߟ޿ߡ߽⸃ᨆࠍⴕߞߚ‫ޕ‬㧮 ⎇ⓥᣇᴺ㧝㧕ኻ⽎ኻ⽎ߪㄭ㓞࿷૑ߩஜᐽ㜞㦂ࡏ࡜ࡦ࠹ࠖࠕ 16 ฬ㧔↵ᕈ 9 ฬ㧘ᅚᕈ 7 ฬ㧘63-80 ᱦ㧘ᐔဋ 82.1± 5.2 ᱦ㧕‫ޔ‬෸߮‫ޔ‬ஜᐽ⧯ᐕࡏ࡜ࡦ࠹ࠖࠕ 13 ฬ㧔↵ᕈ 3 ฬ㧘ᅚᕈ 10 ฬ㧘25-41
ᱦ㧘ᐔဋᐕ㦂 31.5 ± 5.5 ᱦ㧕‫ޕ‬㜞㦂⠪ߦߪోຬ‫ޔ‬Mini-Mental State Test (MMSE)‫ޔ‬Clinical
Dementia Rating (CDR) ╬ߩ⹺⍮ᯏ⢻ᬌᩏࠍⴕ޿‫ޔ‬シᐲ⹺⍮㓚ኂ߿⹺⍮∝ߩ⇼޿߇ߥ޿ߎߣࠍ⏕⹺ߒߚ‫ޕ‬MMSE ߩᓧὐߪ 26-30 ὐߢᐔဋᓧὐ 29.2±1.2 ὐߢ޽ࠅ‫ޔ‬CDR ߪోຬ 0 ὐߢ޽ߞߚ‫ޕ‬㜞㦂⠪ߦߪ◲ᤃ⊛ߥⷞജᬌᩏߣ⡬ജᬌᩏ߽ⴕ޿‫⇣ޔ‬Ᏹ߇ߥ޿ߎ
ߣࠍ⏕⹺ߒߚ‫⧯ޔߚ߹ޕ‬ᐕ⠪ߦߟ޿ߡߪ‫ޔ‬ኻ㕙ࠗࡦ࠲ࡆࡘ࡯ߢⷞജ࡮⡬ജߦ໧㗴߇ߥ޿ߎߣࠍ⏕⹺ߒߚ‫ޕ‬-2-ᧄ⎇ⓥߪ࿖┙㐳ኼක≮⎇ⓥ࠮ࡦ࠲࡯෸߮‫⹺ޔ‬⍮∝੺⼔⎇ⓥ࡮⎇ୃᄢᐭ࠮ࡦ࠲࡯ߩ
୶ℂᆔຬળᛚ⹺ߩరߦⴕࠊࠇ‫଀ోޔ‬ᬌᩏ೨ߦᧄੱ߆ࠄᦠ㕙ߢหᗧࠍᓧߚ‫ޕ‬ᬌᩏߩታᣉߦ޽ߚߞߡߪ‫ⵍޔ‬㛎⠪ߩ∋ഭ߿㓸ਛജߦචಽߥᵈᗧࠍᛄ޿‫ޔ‬දജ⠪ߩࡍ࡯ࠬߢㆡ
ቱભᙑࠍขࠅߥ߇ࠄⴕߞߚ‫ޕ‬㧞㧕㖸ჿೝỗa) ೝỗ↪ߩන⺆෸߮࠮ࡦ࠹ࡦࠬ ߎࠇ߹ߢߩ⎇ⓥߢ૞ᚑߒߚ㖸ჿ࡜ࠗࡉ࡜࡝࡯߆ࠄ‫੹ޔ‬࿁૶↪ߩන⺆෸߮࠮ࡦ࠹ࡦ
ࠬࠍㆬ಴ߒߚ‫ޔߜࠊߥߔޕ‬න⺆ߪ NTT ࠺࡯࠲ࡌ࡯ࠬࠪ࡝࡯࠭ᣣᧄ⺆ߩ⺆ᒵ․ᕈ㨇12㨉ࠍ↪޿ߡ㖸ჿߩⷫኒᐲ㧔ੱ㑆߇ߘߩ⸒⪲ߦᘠࠇⷫߒ߻⒟ᐲࠍਥⷰ⊛ߦ⹏ଔߒߚ⹏ቯ
୯㧕߇ 5.5 એ਄ߩ‫ޔ‬ᣣᧄੱߦߣߞߡߥߓߺ߇㜞޿න⺆ࠍㆬᛯၮḰߣߒ‫ޔ‬3 ࡕ࡯࡜ߩฬ
⹖ࠍ 70 ୘㧔‛ຠ 20‫ޔ‬㘩‛ 20‫ ‛↢ޔ‬20‫⊓ޔ‬႐⠪ 13㧕ߣ‫⃻ޔ‬࿷ᒻ߇ 6 ࡕ࡯࡜ߦߥࠆࠃ
߁ߥേ⹖ 6 ୘߇⊓㍳ߐࠇߡ޿ࠆ‫ߩߎޕ‬ਛ߆ࠄ‫ޔ‬േ‛㧔ࡄࡦ࠳‫࠲ޔࡀ࠷ࠠޔ࡜࡝ࠧޔ‬࠿ࠠ㧕߇‫ޔ‬㘩ߴ‛㧔ߺ߆ࠎ‫ࠅ߁ࠀ߈ޔࠧࡦ࡝ޔ࠽࠽ࡃޔ‬㧕ࠍ‫ޔ‬٤٤ߔࠆ㧔ຈ߃ࠆ‫ޔ‬㓝ߔ‫ޔࠆ߼⌑ޔ‬ᵞ߁㧕‫ߥ߁ࠃߚߞ޿ߣޔ‬ౝኈߢ᭴ᚑߐࠇࠆ‫ޔ‬14 ࡕ࡯࡜ߩ SVO ࠮ࡦ࠹ࡦࠬࠍၮᧄೝỗⷐ⚛ߣߒߡ↪޿ߚ‫ޕ‬  ex1) ࠧ࡝࡜߇ ࡃ࠽࠽ࠍ ຈ߃ߡ޿ࠆ  ex2) ࠲࠿ࠠ߇ ࡝ࡦࠧࠍ 㓝ߒߡ޿ࠆ㖸ჿߪ‫ߩࡠࡊޔ‬ᅚᕈࠕ࠽࠙ࡦࠨ࡯㧔50 ઍ㧕ߦଐ㗬ߒߡ㍳㖸ߒߚ߽ߩߢ‫⥄ޔ‬ὼߥᛥ឴ߢ⹤ߒߚ߽ߩߣ‫ޔ‬ήᛥ឴ߩන⺞ߥჿߢ⹤ߒߚ߽ߩࠍ૶↪ߒߚ‫ޕ‬b) ᧦ઙࠍࠦࡦ࠻ࡠ࡯࡞ߒߚೝỗ㖸ჿߩ૞ᚑ ਄⸥ a)ߢㆬቯߒߚၮᧄ㍳㖸㖸ჿ߆ࠄ‫ޔ‬1) ᛥ឴ 2 ᧦ઙ㧔޽ࠅ㧛ߥߒ㧕‫ޔ‬2) ⊒⹤ㅦᐲ
3 ᧦ઙ㧔ㅦ޿㧛᥉ㅢ㧛ㆃ޿㧕‫ޔ‬3) ᢥ▵㑆㓒 3 ᧦ઙ㧔⍴޿㧛⥄ὼ㧛㐳޿㧕ߩฦ᧦ઙߩ
㖸ჿࡈࠔࠗ࡞ࠍ PC ߢ૞ᚑߒߚ‫ޕ‬㖸ჿߩ✬㓸ߦߪ Sound Engine Free 4.60 (ᩣᑼળ␠ࠦ
࡯࠼࡝࠙ࡓ)ࠍ↪޿ߚ‫ޕ‬1) ᛥ឴᧦ઙ㧦߹ߕ‫ޔ‬ᅚᕈࠕ࠽࠙ࡦࠨ࡯߇㍳㖸ߒߚ‫ޟ‬ᛥ឴޽ࠅ‫ޟߣޠ‬ᛥ឴ߥߒ‫ߩޠ‬㖸ჿࡈࠔࠗ࡞߆ࠄή㖸ㇱಽࠍࠞ࠶࠻ߒߡᢥ▵࡟ࡌ࡞ߢಾࠅ಴ߒ‫ޔ‬න૏ᤨ㑆޽ߚࠅߩᐔဋ⊒⹤ࡕ࡯࡜ᢙࠍᬌ⸛ߒߚߣߎࠈ‫ޟޔ‬ᛥ឴ߥߒ‫ޟߪޠ‬ᛥ឴޽ࠅ‫ߦޠ‬Ყߴߡ⊒⹤ㅦᐲ߇ో⥸⊛ߦㆃ޿௑ะ߇⹺߼ࠄࠇߚߚ߼‫ޔ‬㖸⒟߿㖸࿶߇ᄌࠊࠄߥ޿ࠃ
߁ߦᢥ▵ߩ㐳ߐߩߺࠍ❗߼‫ޔ‬ਔ᧦ઙߣ߽ᐔဋ 5.8㧔mora/sec㧕ߣߥࠆࠃ߁ߦ㖸ჿࡈࠔࠗ࡞ࠍ✬㓸ߒ‫ߩࠇߙࠇߘޔ‬ᛥ឴᧦ઙߩၮᧄ㖸ჿߣߒߚ‫ޕ‬-3-2) ⊒⹤ㅦᐲ᧦ઙ㧦਄⸥ 1) ߢ૞ᚑߒߚၮᧄ㖸ჿࡈࠔࠗ࡞ࠍరߦ‫ޔ‬ౣ↢ㅦᐲࠍ㖸⒟߿㖸࿶ࠍᄌ߃ߕߦ 62%ߦ❗߼ߚ᧦ઙ㧔ㅦ޿㧕ߣ‫᧦ߚ޿↪߹߹ߩߘޔ‬ઙ㧔᥉ㅢ㧕‫ޔ‬150%ߦિᒛߒߚ᧦ઙ㧔ㆃ޿㧕ߩ 3 ⒳㘃ߩ᧦ઙ㧔࿑ 1㧕ߢోߡߩ㖸ჿࡈࠔࠗ࡞ࠍ
✬㓸ߒߚ‫ޕ‬ㅦ䈇 (62%)䉺 䊇 䉨 䈏᥉ㅢ (100%)
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ㆃ䈇 (150%)
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࿑ 1㧦㖸ჿࡈࠔࠗ࡞✬㓸ߦࠃߞߡ૞ᚑߒߚ⊒⹤ㅦᐲฦ 3 ᧦ઙߩ㖸ჿᵄᒻ3) ᢥ▵㑆㓒᧦ઙ㧦਄⸥ 1), ෸߮ 2)ߢ૞ᚑߒߚࡈࠔࠗ࡞ࠍరߦ‫ࠍࠬࡦ࠹ࡦ࠮ޔ‬૞ᚑߒߚ‫ߩߘޕ‬㓙‫ޔ‬ᢥ▵㑆㓒ࠍή㖸ࠍᝌ౉ߔࠆߎߣߦࠃߞߡ⺞ᢛߒ‫ޟޔ‬㑆‫ ߇ޠ‬80 ms
ߩ᧦ઙ㧔⍴޿㧕‫ޔ‬700 ms ߩ‫ޟ‬㑆‫ࠍޠ‬ᝌ౉ߔࠆߎߣߦࠃࠅ⥄ὼߥ࠮ࡦ࠹ࡦࠬߦ⡞ߎ߃ࠆ᧦ઙ㧔⥄ὼ㧕‫ޔ‬1400 ms ߩ‫ޟ‬㑆‫ࠍޠ‬ᝌ౉ߔࠆߎߣߦࠃࠅ㐳ߊᗵߓࠄࠇࠆ
᧦ઙ㧔㐳޿㧕ߩ 3 ᧦ઙߩ࠮ࡦ࠹ࡦࠬࠍ૞ᚑߒߚ㧔࿑ 2㧕‫ޕ‬

-4-

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80 ms

80 ms

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䉺 䊇 䉨 䈏⥄ὼ䊋 䊅 䊅 䉕䈎 䈒 䈚 䈩 䈇 䉎

700 ms䉺 䊇 䉨 䈏㐳䈇

700 ms䊋 䊅 䊅 䉕1400 ms䉺 䊇 䉨 䈏䈎 䈒 䈚 䈩 䈇 䉎1400 ms䊋 䊅 䊅 䉕䈎 䈒 䈚 䈩 䈇 䉎࿑ 2㧦ᢥ▵㑆㓒ࠍ⺞ᢛߒߚฦ 3 ᧦ઙߩ࠮ࡦ࠹ࡦࠬߩ㖸ჿᵄᒻc) ᬌᩏ⺖㗴
⺖㗴ߪ‫ޔ‬਄⸥ߢ૞ᚑߒߚ᭽‫᧦ߥޘ‬ઙߩ⊒⹤࠮ࡦ࠹ࡦࠬࠍ⡬߈‫ߩࠬࡦ࠹ࡦ࠮ߩߘޔ‬ౝኈߦว⥌ߒߚ⛗ࠍㆬ߱ᗧ๧⹺⍮⺖㗴ߢ޽ࠆ‫ޕ‬㖸ჿೝỗߪ‫ޔ‬1) ᛥ឴ 2 ᧦ઙ㧔޽ࠅ㧛ߥߒ㧕‫ޔ‬2) ⊒⹤ㅦᐲ 3 ᧦ઙ㧔ㅦ޿㧛᥉ㅢ㧛ㆃ޿㧕‫ޔ‬3) ᢥ▵㑆㓒 3 ᧦ઙ㧔⍴޿㧛⥄ὼ㧛㐳޿㧕ߩ 2 x 3 x 3 = 18 ᧦ઙߩ㖸ჿ߇࡜ࡦ࠳ࡓߦឭ␜ߐࠇࠆ‫ⵍޕ‬ᬌ⠪ߪ‫ޔ‬㖸ჿೝỗᓟߦ PC ↹㕙ߦឭ␜ߐࠇࠆ⛗ߩਛ߆ࠄ࠮ࡦ࠹ࡦࠬߩᗧ๧ౝኈߦว⥌ߒߚ⛗ࠍㆬࠎߢ‫ޔ‬ߥࠆߴߊᣧߊᱜ⏕ߦ࠲࠶࠴ࠬࠢ࡝࡯ࡦߦ⸅ࠇߡ⸃╵ࠍⴕ߁⺖㗴ߢ޽ࠆ㧔࿑ 3㧕‫ޕ‬࿑ 3㧦⺖㗴଀‫ߣޠࠆ޿ߡߒߊ߆ࠍ࠽࠽ࡃ߇ࠠ࠿࠲ޟ߫߃଀ޕ‬㖸ჿ߇๒␜ߐࠇ‫ޔ‬㖸ჿ⚳ੌᓟߦߎߩࠃ߁ߥ↹௝߇๒␜ߐࠇࠆ‫ⵍޕ‬ᬌ⠪ߪ‫ߩࠬࡦ࠹ࡦ࠮ޔ‬ౝኈߦว⥌ߒߚ⛗㧔ߎߩ႐วߪ⌀ࠎਛߩ⛗㧕ࠍㆬ߮⸃╵ߔࠆ‫ޕ‬-5-d) ᬌᩏᚻ㗅ೝỗ㖸ჿߣ⸃╵↹௝ߩ๒␜ߪ‫ޔ‬Presentation (Neurobehavioral Systems Inc. USA) ࠍ↪
޿ߡ PC ߢᱜ⏕ߦ࠲ࠗࡒࡦࠣࠦࡦ࠻ࡠ࡯࡞ߒߡⴕߞߚ‫ޕ‬㖸ჿߩ๒␜ߦߪኒ㐽ဳࡋ࠶࠼ࡎࡦ㧔SONY MDR-NC200D㧕ࠍ૶↪ߒ‫ޔ‬㖸ჿߪߪߞ߈ࠅ⡬߈ขࠅ߇น⢻ߢਇᔟᗵߩ
ߥ޿ᄢ߈ߐߦ⺞ᢛߒߚ‫↹ޕ‬௝ߩ๒␜ߪᶧ᥏ࡕ࠾࠲࡯‫ޔ‬Flex Scan T175㧔ᩣᑼળ␠࠽࠽
ࠝ㧘ᣣᧄ㧕ࠍ↪޿ߚ‫ⵍޕ‬ᬌ⠪ߩ෻ᔕߪ‫ޔ‬หࡕ࠾࠲࡯ߩ᦭ߔࠆ࠲࠶࠴ᯏ⢻ࠍ↪޿ߡ USB⚻↱ߢ PC ߦขࠅㄟࠎߛ‫ޕ‬ᬌᩏߪ㕒߆ߥㇱደߢᬌᩏ⠪ߣࡑࡦ࠷࡯ࡑࡦߢⴕߞߚ‫࡞ࠕࠗ࡜࠻✚ޕ‬ᢙߪ‫ޔ‬ᛥ឴ 2᧦ઙ‫⹤⊒ޔ‬ㅦᐲ 3 ᧦ઙ‫ޔ‬ᢥ▵㑆㓒 3 ᧦ઙߩ 2 x 3 x 3 = 18 ᧦ઙߩೝỗࠍ‫ޔ‬ฦ᧦ઙ 15࠻࡜ࠗࠕ࡞ߕߟߩว⸘ 270 ࠻࡜ࠗࠕ࡞ߢ‫ ࠍࠇߎޔ‬8 ߟߩ࠮࠶࡚ࠪࡦߦಽߌߡᬌᩏࠍ
ⴕߞߚ‫ޕ‬1 ࠮࠶࡚ࠪࡦߦⷐߒߚᤨ㑆ߪ⚂ 5 ಽ㑆ߢ‫ޔ‬ฦ࠮࠶࡚ࠪࡦߩ㑆ߦ 1-2 ಽ㑆ߩભᙑࠍ᜽ࠎߢ࡝ࡈ࡟࠶ࠪࡘߒߡ߽ࠄ޿‫ޔ‬ᰴߩ࠮࠶࡚ࠪࡦࠍ㐿ᆎߔࠆ࠲ࠗࡒࡦࠣߪฦⵍ
ᬌ⠪ߦછߖߚ‫ޕ‬㧝ੱ޽ߚࠅߩᬌᩏᤨ㑆ߪᦨ⍴ 40 ಽ‫ᦨޔ‬㐳ߢ߽ 60 ಽએౝߢ޽ߞߚ‫ޕ‬ዏ‫ޔ‬ᬌᩏߩᦨೋߦ✵⠌໧㗴ࠍᢙ໧㨪චᢙ໧ⴕ޿‫⺖ޔ‬㗴ߦචಽᘠࠇߚߣ್ᢿߐࠇߡ߆
ࠄᧄᬌᩏࠍ㐿ᆎߒߚ‫ޕ‬e) ࠺࡯࠲⸃ᨆ
࠲࠶࠴ࠬࠢ࡝࡯ࡦ߆ࠄᓧࠄࠇߚ࠺࡯࠲߆ࠄฦⵍᬌ⠪ߩ෻ᔕߩᱜ╵₸ߣ෻ᔕㅦᐲࠍ
▚಴ߒ‫ޔ‬IBM ␠⵾ SPSS ver. 21 ࠍ↪޿ߡ⛔⸘⸃ᨆࠍⴕߞߚ‫ⵍޕ‬ᬌ⠪⟲㧔㜞㦂㧛⧯ᐕ㧕‫ޔ‬ᛥ឴㧔޽ࠅ㧛ߥߒ㧕‫⹤⊒ޔ‬ㅦᐲ㧔ㅦ޿㧛᥉ㅢ㧛ㆃ޿㧕‫ ޔ‬ᢥ▵㑆㓒㧔⍴޿㧛⥄ὼ㧛㐳޿㧕ߩ 4 ⷐ࿃‫ޔ‬2 x 2 x 3 x 3 ᧦ઙߦߟ޿ߡ‫ޔ‬4-way ANOVA (Analysis of Variance)‫ࠍޔ‬↪޿ߡ⸃ᨆߒߚ‫ޕ‬ANOVA ߦ޽ߚߞߡ‫ޔ‬Mauchly ߩᣇᴺߢ⃿㕙ᕈߩ઒ቯࠍᬌቯߒ‫⃿ޔ‬㕙ᕈ߇᫈ළߐࠇߚ႐วߦߪ Greenhouse-Geisser ᴺߢ⥄↱ᐲߩ⵬ᱜࠍⴕߞߚ‫ޕ‬ᄙ㊀Ყセᬌቯߪ Bonferroni ᴺߢ⵬ᱜߒߚ‫᦭ޕ‬ᗧ᳓Ḱߪ p < 0.05 ߣߒ‫ޔ‬0.05 < p < 0.1 ߩ႐วߪ௑
ะ޽ࠅߣߒߚ‫ޕ‬㧯 ⚿ᨐ1) ᱜ╵₸ ᱜ╵₸ߪో⥸⊛ߦ 95%એ਄ߣ㜞߆ߞߚ߇‫ⵍޔ‬ᬌ⠪⟲ߩ᦭ᗧߥਥലᨐ߇⹺߼ࠄࠇ‫ޔ‬㜞㦂⟲ߩᐔဋ✚ᱜ╵₸ߪ⧯ᐕ⟲ࠃࠅ߽᦭ᗧߦૐ߆ߞߚ (96.7% vs 99.1%, p = 0.035)
㧔࿑ 4㧕‫ޕ‬ᛥ឴ߣ⊒⹤ㅦᐲߦߟ޿ߡߪ᦭ᗧߥਥലᨐࠍ⹺߼ߥ߆ߞߚ߇ (p = 0.948, p =0.956)㧔࿑ 5, ਄࡮ਛ㧕‫ޔ‬ᢥ▵㑆㓒ߩਥലᨐߦߟ޿ߡߪ p = 0.081 ߢߘߩ௑ะࠍ⹺߼‫ޔ‬․ߦ㜞㦂⠪ߦ߅޿ߡߪ‫ޔ‬ಽ▵㑆㓒߇⥄ὼߥ႐ว߇ᦨ߽ᱜ╵₸߇㜞ߊ‫ޔ‬ಽ▵㑆㓒߇⍴޿႐วࠃࠅ߽᦭ᗧߦᱜ╵₸߇㜞߆ߞߚ (Bonferroni ⵬ᱜ p = 0.015)㧔 ࿑ 5, ਅ㧕‫ޔߚ߹ޕ‬ⵍᬌ⠪⟲ᛥ឴ಽ▵㑆㓒ߩੑᰴ੤੕૞↪ߦߟ޿ߡ߽௑ะࠍ⹺߼ (p = 0.068)‫ޔ‬
Bonferroni ⵬ᱜߒߚᄙ㊀Ყセߢߪ‫ޔ‬㜞㦂⠪ߢᛥ឴޽ࠅߩ႐วߪಽ▵㑆㓒߇⍴޿ߣ‫⥄ޔ‬-6-ὼߥಽ▵㑆㓒ߦᲧߴ᦭ᗧߦᱜ╵₸߇ૐਅߒ (p = 0.035)‫ޔ‬ㅒߦᛥ឴ߥߒߩ႐วߪ‫ޔ‬ಽ▵㑆㓒߇㐳޿ߣ⥄ὼߥಽ▵㑆㓒ࠃࠅ߽᦭ᗧߦᱜ╵₸߇ૐਅߔࠆߎߣ߇␜ߐࠇߚ (p =0.046)‫ޔߦᦝޕ‬㜞㦂⠪ߩ႐ว‫ޔ‬ಽ▵㑆㓒߇㐳޿ߣ‫ޔ‬ᛥ឴ߥߒ߇ᛥ឴޽ࠅࠃࠅ߽᦭ᗧߦ
ᱜ╵₸߇ૐਅߔࠆ (p = 0.017) ߎߣ߽␜ߐࠇߚ㧔࿑ 6㧕‫ޕ‬

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長い

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࿑ 6㧦ฦᐕ㦂⟲ߦ߅ߌࠆᛥ឴ߣಽ▵㑆㓒߇ᱜ╵₸ߦ෸߷ߔᓇ㗀-9-2) ෻ᔕㅦᐲ ෻ᔕㅦᐲ߽ⵍᬌ⠪⟲ߩ᦭ᗧߥਥലᨐ߇⹺߼ࠄࠇ‫ޔ‬㜞㦂⟲ߩᐔဋ෻ᔕㅦᐲߪ⧯ᐕ⟲ࠃࠅ߽⚂ 600 ms ㆃ޿ߎߣ߇␜ߐࠇߚ (p < 0.001)㧔࿑ 7㧕‫ޕ‬ᛥ឴ߦ㑐ߒߡߪ‫᦭ޔ‬ᗧߥਥലᨐ߽‫ⵍޔ‬ᬌ⠪⟲ߣߩ੤੕૞↪߽⹺߼ߥ߆ߞߚ㧔࿑ 8, ਄㧕‫⹤⊒ޕ‬ㅦᐲߦ㑐ߒߡߪ‫ޔ‬᦭ᗧߥਥലᨐࠍ⹺߼‫⹤⊒ޔ‬ㅦᐲ߇ㅦ޿ߣ‫⹤⊒ޔ‬ㅦᐲ߇᥉ㅢߩ႐ว߿ㆃ޿႐วߣᲧߴ‫ޔ‬᦭ᗧߦ෻ᔕᤨ㑆߇ㅦߊߥࠆ (ߘࠇߙࠇ Bonferroni ⵬ᱜᓟ p = 0.030 ෸߮ p = 0.026 ) ߎߣ߇⹺߼ࠄࠇߚ‫⹤⊒ޕ‬ㅦᐲߣⵍᬌ⠪⟲㑆ߦ᦭ᗧߥ੤੕૞↪ߪ⹺߼ߥ߆ߞߚ߇‫ⵍޔ‬ᬌ⠪⟲೎ߢߩᄙ㊀Ყセߢߪ‫ޔ‬㜞㦂⠪⟲ߩߺߢ⊒⹤ㅦᐲߦࠃࠆ᦭ᗧߥ෻ᔕᤨ㑆ߩᏅࠍ⹺߼ߚ㧔࿑ 8, ਛ㧕‫ޕ‬ಽ▵㑆㓒ߦߟ޿ߡߪ᦭ᗧߥਥലᨐ (p < 0.001) ߣ‫ⵍޔ‬ᬌ⠪⟲㑆ߣߩ᦭ᗧߥ੤੕૞↪ (p = 0.012) ࠍ⹺߼ߚ‫ⵍޕ‬ᬌ⠪⟲೎ߢߩᄙ㊀Ყセߢߪ‫ޔ‬㜞㦂⠪⟲ߩߺߢಽ▵㑆㓒ߦࠃࠆ᦭ᗧߥ෻ᔕᤨ㑆ߩᏅࠍ⹺߼‫ޔ‬㜞㦂⠪ߢߪಽ▵㑆㓒߇⍴޿႐ว‫ޔ‬⥄ὼߥಽ▵㑆㓒߿㐳޿ಽ▵㑆㓒ࠃࠅ߽᦭ᗧߦ෻ᔕᤨ㑆߇ᑧ㐳ߔࠆ (ߣ߽ߦ Bonferroni⵬ᱜᓟ p < 0.001) ߎߣ߇␜ߐࠇߚ㧔࿑ 8, ਅ㧕‫ޕ‬ዏ‫᦭ޔ‬ᗧߥੑᰴ෸߮ਃᰴߩ੤੕૞↪
ߪ⹺߼ߥ߆ߞߚ‫ޕ‬

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࿑ 7㧦ᐔဋ෻ᔕᤨ㑆ߩ⟲㑆Ყセ㧔⺋Ꮕ᫔ߪᮡḰ⺋Ꮕ㧕㩷- 10 -

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HOGHUO\\RXQJ࿑ 8㧦ฦᐕ㦂⟲ߦ߅ߌࠆฦ᧦ઙߩ෻ᔕㅦᐲߩᲧセ- 11 -㩷㧰 ⠨ኤ㖸ჿߪᤨ㑆ゲᣇะߩᖱႎⷐ⚛ࠍᜬߟߚ߼‫ޔ‬㖸ჿᖱႎࠍୃ㘼ߔࠆࡄ࡜ࡔ࡯࠲࡯ߪ㕖Ᏹߦᄙᓀߢ‫⹺ࠍߡోߩߘޔ‬⍮∝㜞㦂⠪ߦ࠹ࠬ࠻ߔࠆߎߣߪ⃻ታ⊛ߦߪਇน⢻ߢ޽ࠆ‫ޕ‬ᓥߞߡ⹺⍮∝㜞㦂⠪ߩ㖸ჿ⹺⍮ߦᓇ㗀ࠍਈ߃ࠆ࿃ሶࠍ᣿ࠄ߆ߦߒߡ޿ߊߚ߼ߦߪ‫ޔ‬߹ߕஜᐽ㜞㦂⠪ߦ߅ߌࠆᱜᏱࡄ࠲࡯ࡦ߿‫ޔ‬ട㦂߇ਈ߃ࠆᓇ㗀ࠍ᣿ࠄ߆ߦߒ‫ߦ․ޔ‬㜞㦂⠪ߩ⹺⍮ᯏ⢻ߦᓇ㗀ߩᒝ޿ⷐ⚛ࠍ⛉ࠅㄟࠎߢ޿ߊᔅⷐ߇޽ࠆ‫੹ޔߢߎߘޕ‬࿁ߪ․ߦ‫ޔ‬ᛥ឴‫⹤⊒ޔ‬ㅦᐲ‫ޔ‬ಽ▵㑆㓒ߣ޿ߞߚⷐ⚛ߦᵈ⋡ߒ‫߇࡯࠲࡯ࡔ࡜ࡄߩࠄࠇߎޔ‬ஜᐽߥ㜞㦂⠪ߣ⧯ᐕ⠪ߩ㖸ჿ࠮ࡦ࠹ࡦࠬߩᗧ๧⹺⍮ߦਈ߃ࠆᓇ㗀ࠍ⹦⚦ߦᬌ⸛ߒߚ‫ޕ‬1) 㖸ჿ࠮ࡦ࠹ࡦࠬߩᗧ๧⹺⍮ߩᱜ⏕ᕈߦᓇ㗀ࠍਈ߃ࠆ࿃ሶ 㜞㦂⟲ߪ⧯ᐕ⟲ࠃࠅ߽‫ޔ‬㖸ჿ࠮ࡦ࠹ࡦࠬᗧ๧⹺⍮ߩ✚ᱜ╵₸߇᦭ᗧߦૐਅߒߡ߅
ࠅ㧔࿑ 4㧕‫ޔ‬㖸ჿୃ㘼ⷐ⚛ߦ㑐ଥߩߥ޿ో⥸⊛ߥട㦂ߩᓇ㗀ࠍ␜ߔߣ⠨߃ࠄࠇߚ‫ޕ‬㖸ჿୃ㘼ⷐ⚛ߩਛߢߪಽ▵㑆㓒߇ᦨ߽ᗧ๧⹺⍮ߦኻߒߡᓇ㗀߇ᒝߊ‫ޔ‬ಽ▵㑆㓒߇⥄ὼߥ႐ว‫ޔ‬ᗧ๧⹺⍮ߩᱜ⏕ᕈ߇ᦨ߽㜞޿ߎߣ߇␜ໂߐࠇߚ‫ߩߘޔߚ߹ޕ‬ᓇ㗀ߪ․ߦ㜞㦂⠪ߦ߅޿ߡ㗼⪺ߢ޽ߞߚ㧔࿑ 5, ਅ㧕‫ޔߪࠇߎޕ‬㜞㦂⠪ߦ߅޿ߡߪ‫ޔ‬ಽ▵㑆㓒߇⍴ߔ߉ࠆߣᖱႎಣℂ߇ㅊ޿ߟ߆ߕߦᗧ๧⹺⍮߇࿎㔍ߦߥࠆߎߣࠍ␜ໂߒߡ޿ࠆ‫৻ޕ‬ᣇ‫ޔ‬㜞㦂⠪ߢߪಽ▵㑆㓒߇㐳ߔ߉ࠆߣ‫ޔ‬ᛥ឴ߩ޽ࠆ㖸ჿߦᲧߴᛥ឴ߩߥ޿㖸ჿߢ᦭ᗧߦ
ᱜ╵₸߇ૐਅߒߚ㧔࿑ 6, ਄㧕‫ޔߪࠇߎޕ‬㜞㦂⠪ߦ߅޿ߡߪ‫ޔ‬ಽ▵㑆㓒߇㐳ߔ߉ࠆߣᛥ឴߇ߥߊߡ㚔ᨴߺߩߥ޿㖸ჿ⸒⺆ࠍࡢ࡯ࠠࡦࠣࡔࡕ࡝ߦ⾂⬿ߔࠆߩ߇࿎㔍ߦߥࠆߎߣࠍ␜ߒߡ޿ࠆߩ߆߽⍮ࠇߥ޿‫ޕ‬2) 㖸ჿ࠮ࡦ࠹ࡦࠬߩᗧ๧⹺⍮ߩᖱႎಣℂㅦᐲߦᓇ㗀ࠍਈ߃ࠆ࿃ሶ ਄⸥ߩᱜ⏕ᕈߣห᭽‫ޔ‬㜞㦂⟲ߪ⧯ᐕ⟲ࠃࠅ߽‫ޔ‬㖸ჿ࠮ࡦ࠹ࡦࠬᗧ๧⹺⍮ߩ෻ᔕㅦᐲ߇᦭ᗧߦૐਅߒߡ߅ࠅ‫ޔ‬㖸ჿୃ㘼ⷐ⚛ߦ㑐ଥߩߥ޿ട㦂ߦࠃࠆో⥸⊛ߥᖱႎಣℂ
ㆃᑧࠍ␜ߒߡ޿ࠆߣ⠨߃ࠄࠇߚ㧔࿑ 7㧕‫ߚ߹ޕ‬ห᭽ߦ‫ޔ‬ᖱႎಣℂㅦᐲߦᦨ߽ᓇ㗀ࠍਈ߃ࠆⷐ⚛߽ಽ▵㑆㓒ߢ޽ߞߚ‫ߩߎޕ‬ᓇ㗀߽㜞㦂⠪ߦ߅޿ߡ㗼⪺ߢ޽ࠅ‫ޔ‬ಽ▵㑆㓒߇⍴޿႐วߪ⥄ὼ‫ߪ޿ࠆ޽ޔ‬㐳޿႐วߦᲧߴ‫ޔ‬෻ᔕᤨ㑆߇ㆃᑧߒߡ޿ߚ㧔࿑ 8, ਅ㧕‫ޕ‬ߎߩ⚿ᨐߪ‫ޟޔ‬㜞㦂⠪ߦ߅޿ߡߪ‫ޔ‬ಽ▵㑆㓒߇⍴ߔ߉ࠆߣᖱႎಣℂ߇ㅊ޿ߟ߆ߕߦ
ᗧ๧⹺⍮߇࿎㔍ߦߥࠆ‫ߚߞ޿ߣޠ‬਄ㅀߩ઒⺑ࠍࠨࡐ࡯࠻ߔࠆ⚿ᨐߢ޽ࠆߣ⠨߃ࠄࠇࠆ‫৻ޕ‬ᣇ‫⹤⊒ޔ‬ㅦᐲߦ㑐ߒߡߪ‫ޔ‬㜞㦂⠪ߩ႐ว‫⹤⊒ޔ‬ㅦᐲ߇ㅦ޿߶ߤ෻ᔕㅦᐲ߽ㅦ
޿௑ะ߇⹺߼ࠄࠇߚ㧔࿑ 8, ਛ㧕‫ߩߎޕ‬ේ࿃ߪਇ᣿ߢ޽ࠆ߇‫ޔ‬ㅦ޿࠹ࡦࡐߦࠃࠆ⊒⹤߇ᖱႎಣℂㅦᐲ߽ଦㅴߒߡ޿ࠆน⢻ᕈࠍ␜ߒߡ޿ࠆߩ߆߽⍮ࠇߥ޿‫ޕ‬3) ஜᐽ㜞㦂⠪ߦ߅ߌࠆᦨㆡࡄ࡜ࡔ࡯࠲࡯
એ਄ࠃࠅ‫ޔ‬㜞㦂⠪ߪ⧯ᐕ⠪ࠃࠅ߽㖸ჿࠍୃ㘼ߔࠆⷐ⚛ߩᓇ㗀ࠍฃߌ߿ߔ޿ߎߣ߇
␜ߐࠇߚ‫੹ޕ‬࿁‫ߚ޿↪ޔ‬ೝỗߩ⊒⹤ㅦᐲߪ‫ޟޔ‬ㅦ޿‫᧦ޠ‬ઙߢߪᐔဋ 9.3 mora/sec‫ޟޔ‬᥉

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ㅢ‫᧦ޠ‬ઙߢߪᐔဋ 5.8 mora/sec‫ޟޔ‬ㆃ޿‫᧦ޠ‬ઙߢߪᐔဋ 3.9 mora/sec ߢ޽ߞߚ‫ޕ‬ᣣᧄੱߩ⥄↱⊒⹤ㅦᐲߪ‫ޔ‬8.5 - 8.6㧔mora/sec㧕‫ ߩ⥸৻ޔ‬TV ࠕ࠽࠙ࡦࠨ࡯߇ේⓂࠍ⺒߻ㅦ
ߐߪ 9.4㧔mora/sec㧕ߢ޽ࠆߣႎ๔ߐࠇߡ޿ࠆ㨇13, 14㨉ߎߣࠃࠅ‫ޟޔ‬ㅦ޿‫᧦ޠ‬ઙ߇
TV ࠕ࠽࠙ࡦࠨ࡯⒟ᐲ‫ޟޔ‬᥉ㅢ‫᧦ޠ‬ઙߪ‫⹤⊒↱⥄ޔ‬ㅦᐲࠃࠅ߽ 30% ⒟ᐲㆃߊ‫ޟޔ‬ㆃ޿‫᧦ޠ‬ઙߢߪ‫⹤⊒↱⥄ޔ‬ㅦᐲߩඨಽએਅߢ޽ࠆ‫੹ޕ‬࿁ߩ⚿ᨐߪ‫▸ߩߎޔ‬࿐ߩ⊒⹤ㅦᐲߢ޽ࠇ߫‫ޔ‬ஜᐽ㜞㦂⠪ߩ࠮ࡦ࠹ࡦࠬ⹺⍮ߦߪ޽߹ࠅᓇ㗀߇ߥ޿ߎߣࠍ␜ߒߡ޿ࠆ‫ޕ‬৻ᣇ‫ޔ‬ಽ▵㑆ߩ‫ޟ‬㑆‫ߪޠ‬㜞㦂⠪ߩ⹺⍮ߦ㊀ⷐߥᓇ㗀ࠍਈ߃ࠆ࿃ሶߢ޽ߞߚ‫੹ޕ‬࿁ߩೝỗߢߪ‫ޟ‬㑆‫ ߇ޠ‬700 ms ߩᤨߦᦨ߽⥄ὼߦ⡞ߎ߃‫ޔ‬వⴕ⎇ⓥ㨇9, 15㨉ߣ৻⥌ߒߡ޿ߚ‫ޕ‬ஜᐽ㜞㦂⠪ߩ႐ว‫ޔ‬㑆߇⍴ߔ߉ߡ߽㐳ߔ߉ߡ߽ᗧ๧⹺⍮ߩᱜ⏕ᕈ߿ᖱႎಣℂㅦᐲߦᓇ㗀ࠍਈ߃‫ޔ‬700 ms ⒟ᐲߩ‫ޟ‬㑆‫߽ᦨ߇ޠ‬ലᨐ⊛ߢ޽ߞߚ‫ޔߚ߹ޕ‬ᛥ឴ߩߥ޿⹤
ߒᣇࠍߔࠆ႐วߪ‫ޔ‬ಽ▵㑆ߩ‫ޟ‬㑆‫߇ޠ‬㐳ߔ߉ࠆߣ㜞㦂⠪ߩᗧ๧⹺⍮ߦᖡᓇ㗀ࠍਈ߃ࠆน⢻ᕈ߽␜ໂߐࠇߚ‫ޕ‬
㧱 ߹ߣ߼
1)

㜞㦂⠪ߩ㖸ჿ⹺⍮ߩ․ᓽ߿ട㦂ߩᓇ㗀ࠍ᣿ࠄ߆ߦߔࠆ⋡⊛ߢ‫ޔ‬ஜᐽ㜞㦂⠪ 16 ฬ‫ޔ‬⧯ᐕ⠪ 13 ฬࠍኻ⽎ߦ‫ޔ‬ᛥ឴‫⹤⊒ޔ‬ㅦᐲ‫ޔ‬ಽ▵㑆㓒ߣ޿ߞߚ㖸ჿᖱႎୃ㘼࿃ሶ߇࠮ࡦ࠹ࡦࠬߩᗧ๧⹺⍮ߦਈ߃ࠆᓇ㗀ߦߟ޿ߡ‫ⴕ⚻␹ޔ‬േቇ⊛ߥᬌ⸛ࠍⴕߞߚ‫ޕ‬

2)㜞㦂⠪ߪో⥸⊛ߦ⧯ᐕ⠪ࠃࠅ߽㖸ჿ࠮ࡦ࠹ࡦࠬߩᗧ๧⹺⍮ߩࡄࡈࠜ࡯ࡑࡦࠬ߇
ૐ߆ߞߚ߇‫ߦ․ޔ‬ᓇ㗀ࠍਈ߃ࠆ࿃ሶߪ‫ࠬࡦ࠹ࡦ࠮ޔ‬ౝߩಽ▵㑆ߩ‫ޟ‬㑆‫ޔࠅ޽ߢޠ‬‫ޟ‬㑆‫߇ޠ‬⍴ߔ߉ߡ߽㐳ߔ߉ߡ߽‫ޔ‬㜞㦂⠪ߩᗧ๧⹺⍮ࡄࡈࠜ࡯ࡑࡦࠬߪૐਅߒߚ‫ޕ‬߹ߚ‫ޔ‬ᛥ឴ߩߥ޿㖸ჿߢ㐳޿‫ޟ‬㑆‫ࠍޠ‬ขߞߚ⹤ߒᣇࠍߔࠆߣ‫ޔ‬㜞㦂⠪ߩᗧ๧⹺⍮ࡄࡈࠜ࡯ࡑࡦࠬߪૐਅߔࠆߎߣ߽␜ߐࠇߚ‫ޕ‬

3)৻ᣇ‫⹤⊒ޔ‬ㅦᐲߪ TV ߩࠕ࠽࠙ࡦࠨ࡯߇ㅢᏱ⹤ߔ⒟ᐲߩㅦߐ߆ࠄ‫ߩߘޔ‬ඨಽ⒟ᐲ
ߩㅦߐߩ▸࿐ߢߪ‫ޔ‬ஜᐽ㜞㦂⠪ߩᗧ๧⹺⍮ߦኻߔࠆᓇ㗀ߪ޽߹ࠅ⹺߼ߥ߆ߞߚ‫ޕ‬

4)੹࿁ᓧࠄࠇߚ⚿ᨐࠍరߦ‫੹ޔ‬ᓟߪ⹺⍮∝㜞㦂⠪ߩ㖸ჿ⹺⍮ߩ․ᓽࠍ᣿ࠄ߆ߦߒ‫ޔ‬੺⼔⠪߇ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠍขࠆ㓙ߦ⇐ᗧߔߴ߈‫ߌ߆ߒ⹤ޟ‬ᣇ‫ࠬࡦ࠺ࡆࠛࠍޠ‬ࡌ࡯ࠬߢឭ⸒ߒߡ޿ߊߎߣࠍ⋡ᜰߒߡ޿ߊ‫ޕ‬⻢ㄉ㧦੹࿁ߩ⎇ⓥߦ޽ߚࠅߏදജ޿ߚߛ޿ߚදജ⠪ߩ⊝᭽ߦᷓ⻢⥌ߒ߹ߔ‫ޕ‬㧳㧚ᒁ↪࡮ෳ⠨ᢥ₂
1)ዊ㐳⼱㓁ሶ㧘⋧ේ༑ሶ㧘ਛ᧛ᤘ▸㧘ዊ═ේᤘᒾ㧘੗਄⼾ሶ.⹺⍮∝ߦ߅ߌࠆ⍮⊛ᯏ⢻ߣࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦᯏ⢻㧦⸒⺆ᕈ㧘෸߮㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦᖱႎ
⹺⍮ᯏ⢻ߦ㑐ߔࠆ⎇ⓥ.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 18 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ-⹺⍮∝㜞㦂⠪ߣߘߩኅᣖߦኻߔࠆ↢ᵴᡰេߣࠤࠕะ਄ߦ
㑐ߔࠆ⎇ⓥ੐ᬺ-㧘61-66:2007.

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2)ዊ㐳⼱㓁ሶ㧘⋧ේ༑ሶ㧘ਛ᧛ᤘ▸㧘ዊ═ේᤘᒾ㧘੗਄⼾ሶ.⹺⍮∝ߦ߅ߌࠆ⍮⊛ᯏ⢻ߣࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦᯏ⢻㧦⸒⺆ᕈ㧘෸߮㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦᖱႎ
⹺⍮ᯏ⢻ߦ㑐ߔࠆ⎇ⓥ.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 19 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ-⹺⍮∝㜞㦂⠪ߣߘߩኅᣖߦኻߔࠆ↢ᵴᡰេߣࠤࠕะ਄ߦ
㑐ߔࠆ⎇ⓥ੐ᬺ-㧘1-10:2008.

3)ዊ㐳⼱㓁ሶ㧘ਛ᧛ᤘ▸㧘㥱⮮ජ᥏㧘㐳ደ᡽ඳ㧘੗਄⼾ሶ.⹺⍮∝㜞㦂⠪ߦኻߔࠆ㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦ㧔NCR㧕ࡊࡠࠣ࡜ࡓߩ
㐿⊒ߣ⹏ଔߦ㑐ߔࠆ⎇ⓥ.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 20 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ-⹺⍮∝੺⼔ߦ߅ߌࠆࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦߦ㑐ߔࠆ⎇ⓥ
੐ᬺ-㧘1-29:2009.

4)ዊ㐳⼱㓁ሶ㧘ਛ᧛ᤘ▸㧘㥱⮮ජ᥏㧘㐳ደ᡽ඳ㧘੗਄⼾ሶ㧘ౝ↰ᔒ଻㧘ጟ↰ኼᄦ.
⹺⍮∝㜞㦂⠪ߦኻߔࠆ㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞࡝ࡂࡆ࡝࠹࡯࡚ࠪ
ࡦ㧔NCR㧕ࡊࡠࠣ࡜ࡓߩ㐿⊒ߣ⹏ଔߦ㑐ߔࠆ⎇ⓥ.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 21 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ ᣉ⸳ߦ߅ߌࠆ⹺⍮∝㜞㦂⠪ߩㅴⴕ੍㒐߅ࠃ߮ QOL ᡷༀࠍ⋡ᜰߒߚ࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦߩ㐿⊒ߣߘߩലᨐᬌ
⸽ߦ㑐ߔࠆ⎇ⓥ੐ᬺ-㧘26-65:2010.

5)ዊ㐳⼱㓁ሶ㧘ਛ᧛ᤘ▸㧘㥱⮮ජ᥏㧘㐳ደ᡽ඳ㧘੗਄⼾ሶ.⹺⍮∝㜞㦂⠪ߦኻߔࠆ㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦ㧔NCR㧕ࡊࡠࠣ࡜ࡓߩ
㐿⊒ߣ⹏ଔߦ㑐ߔࠆ⎇ⓥ.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 22 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ ᣉ⸳ߦ߅ߌࠆ⹺⍮∝㜞㦂⠪ߩㅴⴕ੍㒐෸߮ QOL ᡷༀࠍ⋡ᜰߒߚ࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦߩ㐿⊒㧘ലᨐᬌ⸽෸߮᥉෸ߦ㑐ߔࠆ⎇ⓥ੐ᬺ㧘
45-84:2011.

6)ዊ㐳⼱㓁ሶ㧘ਛ᧛ᤘ▸㧘㥱⮮ජ᥏㧘㐳ደ᡽ඳ㧘੗਄⼾ሶ㧘᧻ᧄᘮᄥ.㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞ࠍ↪޿ߚ⹺⍮∝㜞㦂⠪ߣ࡝ࡂࡆ࡝ߦ㑐ߔࠆ⎇ⓥ́‫ߦޟ‬ߎߦߎ࡝ࡂ‫ ߩޠ‬DVD ૞ᚑ㧘෸߮㖸ჿ⹺⍮ߦὶὐࠍᒰߡߚᣂߚߥขࠅ⚵ߺ́.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 23 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ ᣉ⸳ߦ߅ߌࠆ⹺⍮∝㜞㦂⠪ߩ QOL ะ਄ߩߚ߼ߩᄙర⊛ࠕࡊࡠ࡯࠴࡮࡝ࡂࡆ࡝࠹࡯
࡚ࠪࡦߦ㑐ߔࠆ⎇ⓥ੐ᬺ㧘1-33:2012.

- 14 -

7)ዊ㐳⼱㓁ሶ㧘ਛ᧛ᤘ▸㧘㥱⮮ජ᥏㧘ጊਅ⧷⟤㧘㐳ደ᡽ඳ㧘੗਄⼾ሶ㧘᧻ᧄᘮᄥ.
㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞ࠍ↪޿ߚ⹺⍮∝㜞㦂⠪ߣ࡝ࡂࡆ࡝ߦ㑐ߔࠆ⎇ⓥ‫ߩޠࡂ࡝ߎߦߎߦޟ‬᥉෸߳ߩขࠅ⚵ߺ㧘෸߮ஜᏱ㜞㦂⠪࡮⹺⍮∝㜞㦂⠪ߩ․ᓽ.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 24 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ ᣉ⸳ߦ߅ߌࠆ⹺⍮∝㜞㦂⠪ߩ QOL ะ਄ߩߚ߼ߩᄙర⊛ࠕࡊࡠ࡯࠴࡮࡝ࡂ
ࡆ࡝࠹࡯࡚ࠪࡦߦ㑐ߔࠆ⎇ⓥ੐ᬺ㧘1-27:2013

8)ዊ㐳⼱㓁ሶ㧘ਛ᧛ᤘ▸㧘㥱⮮ජ᥏㧘ጊਅ⧷⟤㧘㐳ደ᡽ඳ㧘੗਄⼾ሶ.㩷 㕖⸒⺆ᕈࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦࠪࠣ࠽࡞ࠍ↪޿ߚ⹺⍮∝㜞㦂⠪ߩ੺⼔ߣ࡝ࡂࡆ࡝ߦ㑐ߔࠆ⎇ⓥ-‫ߩޠࡂ࡝ߎߦߎߦޟ‬᥉෸ߣᄙᣉ⸳ߦ߅ߌࠆ⹜㛎⊛੺౉‫ޔ‬෸߮⹺⍮∝㜞㦂⠪ߩ㖸ჿ⹺⍮ߩ․ᓽߩᬌ⸛́.⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠ ᐔᚑ 25 ᐕᐲ⹺⍮∝੺⼔⎇ⓥႎ๔ᦠ ᣉ⸳ߦ߅ߌࠆ⹺⍮∝㜞㦂⠪ߩ QOL ะ਄ߩߚ߼ߩᄙర
⊛ࠕࡊࡠ࡯࠴࡮࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦߦ㑐ߔࠆ⎇ⓥ੐ᬺ㧘1-26:20149)ਛ᧛ᢅᨑ㧚ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦߦ߅ߌࠆ‫ޟ‬㑆‫ߩޠ‬ᗵᕈᖱႎᔃℂቇ㧚㖸ჿ⎇ⓥ‫ޔ‬
Vol.13 No.1:40-52.2009㧚10) ౝ↰ᾖਭ㧚㖸ჿߩ⊒⹤ㅦᐲߩ೙ᓮ߇ࡇ࠶࠴ᗵ෸߮⹤⠪ߩᕈᩰශ⽎ߦਈ߃ࠆᓇ㗀㧚ᣣᧄ㖸㗀ቇળ⹹ 56(6), 396-405, 2000-06-01
11) ᳰේ઄৻‫ޔ‬ᢪ⮮ඳੱ‫ޔ‬ᱞᎹ⋥᮸㧚⊒⹤ㅦᐲᄌ឵ળ⹤㖸ჿߩශ⽎ಽᨆ㧚㔚ሶᖱႎㅢାቇળᛛⴚ⎇ⓥႎ๔HIPࡅࡘ࡯ࡑࡦᖱႎಣℂ112(46), 1-6, 2012-05-15
12) ᄤ㊁ᚑᤘ࡮═ේ ⷐ࡮ㄭ⮮౏ਭ✬⪺‫ ޔ‬ᣣᧄ⺆ߩ⺆ᒵ․ᕈ ╙㧝ᦼ CD-ROM‫ޔ‬NTT ࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ⑼ቇၮ␆⎇ⓥᚲ⋙ୃ‫ޔ‬ਃ⋭ၴ‫ޔ‬2006㧚13) ⑔⋓⾆ᒄ㧚࠾ࡘ࡯ࠬ⇟⚵ߦ߅ߌࠆࠕ࠽࠙ࡦࠨ࡯࡮ࠠࡖࠬ࠲࡯ߩ⊒⹤ㅦᐲ́2006
ᐕ 5 ᦬ 3 ᣣߩ࠾ࡘ࡯ࠬ⇟⚵ࠍ⾗ᢱߣߒߡ́㧚ᄢ᧲ᢥൻᄢቇᄖ࿖⺆ቇㇱ㧚2008㧚14) ᧛਄ੳ৻‫ޔ‬ᎂጾጊ⨃᮸㧚⥄↱⊒⹤㖸ჿߦ߅ߌࠆ㖸㗀⊛ߥ․ᓽߩᬌ⸛㧚㔚ሶᖱႎㅢାቇળ⺰ᢥ⹹ D-Τ Vol.J78-D-Τ No.12:1741-1749.1995
15) ਛ᧛ᢅᨑ㧚̌㑆㧔߹㧕̍ߩᗵᕈߦ㑐ߔࠆᔃℂቇ⊛⎇ⓥ㧚㔚ሶᖱႎㅢାቇળᛛⴚ⎇ⓥႎ๔ 92㧦37́42㧚1993㧚- 15 -

ㄆ▱⑕㧗㱋⪅࡜ࡢࢥ࣑ࣗࢽࢣ࣮ࢩࣙࣥ࡜ QoL ⥔ᣢࡢࡓࡵࡢ
ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ௓ධ࡟㛵ࡍࡿ◊✲஦ᴗ୺௵◊✲⪅ᑠ㛗㇂ 㝧Ꮚ㸦ㄆ▱⑕௓ㆤ◊✲࣭◊ಟ኱ᗓࢭࣥࢱ࣮◊✲㒊㸧ศᢸ◊✲⪅ᑉ⌔ᒣ ⛱㸦ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉࣭ᩍᤵ࣭⚄⤒ෆ⛉㸧◊✲༠ຊ⪅ୖᮧ ⣧୍㸦ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉࣭ຓᩍ࣭సᴗ⒪ἲኈ㸧ᇛ᳃ Ἠ㸦ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉࣭ᐈဨ◊✲ဨ࣭㡢ᴦ⒪ἲኈ㸧୰ᕝ ୚ᅄ㑻㸦୰㒊኱Ꮫ⏕࿨೺ᗣ⛉Ꮫ㒊࣭ຓᩍ࣭సᴗ⒪ἲኈ㸧㇂฼ ⨾⣖㸦୰㒊኱Ꮫ⏕࿨೺ᗣ⛉Ꮫ㒊࣭ຓᡭ࣭సᴗ⒪ἲኈ㸧⏣୰ ᑗ⿱㸦ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉࣭సᴗ⒪ἲኈ㸧Ỉ㔝 ⣧ᖹ㸦ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉࣭సᴗ⒪ἲኈ㸧ᕝᓮ ࡵࡄࡳ㸦ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉࣭సᴗ⒪ἲኈ㸧኱᳃ 㐩ஓ㸦ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉࣭సᴗ⒪ἲኈ㸧Ϩ㸬◊✲஦ᴗࡢ⫼ᬒᮏ㑥࡟࠾ࡅࡿㄆ▱⑕᭷⑓⋡ࡣ᥎ᐃ 15%๓ᚋ࡜ࡉࢀࠊேཱྀࡢ㧗㱋໬࡜࡜ࡶ࡟ࡑࡢẚ⋡ࡣ㧗ࡃ࡞ࡗ࡚࠸ࡿࠋ㧗㱋⪅௓ㆤ᪋タ࡛ࡣ᭦࡟ࡑࡢẚ⋡࡜⛬ᗘࡣ㧗ࡃ࡞ࡾ ࠊ㧗㱋໬ࡢၥ㢟ࡣྠ᫬࡟ㄆ▱⑕ࡢၥ㢟࡜࠸࠼ࡿ㸦ཌ⏕ປാ┬, 2014㸧ࠋㄆ▱⑕ࡢண㜵࡜㐍⾜ࡀྍ⬟࡞ẁ㝵࡛ࡣ✚ᴟⓗ࡞௓ධࡀ⪃࠼ࡽࢀࡿࡀࠊ᪋タ࡬ࡢධᡤࢆ⪃៖ࡋ࡞ࡃ࡚ࡣ࡞ࡽ࡞࠸ẁ㝵ࡢ୰➼ᗘ㹼㔜ᗘࡢㄆ▱⑕࡛ࡣ㌟య⬟ຊࡢపୗࡸ࿘㎶⑕≧㸦Behavioral Psychological Symptomsof Dementia, BPSD㸧㸦 Finkel et al., 1996㸧ࡢฟ⌧ࡶక࠸ࠊ⏕άࡢ㉁㸦Quality of Life, QoL㸧ࢆ⥔ᣢࡍࡿࡇ࡜ࡉ࠼ᅔ㞴࡜࡞ࡿሙྜࡀᑡ࡞ࡃ࡞࠸ࠋ௓ㆤ᪋タ࡛ࡣࠊ⏕ά✵㛫ࡢᕤኵࡸಶே✵㛫ࡢ☜ಖࡣ⪃៖ࡉࢀ࡚࠸ࡿࡶࡢࡢࠊ୺ࡓࡿ௓
ㆤ⪅ࡣ➨୕⪅࡛࠶ࡿ᪋タࢫࢱࢵࣇ࡛࠶ࡿࡓࡵࠊ ⮬Ꮿ࡛ࡢᐙ᪘ࡸ࣊ࣝࣃ࣮࡟ࡼࡿ⏕ά᥼ຓ࡜ࡣ␗࡞ࡗࡓ࢔ࣉ࣮ࣟࢳࡀᚲせ࡜࡞ࡿࠋ୍᪉ࠊ௓ㆤ᪋タ࡛ࡢ኱ࡁ࡞࣓ࣜࢵࢺࡢࡦ࡜ࡘࡣࠊ
ᐙ᪘࡛ࡣᥦ౪ࡍࡿࡇ࡜ࡀ㞴ࡋ࠸ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡸദ஦ࠊᑡேᩘࡸ㞟ᅋ࡛ࡢࣉࣟࢢࣛ
࣒ࡀ᪥ᖖ⏕ά࡟ྲྀࡾධࢀࡽࢀ࡚࠸ࡿࡇ࡜࡛࠶ࡿࠋ

ศᢸ◊✲⪅ࢢ࣮ࣝࣉ࡛ࡣࠊᖹᡂ 23 ᖺᗘ௨᮶ࠊ᪋タ࡟࠾ࡅࡿㄆ▱⑕㧗㱋⪅ࡢ QoL ࡟㛵ࡋ࡚ᇶ♏ⓗ࠾ࡼࡧ⮫ᗋⓗ◊✲ࢆ⥅⥆ࡋ࡚࠸ࡿࠋ ศᢸ◊✲஦ᴗࡢ୰᰾ⓗ┠ᶆࡣࠊձ᪋タධᒃㄆ▱⑕㧗㱋⪅࡜ࡢពᛮ␯㏻ࠊ࠾ࡼࡧࠊղࡼࡾ㧗࠸ QoL ࡢ⥔ᣢࠊࡇࢀࡽ࡟᭷ຠ࡞௓ධࡸ
᪉⟇ࡢᥦ᱌ࠊ࡛࠶ࡿࠋᖹᡂ 25 ᖺᗘ࠿ࡽࡣࠊቑຍࡍࡿㄆ▱⑕㧗㱋⪅࡟ᑐᛂࡋ࡚᪋タࡢ⌧ሙ࡛ࠊࡼࡾⓗ☜࡞ㄆ▱⑕ࡢ⌮ゎ࡟ᇶ࡙ࡃ௓ㆤࢆ㐍ࡵࡽࢀࡿࡼ࠺ࠊㄆ▱⑕㧗㱋⪅ࡢ≉ᚩᢕᥱࡢヨ⾜ࡶ⾜ࡗ࡚ࡁࡓࠋᮏᖺᗘࡣࠊ⥅⥆ࡋ࡚ࡁࡓ஦ᴗࡢ▱ぢ࡟ᇶ࡙ࡁࠊ᭦࡟ᐇ㊶ⓗ࡞ෆᐜࢆྲྀࡾධࢀࡓ◊✲஦ᴗࢆ⾜ࡗࡓࠋᮏศᢸ◊✲⪅ࢢ࣮ࣝࣉࡢ⾜࠺◊✲஦ᴗࡢ┠ᣦࡍࡶࡢࡀ௓ㆤ᪋タ࡟ධᒃࡍࡿㄆ▱⑕㧗㱋⪅ࡢၥ㢟ࢆ㍍ῶࡍࡿᡭẁࢆ⪃᱌ࡋࡘࡘࠊ࡛ࡁࡿࡔࡅ♫఍ᛶࢆಖࡗࡓ⏕άࢆ᪋タ࡛㏦ࡿࡇ࡜ࡀ࡛ࡁࡿ᪉⟇ࢆ࿊♧ࡍࡿ ࡇ࡜࡛࠶ࡿⅬࡣࠊࡇࢀࡲ࡛
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ࢀࡓࡶࡢ࡛࠶ࡿࠋྛ◊✲஦ᴗࡣࠊ༠ຊ᪋タࡢ⌧ሙ࡛ᐇ᪋ࡋ࡚࠸ࡿࡓࡵࠊᮏሗ࿌᭩ࡢෆᐜࢆྛ᪋タ࡛ྲྀࡾධࢀࡿࡇ࡜࡟ᅔ㞴ࡣ࡞࠸ࠋ௓ㆤ᪋タ࡟࠾ࡅࡿே࡜ே࡜ࡢ㛵ࢃࡾ࡟ຍ࠼ࠊ
⛉Ꮫⓗ╔║Ⅼࢆࡶࡗࡓࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡸ௓ㆤࡢᥦ౪࡬ྥࡅ࡚ ᭷⏝࡞▱ぢࡀᚓࡽࢀࡓ
ࡶࡢ࡜⪃࠼࡚࠸ࡿࠋձ ௓ㆤ᪋タ࡛ࡢㄆ▱⑕ศ㢮࡜௓ㆤࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡜ࡢᑐᛂ࡟㛵ࡍࡿ◊✲ղ 㧗㱋⪅࡟࠾ࡅࡿ⬻༞୰ᚋࡢ⢭⚄⑕≧ࠊ࢔ࣃࢩ࣮㸦↓Ẽຊ㸧ࡢᢕᥱճ ⬻༞୰៏ᛶᮇ࡟࠾ࡅࡿὀពᶵ⬟㈿άㄢ㢟ࡢຠᯝմ ௓ㆤ᪋タ࡟࠾ࡅࡿ㡢ᴦ⒪ἲ
ᮏ◊✲஦ᴗ࡛⾜ࢃࢀࡓ◊✲஦ᴗࡣࠊ඲࡚ྡྂᒇ኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉⏕࿨೔⌮ጤဨ఍ࡢᑂᰝ࡜ᢎㄆࢆᚓ࡚⾜ࢃࢀࡓࠋྡྂᒇ኱Ꮫ௨እࡢ᪋タ࡛ᐇ᪋ࡋࡓ◊✲஦ᴗ࡟ࡘ࠸࡚ࡣࠊ
ྠ೔⌮ጤဨ఍ࡢᣦ㔪࡟‽ᣐࡋࡓྛ᪋タࡢ೔⌮ጤဨ఍࡛ࡢᢎㄆ࡜ཧຍ⪅࠾ࡼࡧཧຍ⪅ᐙ᪘ࡢྠពࢆᚓࡓୖ࡛ᐇ᪋ࡋࡓࠋ

Ϫ㸬◊✲஦ᴗሗ࿌
㸨㸨㸨㸨㸨㸨㸨㸨

◊✲஦ᴗձ ௓ㆤ᪋タ࡛ᚓࡽࢀࡿ᝟ሗ࡟ࡼࡿㄆ▱⑕ࡢศ㢮◊✲஦ᴗձࡣᖹᡂ 25 ᖺᗘࡢ◊✲஦ᴗ࠿ࡽྲྀࡾධࢀ࡚ࡁ࡚࠸ࡿࡶࡢ࡛࠶ࡿࠋᮏᖺᗘ࡟ࡣ
ࡑࡢ᪉ἲࡀࡲ࡜ࡵࡽࢀࠊ◊✲஦ᴗմࡢᐇ᪋࡟㝿ࡋ࡚ࡶ฼⏝ࡋࡓࠋ1㸬⫼ᬒ࡜┠ⓗ⑌ᝈ࡜ࡋ࡚ࡢㄆ▱⑕ࡣ 1990 ᖺ௦ࡲ࡛ࠊ⬻⾑⟶ᛶㄆ▱⑕㸦vascular dementia, VD㸧࡜࢔ࣝࢶࣁ࢖࣐࣮ᆺ⪁ᖺㄆ▱⑕㸦$O]KHLPHU·VGHPHQWLD$'㸧ࡀ୺ࡓࡿࡶࡢ࡛࠶ࡾࠊࡑࡢ
௚ࡣ⛥࡞ኚᛶ⑌ᝈ࡜እയࡸෆ⛉ⓗ࡞⬻⑌ᝈࡢᚋ㑇⑕࡜ࡋ࡚ࡢㄆ▱⑕ࡀ▱ࡽࢀࡿࡢࡳ࡛࠶
ࡗࡓࠋ2000 ᖺ௦࡜࡞ࡾࠊVD ࡜ AD ࡟ຍ࠼ࠊࣞࣅ࣮ᑠయࢆ᭷ࡍࡿㄆ▱⑕㸦dementia with
Lewy bodies, DLB㸧㸦Kosaka and Iseki, 1996㸧࡜๓㢌ഃ㢌ᆺㄆ▱⑕㸦fronto-temporaldementia, FTD㸧㸦Neary et al., 1996㸧ࡀ▱ࡽࢀࡿࡼ࠺࡟࡞ࡾࠊᮏ㑥ࡢㄆ▱⑕ࡢ⌮ゎࡣ୍ኚࡋࡓࠊ࡜ゝࡗ࡚ࡶࡼ࠸ࠋㄆ▱⑕ࡣࡑࢀ⮬యࠊ⑕ೃ⩌࡛࠶ࡾࠊཎᅉ⑌ᝈ࡟ࡼࡾ≉ᚩࡸ⑕≧ࠊ἞⒪ࡸணᚋࡶ␗࡞ࡿࡶࡢ࡛࠶ࡿ㸦ᒣཱྀ, 2010㸧ࠋከࡃࡢ௓ㆤ᪋タ࡛ࡣ௓ㆤᗘࡸ᪥ᖖ⏕ά࡛ࡢ㞀ᐖᗘ࡟ࡼࡗ࡚ࡢศ㢮ࡸᑐᛂࡀ࡞ࡉࢀ ࡚࠾ࡾࠊࡇࡢᑻᗘࡣ௓ㆤಖ㝤ไᗘࡸ᪋タ㐠Ⴀࡢᰕ࡜࡞ࡗ࡚࠸ࡿࠋㄆ▱⑕ࡢ㔜⑕ᗘࡸ௓ㆤᚲせᗘࡣ௓ㆤ᪋タ࡟࠾࠸࡚ᚲせ࡞୰ᚰⓗ᝟ሗ࡛ࡣ࠶ࡿࡶࡢࡢࠊㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅࡟ࡼࡗ࡚⏕ࡌࡿಶࠎࡢၥ㢟ࡸ஦౛ࡣ㔜⑕ᗘࡢࡳ࡛ࡣ⌮ゎࡸᑐᛂࡀᅔ㞴࡞ሙྜࡀ࠶ࡿࠋㄆ▱⑕ࡢデ᩿ࡣ་Ꮫⓗᡤぢࡸ᳨ᰝ࡟ᇶ࡙࠸࡚࡞ࡉࢀࡿࡶࡢ࡛ࡣ࠶ࡿࡀࠊ⌧ᅾ࡛ࡶㄆ▱⑕㧗㱋⪅ࡢᩘࡣ⭾኱࡛࠶ࡾࠊ඲࡚ࡢ᪋タ฼⏝⪅࡟་Ꮫ ⓗデ᩿࡟ࡼࡿ⑓ྡࡀకࡗ࡚࠸ࡿࢃࡅ࡛ࡣ࡞࠸ࠋ
ࡴࡋࢁࠊ௓ㆤ᪋タ࡟ࡣㄆ▱⑕㔜⑕ᗘ࡟ࡼࡿᑐᛂࡣ࡞ࡉࢀ࡚࠸ࡿࡶࡢࡢࠊ་Ꮫⓗ⑓ྡࡀ୙᫂☜࡛࠶ࡗࡓࡾࠊ㛗࠸⑓Ṕࡸ฼⏝⪅ࡢ᪋タ㛫ࡢ⛣ື࡟ࡼࡗ࡚᝟ሗࡀኻࢃࢀ࡚࠸ࡓࡾࡍࡿ
ሙྜࡶᑡ࡞ࡃ࡞࠸ࠋ
ㄆ▱⑕࡟క࠸ࡳࡽࢀࡿ BPSD ࡣㄆ▱⑕ࡢ୰᰾⑕≧࡛࠶ࡿグ᠈㞀ᐖࡸぢᙜ㆑㞀ᐖࠊ㐙⾜ᶵ⬟㞀ᐖ࡟ࡼࡗ࡚⏕ࡌࡿࠋᮏேࡢᛶ᱁ࡸ⎔ቃࠊே㛫㛵ಀ࡜࠸ࡗࡓᚰ⌮ⓗࠊ♫఍ⓗせᅉࡀຍࢃࡿ஦࡛㢧ᅾ໬ࡍࡿ࡜⪃࠼ࡽࢀ࡚࠾ࡾ㸦 Finkel et al., 1996㸧ࠊࢣ࣮ࢫ࣭ࣂ࢖࣭ࢣ࣮ࢫ
࡜ࡋ࡚⌮ゎࡉࢀࡿഃ㠃ࡀ࠶ࡿࠋࡋ࠿ࡋࠊBPSD ࡢฟ⌧ࡣ࠶ࡿ⛬ᗘࠊㄆ▱⑕ࡢཎᅉ⑌ᝈ࡟
ࡼࡗ࡚≉ᚩࡀ࠶ࡾࠊཎᅉ⑌ᝈ࡟ࡼࡿ BPSD ࡢ≉ᚩࢆᤊ࠼ࡿࡇ࡜ࡣ᪋タ฼⏝⪅࡬ࡢࡼࡾⰋ
࠸ᑐᛂࢆ⪃࠼ࡿୖ࡛ࡶ㔜せ࡛࠶ࡿ㸦Srikanth, 2005; Bjoerke-Bertheussen et al., 2012;
Hsieh et al., 2009㸧ࠋࡉࡽ࡟ BPSD ࡣࠊQoL ࡢపୗࡸ௓ㆤ⪅ࡢࢫࢺࣞࢫࡢቑຍࠊㄆ▱⑕ࢣ࢔࡟㛵ࢃࡿࢥࢫࢺࡢቑ኱࡜࠸ࡗࡓᵝࠎ࡞ၥ㢟࡟ᙳ㡪ࢆ୚࠼࡚࠸ࡿⅬ࡛ ᑐᛂࡣ㔜せ࡛࠶ࡿ㸦Samus et al., 2005; Herrmann et al., 2006㸧ࠋBPSD ࡣ᪋タ฼⏝⪅࡬ࡢ௓ㆤࡸࣜࣁ
ࣅࣜࢸ࣮ࢩࣙࣥࢆ⪃࠼ࡿୖ࡛ࠊᴟࡵ࡚㔜せ࡞஦㡯ࡢࡦ࡜ࡘ࡛࠶ࡿ㸦van der Linde et al.,2014㸧ࠋBPSD ࡢ㢖ᗘࡸෆᐜࢆ⌮ゎࡍࡿ஦ࡣࠊ᪋タ฼⏝⪅ࡢᐙ᪘ࡀᚲせ࡜ࡍࡿࢧ࣏࣮ࢺ ࢆணࡍࡿୖ࡛ࡢ᭷ຠ࡛࠶ࡿ㸦Spalletta, 2010㸧ࠋࡲࡓㄆ▱⑕ࡢ⑕≧ࡸ⾜ືࡢ≉ᛶ࡟ࡼࡾ᪋タ฼⏝⪅ࢆ࠶ࡿ⛬ᗘࢢ࣮ࣝࣉศࡅࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࢀࡤࠊࡼࡾ᭷ຠ ࡞௓ㆤࡸ௓ධࢆ⾜࠺ࡇ࡜ࡀ࡛ࡁࡿྍ⬟ᛶࡀ࠶ࡿ㸦Kverno et al., 2008; Lyketsos et al., 2001㸧ࠋᮏ㑥࡛ࡣࠊ㧗㱋໬ࡢ㐍ᒎࠊせ௓ㆤ㧗㱋⪅ࡢቑຍࠊࡲࡓ௓ㆤࡍࡿᐙ᪘ࡢ㧗㱋໬ࠊ᰾ᐙ᪘
໬ࡀ㐍⾜ࡋࠊ2000 ᖺࡼࡾ௓ㆤಖ㝤ไᗘࡀ᪋⾜ࡉࢀࠊ♫఍඲య࡛㧗㱋⪅ࢆ௓ㆤࡍࡿ௙⤌ࡳࡀᑟධࡉࢀࡓࠋ᪋⾜ࡉࢀ࡚࠿ࡽ 10 ᖺ௨ୖࡀ⤒㐣ࡋࠊ௓ㆤࢧ࣮ࣅࢫ฼⏝⪅ࡣᙜึࡢ 2 ಸࢆ㉸࠼ࠊ㧗㱋ᮇࡢᬽࡽࡋࢆᨭ࠼ࡿ♫఍ಖ㞀ไᗘࡢ୰᰾࡜ࡋ࡚ᚲせ୙ྍḞ࡜࡞ࡗ࡚࠸ࡿ㸦 ෆ
㛶ᗓ, 2013㸧ࠋ୍᪉ࠊ௓ㆤಖ㝤ไᗘࢆ฼⏝ࡍࡿㄆ▱⑕㧗㱋⪅㸦᪥ᖖ⏕ά⮬❧ᗘϩ௨ୖ㸧ࡣ
2010 ᖺࡲ࡛࡟⣙ 280 ୓ேࠊ2015 ᖺ࡟ࡣ 345 ୓ேࠊ2025 ᖺ࡟ࡣ 470 ୓ே࡟࡞ࡿ࡜ண
ࡉࢀ࡚࠸ࡿ㸦ෆ㛶ᗓ, 2013㸧ࠋㄆ▱⑕㧗㱋⪅ࡢቑຍࠊ་Ꮫⓗデ᩿ࢆཷࡅࡿᶵ఍ࢆ⤒ࡎ࡟௓ㆤಖ㝤᪋タࢆ฼⏝ࡍࡿሙྜࡸࠊ༢࡟ࠕㄆ▱⑕ࠖ࡜ࡢデ᩿࡟ࡼࡗ࡚ᢅࢃࢀࡿሙྜࡀᏑᅾࡍ
ࡿཎᅉ࡟࡞ࡗ࡚࠸ࡿࠋ་Ꮫⓗ࡞デ᩿ࡀ࡞ࡉࢀ࡚࠸ࡓሙྜ࡛ࡶࠊ᪋タ฼⏝ࡲ࡛ࡢ㐣⛬࡛ࠊ」ᩘᅇࡢ㌿㝔ࡸධ㏥㝔࡞࡝ࡢࡓࡵ࡟ࠊᙜึࡢデ᩿ࡀ࡞ࡉࢀࡓ་⒪ᶵ㛵࠿ࡽࡢデ⒪᝟ሗࡀᚓࡽࢀ࡟ࡃ࠸≧ἣࡀ࠶ࡿࡇ࡜ࡶ⌧ᐇ࡛࠶ࡿࠋࡋ࠿ࡋࠊேⓗ㈨※ࡸಖ㝤ࡢᢅ࠸࠿ࡽ௓ㆤ᪋タ฼⏝ࡢẁ㝵࡛ࠊㄆ▱⑕࡟㛵ࡍࡿ་Ꮫⓗデ᩿ࡢࡓࡵ࡟་⒪ᶵ㛵ࡢཷデࡸ᳨ᰝࢆ⾜࠺ࡇ࡜ࡣࠊㄆ▱⑕㧗㱋⪅ࡢᩘࢆ⪃៖ࡋ࡚ࡶ⌧ᐇⓗ࡛ࡣ࡞࠸ࠋࡑࡢࡓࡵ᪋タࡢ⫋ဨࡀ௓ධࡸ௓ㆤ
ࡢෆᐜࢆ⑓ᆺ࡟ᑐᛂࡉࡏࡿࡢࡣᐜ࡛᫆ࡣ࡞࠸ࠋ
ᮏ◊✲࡛ࡣࠊࡇࡢࡼ࠺࡞⌧≧ࢆ⪃࠼ࠊ་Ꮫⓗ࡞デ᩿࡛ࡣ࡞ࡃ௓ㆤ᪋タ࡛ࡢ฼⏝⪅࡬ࡢ௓ㆤࡸ௓ධࢆࡼࡾຠᯝⓗ࡟ࡍࡿࡓࡵ࡟ࠊ᪋タ࡛ᚓࡽࢀࡿ᝟ሗ࡜⾜ື≉ᛶࡢほᐹ࠿ࡽࠊㄆ
▱⑕㧗㱋⪅ࡢศ㢮ࢆ⾜࠸ࠊ௓ㆤࡸ௓ධ࡟ྲྀࡾධࢀࡿࡇ࡜ࢆ┠ⓗ࡜ࡋࡓࠋ ᪋タ฼⏝୰ࡢㄆ▱⑕㧗㱋⪅ࢆศ㢮ࡍࡿࡇ࡜࡟ࡼࡾࠊศ㢮ࡉࢀࡓ⩌࡛ඹ㏻ࡍࡿ⑕≧ࡸ⾜ື≉ᛶࢆ௓ㆤ⪅ࡸ᪋タࢫࢱࢵࣇࡀᢕᥱ࡛ࡁࡿⅬࠊࢫࢱࢵࣇ㛫ࡢ᝟ሗඹ᭷ࡢ Ⅼࠊ࡛᭷⏝࡜⪃࠼ࡽࢀࡿࠋ⑕≧ࢆᢕᥱࡍࡿࡇ࡜࡟ࡼࡾࠊ฼⏝⪅ࡢ᪋タ⏕άᨭ᥼ࡸ⏕ࡌࡸࡍ࠸ࣜࢫࢡண㜵࡟ࡶ⏝࠸ࡿࡇ࡜ࡀ࡛ࡁࡿ࡜⪃࠼ࡽࢀࡿࠋ

2㸬᪉ἲᑐ㇟⪅ࡣ⪁ேಖ㝤᪋タධ฼⏝⪅ࡢ࠺ࡕࠊㄆ▱⑕ࢆ᭷ࡍࡿ 118 ྡ㸦⏨ᛶ 87 ྡࠊዪᛶ 31ྡࠊᖹᆒᖺ㱋 83.9±8.8 ṓࠊᖹᆒ HDS-R13.3±8.5 Ⅼ㸧࡜ࡋࡓࠋデ⒪᝟ሗ࡜ࡋ࡚ㄆ▱⑕࡜デ᩿ࡉࢀ࡚࠸ࡿ฼⏝⪅ࠊࡲࡓࡣ◊✲ᐇ᪋᫬Ⅼ࡛ DSM-ϫ࡛ㄆ▱⑕࡛࠶ࡿ࡜デ᩿ࡉࢀࡓ⪅ࢆᑐ㇟࡜ࡋࡓࠋࡲࡓࠊ᪋タධᡤᮇ㛫ࡀ 4 ࣨ᭶௨ୖࡢ⪅࡜ࡋࡓࠋᑐ㇟⪅඲య࡛᪋タධᡤࡲ
࡛ࡢ᫬Ⅼ࡛ࠊAD ࡜デ᩿ࡉࢀ࡚࠸ࡿ⪅ࡣ 22 ྡࠊDLB ࡣ 7 ྡࠊFTD ࡣ 1 ྡࠊࡉࡽ࡟༢࡟
ࠕㄆ▱⑕ࠖ࡜ࡔࡅデ᩿ࡢ௜࠸ࡓᑐ㇟⪅ࡣ 27 ྡ࡛࠶ࡗࡓࠋ
⚄⤒⢭⚄Ꮫⓗホ౯㸦Neuropsychiatric Inventory, NPI㸧㸦Cummings et al., 1994㸧࠾ࡼࡧㄆ▱⑕デ᩿ᇶ‽ࢆཧ⪃࡟᪋タ࡛ホ౯ྍ⬟࡞ㄆ▱⑕ࡢ⑕≧ 11 㡯┠ࢆ㑅ᢥࡋࡓࠋ11 㡯┠ࡣࠕዶ᝿ࠖࠊࠕ࠺ࡘࠖࠊࠕᗁどࠖࠊࠕ่⃭᫆ᛶࠖࠊ
ࠕ␗ᖖ⾜ືࠖࠊ
ࠕࣃ࣮࢟ࣥࢯࢽࢬ࣒ࠖࠊࠕ㌿ಽࠖࠊࠕ኱⬻ᒁᡤ⑕≧ࠖࠊࠕࡲࡔࡽᛶࠖࠊ
ࠕឤ᝟ኻ⚗ࠖࠊ⊂ㄒ࣭ᗁ⫈࡜࠸ࡗࡓࠕ⢭⚄⑕≧࡛ࠖࡗࡓ㸦 ⾲㸯㸧ࠋ

ᅗ 1 ࢳ࢙ࢵࢡࣜࢫࢺ
⾲ 1㸬ㄆ▱⑕ศ㢮ࡢࡓࡵࡢࢳ࢙ࢵࢡ㡯┠
Ặྡ

ᖺ㱋

ᛶู

デ᩿ྡ

ホ౯᪥

ධᡤ᪥

HDS-R
⑕≧ࡢ᭷↓

⾜ື
1.࠺ࡘ

࠶ࡾ

㸭

࡞ࡋ

2.ឤ᝟ኻ⚗

࠶ࡾ

㸭

࡞ࡋ

3.ዶ᝿

࠶ࡾ

㸭

࡞ࡋ

4.ᗁど

࠶ࡾ

㸭

࡞ࡋ

5.่⃭᫆ᛶ࠶ࡾ㸭࡞ࡋ

6.␗ᖖ⾜ື࠶ࡾ㸭࡞ࡋ

7.⢭⚄⑕≧

࠶ࡾ

㸭

࡞ࡋ

8.㌿ಽ

࠶ࡾ

㸭

࡞ࡋ

9.ࡲࡔࡽᛶ࠶ࡾ㸭࡞ࡋ

10.኱⬻ᒁᡤ⑕≧

࠶ࡾ

㸭

࡞ࡋ

11.ࣃ࣮࢟ࣥࢯࣥ⑕≧

࠶ࡾ

㸭

࡞ࡋ

సᡂࡋࡓࢳ࢙ࢵࢡࣜࢫࢺࢆࡶ࡜࡟ࠊ᪋タࡢデ⒪グ㘓ࡸ⑓Ṕ࠿ࡽྛᑐ㇟⪅ࡢホ౯ࢆ⾜ࡗࡓࠋཧ⪃࡜ࡍࡿデ⒪グ㘓ࡣࠊホ౯᪥ࡼࡾ 3 ࣨ᭶㐳ࡗ࡚ࡑࡢෆᐜࢆホ౯ࡋࡓࠋࡲࡓࠊᐇ㝿࡟฼⏝ࡋࡓデ⒪グ㘓ࡣࠊ௓ㆤ࠾ࡼࡧ┳ㆤグ㘓ࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥデ⒪㘓ࠊࣜࣁࣅࣜࢸ
࣮ࢩࣙࣥィ⏬᭩࡛࠶ࡿࠋ⑕≧ࡢグ㍕ࡀ࠶ࡿሙྜࠊ 1 Ⅼࠋ࡞࠸ሙྜࠊ0 Ⅼࠋ࡜ྛ㡯┠ࢆⅬᩘ໬ࡋࠊ11 Ⅼ‶Ⅼ࡛ྛᑐ㇟⪅ࢆホ౯ࡋࡓࠋࢳ࢙ࢵࢡࣜࢫࢺࡢྛ㡯┠㛫ࢆࢫࣆ࢔࣐ࣥࡢ㡰఩┦㛵ಀᩘࢆ⏝࠸ࠊ࡝ࡢ㡯┠࡜࡝ࡢ㡯┠࡟┦㛵ࡀ࠶ࡿࡢ࠿᳨ᐃࡋࡓࠋ᳨ᐃ࡟ࡼࡾᚓࡽࢀࡓ⤖ᯝ࠿ࡽࠊศ㢮࡟ᚲせ࡞㡯┠ࢆᢳฟࡋࠊ
ᑐ㇟⪅ࢆ᭱ࡶ⡆౽࡟ศ㢮ࡍࡿ஦ࡢฟ᮶ࡿࣇ࣮ࣟ ࢳ࣮ࣕࢺࢆసᡂࡋࡓࠋసᡂࡋࡓࣇ࣮ࣟࢳ
࣮ࣕࢺࢆᇶ࡟ᑐ㇟⪅ࢆ 4 ⩌࡟ศ㢮ࡋࡓࠋࢳ࢙ࢵࢡࣜࢫࢺ࡟ࡼࡾᚓࡽࢀࡓ⤖ᯝࢆࢫࣆ࢔࣐
ࣥࡢ㡰఩┦㛵ಀᩘ࡟ࡼࡾ᳨ᐃࢆ⾜ࡗࡓ⤖ᯝࠊዶ᝿࡜ᗁど㸦 r㸻0.34, p<0.05㸧ࠊዶ᝿࡜⢭⚄⑕≧㸦r㸻0.30 p<0.05㸧ࠊᗁど࡜⢭⚄⑕≧㸦r㸻0.26, p<0.05㸧࡟ṇࡢ┦㛵ࡀㄆࡵࡽࢀࡓࠋ
ࡲࡓࠊࡲࡔࡽᛶ࡜኱⬻ᒁᡤ⑕≧㸦r㸻0.66, p<0.05㸧ࠊࡲࡔࡽᛶ࡜ࣃ࣮࢟ࣥࢯࣥ⑕≧㸦r㸻
0.47 p<0.05㸧ࠊ኱⬻ᒁᡤ⑕≧࡜ࣃ࣮࢟ࣥࢯࣥ⑕≧㸦r㸻0.32, p<0.05㸧ࡢ㸱㡯┠㛫࡛ࡶṇࡢ┦㛵ࡀࡳࡽࢀࡓࠋࡇࡢ௚ࠊ࠺ࡘ࡜ᗁど㸦r㸻0.34, p<0.05㸧ࠊឤ᝟ኻ⚗࡜ዶ᝿㸦r㸻0.19,
p<0.05㸧࡟ࡶṇࡢ┦㛵ࡀㄆࡵࡽࢀࡓ㸦⾲ 2㸧ࠋ┦㛵ࡀㄆࡵࡽࢀࡓ㡯┠ࢆ⏝࠸ࠊḟ࡟ࣇ࣮ࣟࢳ࣮ࣕࢺࢆసᡂࡋࡓࠋࡇࡢ⤖ᯝࡣᖹᡂ 25 ᖺᗘᐇ᪋ࡢ⤖ᯝ࡜ᇶᮏⓗ࡟ྠᵝ࡛࠶ࡿࠋ┦㛵ࡢ⤖ᯝࢆᇶ࡟ࣇ࣮ࣟࢳ࣮ࣕࢺࢆసᡂࡋࡓ㸦ᅗ 1㸧ࠋ௒ᅇࡢ⤖ᯝ࡛ࡣᑐ㇟⪅ࡣ኱ࡁࡃ㸰ࡘࡢ≉ᛶ࡟ࡼࡗ࡚ศ㢮ࡉࢀࡿ஦ࡀㄆࡵࡽࢀࡓࠋ୍ࡘ┠ࡣዶ᝿ࠊᗁどࠊ⢭⚄⑕≧ࡢ㸱㡯┠ࠊ୍᪉ࡣࡲࡔࡽᛶࠊ኱⬻ᒁᡤ⑕≧ࠊࣃ࣮࢟ࣥࢯࣥ⑕≧ࡢ㸱㡯┠࡛࠶ࡿࠋࡑࡇ࡛ዶ᝿ࠊᗁどࠊ⢭⚄⑕≧ࡢ๭ྜࢆ(a)ࠋࡲࡔࡽᛶࠊ኱⬻ᒁᡤ⑕≧ࠊࣃ࣮࢟ࣥࢯࣥ⑕≧ࡢ๭ྜࢆ (b)࡜ࡋࠊྛ
ᑐ㇟⪅ࡢ๭ྜ(a)ࠊ(b)ࢆẚ㍑ࡋࡓࠋጞࡵ࡟඲ᑐ㇟⪅ࢆ(a)㸼(b)ࡢ⩌ࠊ(a)㸺(b)ࡢ⩌ࠊࡉࡽ࡟(a)=(b)ࠊ(a)=(b)=0 ࡢ⩌ࡢ 3 ࡘ࡟ศ㢮ࡋࡓࠋࡉࡽ࡟ࠊ࠺ࡘ࡜ᗁど࡟ࡶṇࡢ┦㛵ࡀㄆࡵࡽࢀࡓࡓࡵࠊ(a)㸼(b)ࡢ⩌ࢆ࠺ࡘࡢ᭷↓࡛ 2 ࡘ࡟⩌ศࡅࡋࠊ᭱⤊ⓗ࡟ᑐ㇟⪅ࢆ AࠊBࠊCࠊ
D ࡢ 4 ࡘࡢ⩌࡟ศ㢮ࡋࡓ㸦ᅗ 1㸧ࠋ1.0001.000-0.058

ղ

1.000

0.188

0.102

ճ

⅊Ⰽࡢ㡯┠ࡀ᭷ព࡞┦㛵㸦p<0.05㸧ࢆ♧ࡋࡓࠋջࣃ࣮࢟ࣥࢯࣥ⑕≧պ኱⬻ᒁᡤ⑕≧

չࡲࡔࡽᛶ

ո㌿ಽ

շ⢭⚄⑕≧

նᖖྠᛶ

յ่⃭᫆ᛶ

մᗁぬ

ճዶ᝿

ղឤ᝟ኻ⚗

ձ࠺ࡘ

ձ

⾲ 2㸬ྛࢳ࢙ࢵࢡ㡯┠㛫ࡢ┦㛵

1.000

0.342

0.114

0.336

մ

1.000

-0.005

0.088

0.15

0.006

յ

1.000

-0.007-0.033-0.09-0.065

0.027

ն

1.000

0.148

0.139

0.262

0.298

-0.024

0.103

շ

1.000

-0.005

0.111

0.063

0.117

0.163

-0.01

0.125

ո

1.000

0.107

0.036

-0.017

0.053

0.054

-0.031

0.058

0.094

չ

1.000

0.664

0.054

-0.0180.035-0.0130.024-0.0890.004-0.029

պ

1.000

0.315

0.468

0.167

0.14

-0.022

0.113

0.092

0.025

-0.022-0.011ջ8ᅗ㸰ࠉࣇ࣮ࣟࢳ࣮ࣕࢺᑐ㇟⪅(a)ዶ᝿ࠊᗁぬࠊ⢭⚄⑕≧or(b)ࡲࡔࡽᛶࠊ኱⬻ᒁᡤ⑕≧ࠊࣃ࣮࢟ࣥࢯࣥ⑕≧ࡢ࡝ࡕࡽࡢ๭ྜࡀ㧗࠸

a>b

a,b=0
a=b

a<b

࠺ࡘ⑕≧
ࡢ᭷↓

C

D

yes

no
A

B
ᅗ 1㸬ㄆ▱⑕ศ㢮ࡢࣇ࣮ࣟࢳ࣮ࣕࢺ

3㸬⤖ᯝศ㢮ࡉࢀࡓ 4 ⩌࡛ࡣࠊA ⩌ 25 ྡ㸦ᖹᆒᖺ㱋 86.1±7.0 ṓ㸧ࠊB ⩌㸵ྡ㸦ᖹᆒᖺ㱋 80.4±9.8
ṓ㸧ࠊC ⩌ 34 ྡ㸦ᖹᆒᖺ㱋 80.9±10.3 ṓ㸧ࠊD ⩌ 52 ྡ㸦ᖹᆒᖺ㱋 85.4±8.2 ṓ㸧࡛࠶ࡗࡓࠋ୍ඖ㓄⨨ศᩓศᯒࡢ⤖ᯝࠊᖹᆒᖺ㱋࡟࠾࠸࡚ A ⩌࡜ D ⩌ࡀ௚ࡢ⩌࡜ẚ࡭㧗࠸⤖ᯝࢆ♧ࡋࡓ㸦p㸺0.05㸧ࠋࡲࡓ HDS³R ࡢᖹᆒᚓⅬࡣ A ⩌ 7.4 ⅬࠊB ⩌ 9.1 ⅬࠊC ⩌ 11.2 ⅬࠊD ⩌ 11.3 Ⅼ࡛ࠊ⩌㛫࡛᭷ពᕪࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ
A ⩌ࡢ࠺ࡕࠊ⢭⚄⑕≧࡜ዶ᝿ࡀฟ⌧ࡋ࡚࠸ࡿᑐ㇟⪅ࡣ 68㸣࡜ 64㸣࡛㧗࠸๭ྜࢆ♧ࡋࡓࠋḟ࠸่࡛⃭᫆ᛶࡀ 40㸣࡜௚ࡢ⩌࡜ẚ㍑ࡋ㧗࠸๭ྜࢆ♧ࡋࡓࠋB ⩌࡛ࡣ඲ဨ࡟࠺ࡘࡀ
ࡳࡽࢀࡿ௚ࠊዶ᝿ࠊᗁどࠊ⢭⚄⑕≧࡟࠾࠸࡚ 57㸣࡜㧗࠸๭ྜࢆ♧ࡋࡓࠋࡉࡽ࡟௚ࡢ⩌࡜ẚ㍑ࡍࡿ࡜㌿ಽࡢ㡯┠࡟࠾࠸࡚ 43㸣࡜ࠊB ⩌ࡀ᭱ࡶ㧗࠸๭ྜࢆ♧ࡍ⤖ᯝ࡜࡞ࡗࡓࠋC ⩌࡛ࡣࠊዶ᝿ࠊᗁどࠊ⢭⚄⑕≧ࡣ 3㸣ࠊ0㸣ࠊ3㸣࡜ప࠸๭ྜࢆ♧ࡋࠊࡲࡔࡽᛶࡀ 38㸣࡜௚ࡢ 3 ࡘࡢ⩌ࡼࡾ㧗ࡃࠊ኱⬻ᒁᡤ⑕≧ࡀ 91㸣࡜ C ⩌࡟ᒓࡍࡿᑐ㇟⪅ࡢ࡯࡜ࢇ࡝࡟ㄆࡵࡽ

9

ࢀࡓࠋD ⩌࡛ࡣࠊ่⃭᫆ᛶࡀ 23㸣࡜᭱ࡶ㧗࠸๭ྜࢆ♧ࡋࡓࡀࠊࡑࡢ௚ࡢ㡯┠࡟ࡘ࠸࡚ࡣ
15㸣௨ୗ࡜࡞ࡗࡓ㸦ᅗ 2㸧ࠋA ⩌࡟ᒓࡍࡿᑐ㇟⪅ࡢෆࠊAD ࡜デ᩿ࡉࢀ࡚࠸ࡿ⪅ࡣ 12 ྡࠊDLB ࡜デ᩿ࡉࢀ࡚࠸ࡿ
⪅ࡣ 2 ྡࠊFTD ࡣ 0 ྡࠊࠕㄆ▱⑕ࠖࡣ 5 ྡ࡛࠶ࡗࡓࠋB ⩌࡛ࡣ AD ࡀ 1 ྡࠊDLB ࡀ 4 ྡࠊ
FTD ࡀ 0 ྡࠊࠕㄆ▱⑕ࠖࡀ 0 ྡ࡛࠶ࡗࡓࠋ࢝࢖஧஌᳨ᐃࡢ⤖ᯝࠊA ⩌ࡣ AD ࡜デ᩿ࡉࢀࡓᑐ㇟⪅ࡀከࡃศ㢮ࡉࢀ࡚࠾ࡾ㸦p㸺0.05㸧ࠊB ⩌࡛ࡣ DLB ࡜デ᩿ࡉࢀࡓᑐ㇟⪅ࡀ௚ࡢAD ࡸ FTDࠊࠕㄆ▱⑕ࠖ࡟ẚ࡭᭱ࡶከ࠸࡜࠸࠺⤖ᯝࢆ♧ࡋࡓ㸦 p㸺0.05㸧ࠋC ⩌ࡣࠕㄆ▱⑕ࠖ࡜デ᩿ࡉࢀࡓ⪅ࡀ 12 ྡᒓࡋࠊ௚ࡢデ᩿ࡣ C ⩌࡟ࡣศ㢮ࡉࢀ࡞࠿ࡗࡓࠋFTD ࡜デ᩿ࡉࢀ࡚࠸ࡿ⪅ࡣ D ⩌࡟ᒓࡋ࡚࠸ࡓࠋ

4㸬⤖ᯝࡢ฼⏝࡜⪃ᐹᮏᖺᗘࡢ◊✲஦ᴗ࡛ࡣࠊᮏ᪉ἲ࡟ࡼࡗ࡚ศ 㢮ࢆ᪋タ฼⏝⪅࡬ࡢ௓ධ࡟฼⏝ࡋࡓ㸦◊✲஦ᴗմ㸧ࠋᮏศ㢮ࡣୖグࡢࡼ࠺࡟་Ꮫⓗデ᩿࡜࠶ࡿ⛬ᗘᑐᛂࡋ࡚࠸ࡿࡶࡢࡢࠊデ᩿ࡀ┠ⓗ࡛ࡣ࡞ࡃࠊ᪋タ࡟࠾࠸࡚฼⏝⪅ࡢ≉ᛶࡀࢫࢱࢵࣇ㛫࡛ඹ᭷ࡋ࡚ᢕᥱࡉࢀࠊ௓ㆤࡸ௓ධ࡟
฼⏝ࡍࡿࡇ࡜ࡀ┠ⓗ࡛࠶ࡿࠋ࡜ࡾ࠶࠼ࡎࡢศ㢮⤖ᯝࡣࠊ᪋タデ⒪㘓ࡢ⫼⾲⣬࡞࡝⡆༢࡟ࢃ࠿ࡿࡼ࠺࡟Ⰽࢩ࣮ࣝࢆࡘࡅࡿ࡞࡝ࡢ᪉⟇ࡀ⪃࠼ࡽࢀࡓࠋᮏ◊✲஦ᴗ࡛ࡢヨ⏝࡛ࡣࠊศ㢮ࡉࢀࡓ D ⩌ࢆᑐ㇟࡟ᑡேᩘࡢ௓ධࢆᐇ᪋ࡋࡓࠋ4 ⩌ࡢ࠺ࡕ D ⩌ࡣࠊ࡝ࡢ⑕≧࡟ࡘ࠸࡚ࡶฟ⌧㢖ᗘࡀᑡ࡞࠸⩌࡛࠶ࡿࠋD ⩌࡟ศ㢮ࡉࢀࡿሙྜࡣࠊBPSD ࡞࡝᪋タ࡛ࡢ⏕ά࡟ᨭ㞀ࡢ࠶ࡿၥ㢟ࡸᑡ࡞࠸ࡶࡢࡢ⮬Ⓨⓗάືࡀᑡ࡞ࡃࠊ᪋タࢫࢱࢵࣇ࡜ࡢࢥ࣑ࣗࢽࢣ࣮ࢩࣙ
ࣥࡸ཯ᛂᛶ࡟ஈࡋ࠸౛ࡀከࡃྵࡲࢀࡓࠋ
᪋タ࡛⾜ࢃࢀࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡣࠊ≉ᐃࡢ฼⏝⪅࡟ᑐࡋ࡚⾜ࢃࢀࡿ◊✲஦ᴗ մ࡛ᐇ᪋ࡋࡓࡼ࠺࡞ࠊពḧࡸάືᛶࡢ㈿άࡀᮇᚅࡉࢀࡿ᪋タ࡛ࡢ௓ධࡣ D ⩌ࢆᑐ㇟࡟⾜࠺ࡇ࡜ࡀ᝿ᐃࡉࢀࡿࠋࡋ࠿ࡋࠊᐇ㝿ࡢ௓ධࢆ⾜࠺ࢫࢱࢵࣇࡸ⒪ἲኈ࡟ࡣㄆ▱⑕࡟㛵ࡍࡿ᝟ሗࢆࡑࡢሙ࡛ࡣࡍࡄ࡟ᢕᥱࡍࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡾࠊ௓ධ࡟ඛ❧ࡗ࡚ࡑࡢ㒔ᗘホ౯ࡸศ㢮ࢆ⾜ࢃ࡞ࡃ࡚ࡣ࡞ࡽ࡞࠸ࠋ୍᪉ࠊ᪋タ฼⏝⪅඲ဨ࡟ᥦ౪ࡉࢀࡿ௓ධࡸࣉࣟࢢ࣒ࣛࡣ୍⯡ⓗ࡟࡞ࡉࢀ࠾ࡾࠊ᪋タ⏕άࡢ୰࡛ࡣ㔜せ࡞せ⣲࡟ࡣ࡞ࡗ࡚࠸ࡿࡀࠊ⑕≧ࡸᑐ㇟ࢆ⤠ࡗࡓຠᯝࢆᮇᚅࡍࡿࡇ࡜࡟ࡣ㝈⏺ࡀ࠶ࡿࠋ᪋タ࡛ࡢ௓ධࡸࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ඲࡚࡟ࡇࡢࡼ
࠺࡞ศ㢮ࢆ฼⏝ࡍࡿᚲせࡣ࡞࠸ࡶࡢࡢࠊ≉໬ࡋࡓࣉࣟࢢ࣒ࣛࢆ⾜࠺࡟㝿ࡋ࡚࠶ࡽ࠿ࡌࡵ
ㄆ▱⑕ࡢ᝟ሗࡀᩚ⌮ࡉࢀ࡚࠸ࡿࡇ࡜࡛ࡼࡾຠᯝⓗ࡞ෆᐜࢆ⪃៖ࡍࡿࡇ࡜ࡀ࡛ࡁࡼ࠺ࠋ

10ㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅ࡢᩘࡀ௒ᚋ࡜ࡶቑຍࡍࡿ୰࡛ࠊㄆ▱⑕ࡢ≉ᛶࢆ⡆౽࡟ᢕᥱࡍࡿ
ࡇ࡜ࡣ་Ꮫⓗデ᩿ࢆู࡜ࡋ࡚ࡶᚲせ࡞ࡇ࡜࡛࠶ࢁ࠺ࠋ᪋タࢫࢱࢵࣇࡢ⤒㦂ࡸほᐹ࡟ࡼࡗ࡚ࠊྛࢫࢱࢵࣇࡣᴗົࡢ୰࡛࠾࠾ࡲ࠿࡞ศ㢮ࢆࡋ࡚࠸ࡿࡶࡢ࡜ ᥎ࡍࡿࡀࠊࢫࢱࢵࣇ㛫࡛ࡢ᝟ሗࡢඹ᭷ࡸఏ㐩ࡢࡓࡵ࡟ࡣࡇࡢࡼ࠺࡞ㄆ▱⑕ࢱ࢖ࣉࡢ⌧ሙ࡛ࣞ࣋ࣝࡢศ㢮ࡣ᭷⏝࡜⪃࠼ࡽࢀࡓࠋ

ᑐ㇟⪅ᩘ䠄䠂䠅
0

20

40

60

80

100

ᑐ㇟⪅ᩘ䠄䠂䠅
0

20

40

60

80

C⩌
⩌

0

20

40

60

80

100

0

20

40

60

80

100

ᅗ 2㸬ྛศ㢮⩌࡟࠾ࡅࡿ⑕≧ࡢฟ⌧㢖ᗘ

䛖䛴
ឤ᝟ኻ⚗
ዶ᝿
ᗁぬ
่⃭᫆ᛶ
ᖖྠᛶ
⢭⚄⑕≧
㌿ಽ
䜎䛰䜙ᛶ
኱⬻ᒁᡤ⑕≧
䝟䞊䜻䞁䝋䈈

A⩌
⩌

ᖖྠᛶ

100

䛖䛴
ឤ᝟ኻ⚗
ዶ᝿
ᗁぬ
่⃭᫆ᛶ
⢭⚄⑕≧
㌿ಽ
䜎䛰䜙ᛶ
኱⬻ᒁᡤ⑕≧
䝟䞊䜻䞁䝋䞁䈈

ᑐ㇟⪅ᩘ䠄䠂
䠂䠅ᑐ㇟⪅ᩘ䠄䠂䠅

䛖䛴
ዶ᝿

ឤ᝟ኻ⚗

䛖䛴

D⩌
⩌

B⩌
⩌

ᗁぬ

ዶ᝿

ឤ᝟ኻ⚗
ᗁぬ
่⃭᫆ᛶ

่⃭᫆ᛶ
ᖖྠᛶ

䜎䛰䜙ᛶ

㌿ಽ

㌿ಽ

⢭⚄⑕≧

⢭⚄⑕≧

ᖖྠᛶ

䜎䛰䜙ᛶ

኱⬻ᒁ䈈

኱⬻ᒁᡤ⑕≧

䝟䞊䜻䞁䈈䝟䞊䜻䞁䝋䞁䈈

1112㸨㸨㸨㸨㸨㸨㸨㸨

◊✲஦ᴗղ 㧗㱋⪅࡟࠾ࡅࡿ⬻༞୰ᚋࡢ⢭⚄⑕≧ࠊ࢔ࣃࢩ࣮㸦↓Ẽຊ㸧ࡢᢕᥱ1㸬⫼ᬒ࡜┠ⓗ㧗㱋⪅ࡢ⬻⾑⟶㞀ᐖᚋ࡟ぢࡽࢀࡿ࠺ࡘ⑕≧ࡸ࢔ࣃࢩ࣮㸦↓Ẽຊ㸧ࡣࠊ⬻⾑⟶ᛶ࠺ࡘ⑕࡜ࡋ࡚ᤊ࠼ࡽࢀ࡚ࡁࡓࠋ⬻⾑⟶ᛶ࠺ࡘ⑕ࡣ⾑⟶ᛶㄆ▱⑕ࡢ༴㝤ᅉᏊ࡛࠶ࡿ࡜࡜ࡶ࡟ࠊ⏕άືస⬟ຊࡸ⑓ែㄆ▱⬟ຊࡢపୗ࡜㛵㐃ࡋࠊࡉࡽ࡟ࡣࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࡬ࡢᑟධࡸࡑ
ࡢຠ⋡ࢆపୗࡉࡏࠊᶵ⬟ᅇ᚟ࢆ୙Ⰻ࡜ࡍࡿᅉᏊ࡜ࡋ࡚ࡶ㔜せ࡜ࡉࢀ࡚࠸ࡿࠋࣜࣁࣅࣜࢸ
࣮ࢩࣙࣥࡢᐇ᪋࡟࠶ࡓࡗ࡚ࡣࠊ⬻⾑⟶ᛶ࠺ࡘ⑕ࡢ␲ࢃࢀࡿ⑕౛࡛ࡣ✚ᴟⓗ࡟ࢫࢡ࣮ࣜࢽ
ࣥࢢࢆ⾜࠸ࠊࡑࢀࡒࢀࡢ⑓ែ࡟ᛂࡌࡓᑐᛂࢆ⾜࠺ࡇ࡜ࡀࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ෇⁥࡞ᐇ᪋࡟ࡘ࡞ࡀࡾࠊᝈ⪅⮬㌟ࡢ QOL ࡸணᚋࢆᨵၿࡍࡿ࠺࠼࡛㔜せ࡜ࡉࢀ࡚࠸ࡿࠋ་⒪ᶵ㛵ࡸ᪋タࢆ฼⏝ࡍࡿ㧗㱋⪅ࡢ୰࡟ࡣ࠺ࡘ⑕≧࠶ࡿ࠸ࡣ࢔ࣃࢩ࣮ࢆ࿊ࡋࠊㅖάື࡬ࡢཧຍព
ḧࡸᐇ㝿ࡢάືࡀஈࡋࡃࠊᐙ᪘ࡸ᪋タࢫࢱࢵࣇࡀᅔᝨࡍࡿ஦౛ࡀᑡ࡞ࡃ࡞࠸ࠋ
⬻⾑⟶ᛶ࠺ࡘ⑕ࡣࠊձ⑓ኚࡢᒁᡤ⑕≧࡟ࡼࡿ⢭⚄⑕≧ࠊղ⬻⾑⟶㞀ᐖᚋ࡟ేⓎࡍࡿ⢭⚄⑌ᝈ࡜ࡋ࡚ࡢ࠺ࡘ⑕≧ࠊ࡟ຍ࠼㏆ᖺࠊ ճ㠀≉␗ⓗ⬻ᶵ⬟㞀ᐖ࡟ࡼࡿ⢭⚄⑕≧ࠊࡀཎᅉ࡜ࡋ࡚⪃࠼ࡽࢀࡿࡼ࠺࡟࡞ࡗࡓࠋճࡣࠊ኱⬻㎶⦕⣔㸦LS㸧ࠊ኱⬻ᇶᗏ᰾㸦BG㸧࡜๓㢌ⴥ࡜ࡢ⥺⥔㐃⤡ᛶࡸ⓶㉁㛫⤖ྜᇶ♏άື㸦 default-mode network, DMN㸧ࡢᶵ⬟㞀ᐖ࡟ࡼࡗ࡚⏕ࡌࠊ⢭⚄ⓗ⑕≧ࡸពḧࠊᛶ᱁ኚ໬࡞࡝ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢጉࡆ࡜࡞ࡿ⑕≧ࢆᘬࡁ㉳ࡇࡍ࡜ᣦ᦬ࡉࢀ࡚࠸ࡿࠋ
ᮏ◊✲஦ᴗ࡛ࡣࠊ⬻⾑⟶㞀ᐖᝈ⪅ࢆᑐ㇟࡟࠺ࡘ⑕࡟㛵㐃ࡍࡿ⢭⚄⑕≧ࠊㄆ▱ᶵ⬟ࠊ᪥ᖖ⏕άືస⬟ຊ࠾ࡼࡧࡑࢀࡽ࡟㛵㐃ࡍࡿᣦᶆࢆ⏝࠸࡚ホ౯ࡋࠊᚑ᮶࡟ࡣ࡞࠿ࡗࡓ ձ㹼ճࡢ⑓⌮ࡢどⅬ࠿ࡽࠊ⬻⾑⟶ᛶ࠺ࡘ⑕ࡢ≉ᚩࠊ ᒁᡤ⑕≧࡜ᒁᡤ⑕≧ࠊ⢭⚄⑕≧࡜ࡢ㛵㐃ࠊᶵ⬟ᅇ᚟ࡸ⏕ά㐺ᛂ࡬ࡢ฿㐩ᗘ࡬ࡢᙳ㡪ࢆ᫂ࡽ࠿࡟ࡋࡓࠋ ≉࡟ࠊ㧗㱋⪅ࡢ࠺ࡘ⑕࡜↓Ẽຊ࡛ࡣఱࡀ࡝ࡢࡼ࠺࡟␗࡞ࡿࡢ࠿ࠊᐇ㝿ࡢ㢖ᗘࡣ࡝ࡢ⛬ᗘ࡟ㄆࡵࡽࢀࡿࡢ࠿ࠊᶵ⬟ⓗ࡞ホ౯࡜௓ධࡢྍ⬟ᛶࡀ࠶ࡿࡢ࠿ࠊ࡟ࡘ࠸࡚⪃ᐹࢆ㐍ࡵࡓࠋ

13

2㸬᪉ἲ
⬻༞୰ᅇ᚟ᮇࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓㝔࡟࠾ࡅࡿධ㝔ᝈ⪅ࢆᑐ㇟࡜ࡋࡓࠋ
࣭ྲྀࡾ㎸ࡳᇶ‽ձCT ࡲࡓࡣ MRI ࡟࠾࠸࡚⬻⾑⟶㞀ᐖࡀ☜ㄆ࡛ࡁࡿࡇ࡜
ղ㔜ᗘࡢㄆ▱⑕ࡸ㧗ᗘࡢኻㄒ⑕ࡀ࡞ࡃ⮬グᘧㄪᰝ⚊࡬ࡢᅇ⟅ࡀྍ⬟࡛࠶ࡿࡇ࡜࣭㝖እᇶ‽ձ ㄪᰝ⚊࡬ࡢᅇ⟅ࡸࠊホ౯࣭㉁ၥࡢᐇ᪋ࡀᅔ㞴࡞ሙྜղ ⬻⾑⟶㞀ᐖ௨እࡢ୰ᯡ⚄⤒ࡢ⑓Ṕ࡟ࡼࡿሙྜ

ᐇ᪋ᮇ㛫୰࡟ᐇ᪋᪋タ࡟ධ㝔ࡋࡓ 88 ྡࡢ࠺ࡕࠊᇶ‽࡟ྜ⮴ࡍࡿ 42 ྡ㸦62.5%㸧ࢆᑐ㇟࡜ࡋࡓࠋ42 ྡࡢᴫせࡣࠊ⏨ᛶ 32 ྡࠊዪᛶ 10 ྡ㸦ᖹᆒᖺ㱋㸸72.6±9.8㸦SD㸧ṓ㸧㸧ࠊᚋ㑇⑕㸸ᕥ∦㯞⑷ 15 ౛ࠊྑ∦㯞⑷ 12 ౛ࠊ㯞⑷࡞ࡋ 15 ౛ࠊཎ⑌ᝈ㸸⬻᱾ሰ 26 ౛ࠊ⬻ฟ
⾑ 13 ౛ࠊࢡࣔ⭷ୗฟ⾑ 2 ౛ࠊࡑࡢ௚ 1 ྡࠊ࡛࠶ࡗࡓࠋホ౯㡯┠ࡣࠊ⾲ 3 ࡟♧ࡍ࡜࠾ࡾ࡛
࠶ࡾࠊධ㝔᫬ࡢᙜึᩘ᪥ࢆ࠿ࡅ࡚ᐇ᪋ࡋࡓࠋ ᮏᖺᗘࡢ◊✲஦ᴗ࡛ࡣࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ᪋タධ㝔᫬㸦ึᅇホ౯᫬㸧ࡢ࢔ࣃࢩ࣮࡜࠺ࡘ⑕࡜ࡢ㛵ಀ࡟ࡘ࠸࡚᫂ࡽ࠿࡟ࡋࡓࠋ

14

⾲ 3㸬ホ౯࡟⏝࠸ࡓホ౯ᑻᗘ࠺ࡘ⑕≧ホ౯

Zung self-rating depression scale㸦SDS㸧㸦Zung, 1965㸧ពḧࡢホ౯

Apathy scale 㸦AS, ࡸࡿẼࢫࢥ࢔㸧*
㸦Starkstein et al., 1992; ᒸ⏣ࡽ, 1998㸧*Vitality Index 㸦VI, ពḧࡢᣦᶆ㸧㸦Toba et al., 2002㸧*QOL ホ౯

Stroke Specific Quality of Life Scale 㸦SSQOL㸧*⢭⚄⑕≧࣭ㄆ▱⑕ࡢホ౯

MMSE/HDS-R *Dementia Behavior Disturbance Scale㸦DBD㸧ㄆ▱ᶵ⬟ホ౯

Visual Digit span㸦forward, backward㸧㸦ὀព/㐙⾜ᶵ⬟㸧Visual Cancellation Test㸦௬ྡࠊᩘᏐ㸧
Symbol Digit Modalities Test 㸦SDMT㸧
Trail-Making-Test㸦A,B㸧ᄟୗᶵ⬟ᦤ㣗࣭ᄟୗ⬟ຊࢢ࣮ࣞࢻ
཯᚟ၚᾮ㣧ࡳࢸࢫࢺ㸦RSST㸧Ỉ㣧ࡳࢸࢫࢺ㸦MWST㸧⏕άᶵ⬟

NIH Stroke Scale㸦NIHSS㸧modified Rankin Scale㸦mRS㸧
Functional Independent Measure㸦FIM㸧࠺ࡘ⑕ࡢホ౯࡟⏝࠸ࡓ Self-rating depression scale㸦SDS㸧ࡣࠊZung㸦1965㸧࡟ࡼࡾ⪃᱌ࡉࢀࡓ 20 㡯┠ࡢ⮬ᕫグධᘧ㉁ၥ⾲࡛࠶ࡿ㸦⾲ 4㸧ࠋྛ㉁ၥ㡯┠࡟ࡣ㉁ၥෆᐜࡢヱᙜࡍࡿ㢖ᗘࢆ 4 ẁ㝵࡛ᅇ⟅ࡍࡿࠋSDS ࡣ 50 Ⅼ௨ୖࡀࠕ୰➼ᗘࡢ࠺ࡘ⑕࠶ࡾࠖ࡜ุᐃࡉࢀ
ࡿࠋ㸦* ࡣᮏᖺᗘࡢ◊✲஦ᴗሗ࿌࡟ྵࡲࢀࡿ㈨ᩱ㸧

15

⾲ 4㸬Self-rating depression scale㸦SDS, Zung, 1965㸧

Starkstein et al.㸦1992㸧ࡢ㛤Ⓨࡋࡓ Apathy scale ࢆᒸ⏣ࡽ㸦1998㸧ࡣ᪥ᮏㄒ࡟⩻ヂࡋ⤂௓ࡋࡓࠋ᪥ᮏㄒ࡛ࡣࠕࡸࡿẼࢫࢥ࢔ࠖ࡜ࡋ࡚࠸ࡿ㸦⾲ 5㸧ࠋ16 Ⅼ௨ୖ࡛ࠕ࢔ࣃࢩ࣮࠶ࡾࠖ࡜ホ౯ࡉࢀࡿࠋ

16

⾲ 5㸬ࡸࡿẼࢫࢥ࢔㸦ᒸ⏣ࡽ, 1998㸧ࡶ࠺ࡦ࡜ࡘࡢ࢔ࣃࢩ࣮ホ౯ᣦᶆࡣ Vitality Index㸦VI, ⾲ 6㸧࡛࠶ࡾࠊ㫽⩚ࡽ࡟ࡼࡗ࡚
ࠕពḧࡢᣦᶆࠖ࡜ࡋ࡚ሗ࿌ࡉࢀ࡚࠸ࡿ㸦Toba et al., 2002㸧ࠋព㆑㞀ᐖୗࡸᛴᛶ⑌ᝈ࡛ࡢ
ุᐃࡢ㝖እࡸุᐃୖࡢὀព஦㡯ࡀつᐃࡉࢀ࡚࠸ࡿ㸦Toba et al., 2002㸧ࠋ10 Ⅼ‶Ⅼ࡛ 7 Ⅼ௨ୗࡀពḧࡢపୗࡢ࢝ࢵࢺ࢜ࣇ್࡛࠶ࡿࠋᮏ◊✲஦ᴗ࡛ࡣࠊAS ࡟ࡘ࠸࡚ࡸࡿẼࢫࢥ࢔ࢆ
⏝࠸ࡓࠋ

17

⾲ 6㸬ពḧࡢᣦᶆ㸦Toba et al., 2002㸧

3㸬⤖ᯝᑐ㇟⪅ 42 ྡ࡛ࡢ⤖ᯝࡣᅗ 3 ࡟♧ࡍࡼ࠺࡟ࠊධ㝔ࡢ᫬Ⅼࡢ༙ᩘ௨ୖ࡛࢔ࣃࢩ࣮࠶ࡿ࠸ࡣ
࠺ࡘ⑕ࡢ࡝ࡕࡽ࠿ࢆ᭷ࡋ࡚࠸ࡓࠋ࢔ࣃࢩ࣮࡜࠺ࡘ⑕ࡢྜేࡣᑡᩘ౛㸦2 ౛㸧࡟࡜࡝ࡲࡗ
ࡓࠋⓎ⑕ᚋࠊึᅇホ౯㸦ධ㝔᫬㸧ࡲ࡛ࡢ⤒㐣᪥ᩘࡣᖹᆒ 25.5±8.5 ᪥㸦10㹼44 ᪥㸧࡛࠶ࡾࠊ⤒㐣᪥ᩘ࡜࢔ࣃࢩ࣮ホ౯ᣦᩘ࡜ࡢ┦㛵ࡣ↓࠿ࡗࡓ 㸦ᅗ 4㸧ࠋࡲࡓࠊධ㝔᫬ࡢ࢔ࣃࢩ࣮
࡜࠺ࡘ⑕ࡢᣦᩘࡢ┦㛵ࡶ᭷ព࡛ࡣ࡞࠿ࡗࡓ㸦ᅗ 5㸧ࠋ࢔ࣃࢩ࣮࠶ࡿ࠸ࡣ࠺ࡘ⑕࡜ㄆ▱⑕࡜ࡢ㛵㐃࡟ࡘ࠸࡚ࠊMMSE ࡜ࡢ┦㛵ࢆồࡵࡓࡀࠊᑐ㇟⪅ෆ࡛ࡣࠊ࢔ࣃࢩ࣮ホ౯ᣦᩘ࡜ MMSE
Ⅼᩘ࡟᭷ព࡞┦㛵ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓ㸦ᅗ 6㸧ࠋ18

ᅗ 3㸬ᐇ᪋౛ࡢ↓Ẽຊ㸦Apathy㸧࡜࠺ࡘ⑕㸦Depression㸧ᅗ 4㸬࢔ࣃࢩ࣮ホ౯㸦AS score㸧࡜Ⓨ⑕ᚋ᪥ᩘ㸦ホ౯᫬㸧ࠋ⬻⾑⟶㞀ᐖⓎ⑕ᚋࡢ᪥ᩘ࡜ ࡢ┦㛵ࡣ᭷ព࡛ࡣ࡞࠿ࡗࡓࠋ

19

ᅗ 5㸬࢔ࣃࢩ࣮㸦AS㸧࡜࠺ࡘ⑕㸦SDS㸧ࡢホ౯ᣦᩘ࡜ࡢ┦㛵ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ

ᅗ 6㸬MMSE ࡜࢔ࣃࢩ࣮ホ౯ᣦᩘ㸦AS㸧࡜ࡢ┦㛵ࡶ᭷ព࡛ࡣ࡞࠿ࡗࡓࠋ

20

ᅗ 7㸬࢔ࣃࢩ࣮㸦AS㸧ࡢ᭷↓࡟ࡼࡿ⏕άࡢ㉁ᑻᗘ㸦SSQOL㸧ࠋᖹᆒ್ࡣ࢔ࣃࢩ࣮㸦㸫㸧⩌ࡀࡸࡸ㧗࠸ࡀ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ

4㸬⪃ᐹ௒ᖺᗘ࡟ᐇ᪋ࡋࡓᑐ㇟⪅ᩘࡣࠊ⬻༞୰ᅇ᚟ᮇࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥᑓ㛛⑓㝔࡟ධ㝔ࡋ
ࡓ 88 ྡ୰ࡢ 42 ྡ࡛࠶ࡾࠊ࢔ࣃࢩ࣮࠶ࡿ࠸ࡣ࠺ࡘ⑕ࢆ᭷ࡍࡿᝈ⪅ᩘࡣ༙ᩘ࡟ࡢࡰࡗࡓࠋ
◊✲஦ᴗձ࡛⾜ࡗࡓࠊ௓ㆤಖ㝤᪋タ࡟࠾ࡅࡿㄆ▱⑕㧗㱋⪅ࡀ࠺ࡘ⑕≧ࢆ࿊ࡍࡿ๭ྜࡣ
10%ෆእ࡛࠶ࡗࡓࡇ࡜࠿ࡽࠊ⬻༞୰ᚋ࡟࠸ࢃࡺࡿ࢔ࣃࢩ࣮࠶ࡿ࠸ࡣ࠺ࡘ⑕ࢆ⏕ࡌࡿ㢖ᗘࡣ㧗࠸࡜⪃࠼ࡽࢀࡿࠋᮏ◊✲஦ᴗࡶࡑ࠺࡛࠶ࡗࡓࡼ࠺࡟ࠊㄆ▱⑕ࡀ୰➼ᗘ௨ୖ࡜࡞ࡿ࡜ࠊ
࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕࡟㛵ࡍࡿ⮬グᘧ㉁ၥ࡬ࡢᅇ⟅ࡀᅔ㞴࡜࡞ࡾࠊࡲࡓ⮬㌟ࡢ ᚰ㌟ⓗ⑕≧࡟ᑐࡍࡿㄆ㆑࡜⾲ฟࡀᅔ㞴࡜࡞ࡿࡇ࡜࠿ࡽࠊ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕ࡢホ౯ࡑࡢࡶࡢ࡟㝈⏺ࡀ⏕ࡌࡿࠋ◊✲஦ᴗձ࡛ D ⩌࡟ศ㢮ࡉࢀࡓ฼⏝⪅ࡣࠊ඲య࡟άືᛶࡀపࡃࠊㄆ▱⑕࡜ࡋ࡚ࡢ
㝧ᛶ⑕≧ࡣᑡ࡞࠸ࠊ࡜ゝ࠼ࡿࠋࡋ࠿ࡋࠊ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕≧࡞࡝࡜ࡋ࡚⏕ࡌࡿពḧࡢḞዴ࡜࠸ࡗࡓ㝜ᛶ⑕≧࡟ࡘ࠸࡚ࡣࠊࡑࢀࡀ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕࡜ࡋ࡚ࡢ⢭⚄⑕≧࡞ࡢ࠿ࠊㄆ
▱⑕࡟ࡼࡗ࡚άືࡀపୗࡋࡓᶵ⬟పୗࡢ⤖ᯝ࡞ࡢ࠿ࠊุูࡍࡿࡇ࡜ࡣ༢⣧࡛ࡣ࡞࠸࡜⪃࠼ࡽࢀࡓࠋ◊✲஦ᴗղ࡛ࡢᑐ㇟⪅ࡣ⬻༞୰ᚋࡢ㧗㱋⪅࡛࠶ࡾࠊᅗ 6 ࡛♧ࡍࡼ࠺࡟ㄆ▱⑕ࡢ␲࠸࡜
࡞ࡿ MMSE ࡀ 21 Ⅼ௨ୗࡢᑐ㇟⪅ࡣᑡᩘ㸦4 ౛㸭42 ౛୰㸧ࡢࡳ࡛࠶ࡗࡓࠋ⬻༞୰ᚋࡢ㧗

21㱋⪅࡛ࡣ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕ࡣㄆ▱⑕ࡢࢫࢡ࣮ࣜࢽࣥࢢ࡜ࡋ࡚⏝࠸ࡽࢀࡿ⑕≧࡟ᚲࡎࡋࡶ
㛵㐃ࡋ࡚ฟ⌧ࡍࡿࡶࡢ࡛ࡣ࡞࠸ࠊࡇ࡜ࡣ♧၀ࡉࢀࡓࠋ
ୖ㏙ࡢࡼ࠺࡟ࠊㄆ▱⑕ࡀ㐍⾜ࡋࡓሙྜࠊ᪥ᖖ⏕ά࡟࠾ࡅࡿάືࡀ ṇᖖࢆ㐓⬺ࡋࡓࡾࠊ␗ᖖ࡞⾜ືࡀ⃭ࡋ࠿ࡗࡓࡾࡋࡓሙྜࠊពḧ࡜ࡢ㛵ಀࢆᐃ⩏࡙ࡅࡿࡇ࡜ࡀᅔ㞴࡜࡞ࡿࠋᮏ
◊✲஦ᴗ࡛ࡣࠊࡇࡢⅬࡶ᫂ࡽ࠿࡟ࡍࡿ┠ⓗ࡛ࠊMMSE ࡢࡼ࠺࡞ㄆ▱⑕ࡢࢫࢡ࣮ࣜࢽࣥࢢ
᳨ᰝ࡟ຍ࠼ࠊ๓㢌ⴥᶵ⬟ࢆ཯ᫎࡍࡿホ౯㡯┠ࢆຍ࠼࡚ ᳨ウࢆጞࡵࡓࠋᮏᖺᗘ࡟ࡣ⤖ᯝࡢ୍㒊ࢆሗ࿌ࡍࡿ࡟࡜࡝ࡲࡿࡀࠊḟᖺᗘ࡟ྥࡅ࡚ヲ⣽࡞⤖ᯝࡀ⵳✚ࡉࢀࡘࡘ࠶ࡿࠋ
௒ᖺᗘࡢᮏ◊✲஦ᴗࡢ⤖ᯝࡣࠊ⬻༞୰ᚋ㑇⑕ࢆ ᭷ࡍࡿ㧗㱋⪅ࡣࠊᶵ⬟ᅇ᚟ࡢࡓࡵࡢࣜ
ࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ⾜࠺࡭ࡁᅇ᚟ᮇ࡛࠶ࡗ࡚ࡶࠊ ᅇ᚟ࡢጉࡆ࡜࡞ࡿ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕ࢆ
᭷ࡍࡿ๭ྜࡀ㧗࠸ࡇ࡜ࡀ♧ࡋࡓࠋⓎ⑕ᚋࡢ⨯⑓ᮇ㛫ࡸㄆ▱⑕ࢫࢡ࣮ࣜࢽࣥࢢ᳨ᰝ࡛ࡢ್
࡜ࡶ᫂ࡽ࠿࡞┦㛵ࡣㄆࡵ࡞࠿ࡗࡓࠋ⤖ᯝࡣࠊ⬻༞୰Ⓨ⑕ᚋࡢᅇ᚟ᮇ ࡟࠾ࡅࡿᝈ⪅ࡸ᪋タ฼⏝⪅࡟ᑐࡋ࡚ࡣࠊ
ࠕ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕ࢆ᭷ࡋ࡚࠸ࡿࠖࡇ࡜ࢆᛕ㢌࡟⨨࠸࡚ࡶࡼ࠸㢖ᗘ࡛࠶ࡿࠋ◊✲஦ᴗࡢ⤖ᯝ࡟ࡶ♧ࡉࢀࡿࡼ࠺࡟ࠊ࢔ࣃࢩ࣮ࡀ⏕ࡌ࡚࠸ࡿ㝶కせᅉࡣ༢⣧࡞ࡶࡢ࡛ࡣ↓࠸࡜⪃࠼ࡽࢀࡿࡇ࡜࠿ࡽࠊ୍⩏ⓗ࡟ࠕࡸࡿẼࡀ࡞࠸ࠖ࡜ゎ㔘ࡍࡿࡇ࡜㑊ࡅࡿ࡭ࡁ࡛࠶ࡿࠋࡲࡓࠊ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕ࡣࠊࡑࡢάືᛶࡢపࡉ࠿ࡽࠊㄆ▱⑕ࡢ࠶ࡿẁ㝵࡜ࡋ࡚⪃࠼ࡽࢀ࡚ࡋࡲ࠺ྍ⬟ᛶࡀ࠶ࡿࠋ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕ࡣࡑࢀ⮬యࠊึᮇ࡛࠶ࢀࡤㄆ▱⑕࡜ࡢ㛵㐃ࡣஈࡋ࠸ࡓࡵࠊࢥ࣑ࣗࢽࢣ࣮ࢩࣙࣥ㔞ࡸάືᛶࢆቑຍࡉࡏࡿ௓ධࡀ᭷ຠ࡜࡞ࡿ
ྍ⬟ᛶࡀ⪃࠼ࡽࢀࡿࠋࡇࢀࡽࡢ㝜ᛶ⑕≧࡟ᑐࡋ࡚࢔ࣉ࣮ࣟࢳࡸ௓ධࡀ୍ᐃ࡟⾜ࢃࢀ࡚࠸ࡿ⑓㝔ࡸ᪋タෆࡶከ࠸࡜⪃࠼ࡽࢀࡿࡀࠊㄆ▱⑕࡜ࡢ༊ูࢆ⾜࠺ࡇ࡜ࡣ㔜せ࡜⪃࠼ࡓࠋᮏ◊✲ࡣࠊ௒ᚋ⥅⥆ⓗ࡟ᐇ᪋ࡍࡿணᐃ࡛࠶ࡾࠊ᪋タ࡛ࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡸ௓ධ࡟
ࡼࡾ࢔ࣃࢩ࣮ࡸ࠺ࡘ⑕ࡀ࡝ࡢࡼ࠺࡟ኚ໬ࡍࡿࡢ࠿ࠊኚ໬ࡍࡿせᅉࡸ௚ࡢㄆ▱ᶵ⬟࡜ࡢ㛵㐃࡟ࡘ࠸࡚᫂ࡽ࠿࡟ࡋ࡚࠸ࡃィ⏬࡛࠶ࡿࠋ㸨㸨㸨㸨㸨㸨㸨㸨

◊✲஦ᴗճ ⬻༞୰៏ᛶᮇ࡟࠾ࡅࡿὀពᶵ⬟㈿άㄢ㢟ࡢຠᯝ◊✲஦ᴗճࡣࠊᖹᡂ 25 ᖺᗘࡼࡾ⥅⥆ࡋ࡚⾜ࡗ࡚࠸ࡿࠊὀពᶵ⬟㈿άㄢ㢟࡟㛵ࡍࡿ◊✲஦ᴗ࡛࠶ࡿࠋᖹᡂ 25 ᖺᗘࡲ࡛ࡣࠊ⬻༞୰Ⓨ⑕ᚋࡢᅇ᚟㐣⛬࠾ࡼࡧ㍍ᗘࡢㄆ▱⑕ᝈ⪅

22࡟࠾ࡅࡿὀពᶵ⬟ࢆ᫂ࡽ࠿࡟ࡋ࡚ࡁࡓࡀࠊᮏᖺᗘࡣࠊ ୰➼ᗘࡢㄆ▱⑕ࢆ᭷ࡍࡿ⬻༞୰ᚋ៏ᛶᮇࡢ௓ㆤಖ㝤᪋タ฼⏝⪅ࢆᑐ㇟࡜ࡋ࡚ྠᵝ࡞ㄢ㢟ࢆ⾜࠸ࠊὀព ᶵ⬟࡟ࡘ࠸࡚ᨵၿࡢ
᭷↓ࢆほᐹࡋࡓࠋᐇ᪋ࡋࡓὀពᶵ⬟㈿άㄢ㢟ࡣࠊࡑࢀ⮬యࠊὀពᶵ⬟ࡢホ౯࡜࡞ࡾࡘࡘྠ᫬࡟カ⦎࡜࡞ࡿㄢ㢟࡛࠶ࡿࠋ1㸬⫼ᬒ࡜┠ⓗㄆ▱⑕ࡢ୰᰾⑕≧࡟ࡣࠊグ᠈ࡸぢᙜ㆑ࡢ㞀ᐖࠊ⌮ゎࡸุ᩿ຊࡢపୗࠊ㐙⾜ᶵ⬟ࡢపୗ࡞࡝ࡀྵࡲࢀࡿࠋࡇࢀࡽࡢ⑕≧࡟࠾࠸࡚ࡣࠊ㛵୚ࡢ኱ᑠࡣ࠶ࡗ࡚ࡶࠊ⬻ࡢᇶ┙ⓗᶵ⬟࡛࠶ࡿὀពᶵ⬟ࡢ㞀ᐖࡀᏑᅾࡍࡿࠋὀពᶵ⬟ࡣࠊグ᠈ࡸぢᙜ㆑ࠊุ᩿࡞࡝඲࡚ࡢㄆ▱ᶵ⬟ࡢᇶ࡜࡞ࡿ⬻ᶵ⬟࡛࠶ࡾࠊㄆ▱⑕ᝈ⪅࡛ࡣ㧗ᗘ࡟㞀ᐖࡉࢀ࡚࠸ࡿ㸦Kolanowski et al.,2012㸧ࠋࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㡿ᇦ࡛ࡣㄆ▱⑕㧗㱋⪅࡟ὀពᶵ⬟ࡢᨵၿࡀ᪥ᖖ⏕ά࡛ࡢάື
ᛶᨵၿ࡟ᚲ㡲࡛࠶ࡿⅬࡣ♧ࡉࢀ࡚࠸ࡿࡶࡢࡢ㸦㎞ᓥࡽࠊ1999㸹 㥖஭ࡽࠊ2010㸧ࠊὀពᶵ⬟ࡢ㈿άࢆᮇᚅࡋࡓࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡸ௓ධࡀ⾜ࢃࢀࡿࡇ࡜ࡣᑡ࡞࠸ ࠋ
ᖹᡂ25ᖺᗘ࡟㛤Ⓨࡋࡓὀពᶵ⬟ᨵၿࢆಁࡍẁ㝵ⓗㄢ㢟ࡣࠊὀពᶵ⬟ࡢᅇ᚟࡟㛵ࡋ࡚ணᚋண࡜ᑐᛂࡋࡓẁ㝵ⓗ࡞௓ධㄢ㢟࡛࠶ࡗࡓࠋὀពᶵ⬟ࡢ㈿άຠᯝࡣⰋዲ࡛ࠊ࡯ࡰ඲࡚

ࡢᑐ㇟⪅ࡀᶵ⬟ᅇ᚟ࢆ⏕ࡌ࡚࠸ࡓࠋᚓࡽࢀࡓ⤖ᯝ ࡣࠊ㐩ᡂࡋࡓㄢ㢟ࡣ᪥ᖖ⏕άືస࡟࠾
ࡅࡿ⬟ຊ࡟┦㛵ࡋ࡚࠾ࡾࠊẁ㝵ⓗㄢ㢟ࡣ᪥ᖖ⏕ά࡟ᚲせ࡞ὀពᶵ⬟ࡢᅇ᚟ᣦᶆ࡜࡞ࡿࡇ
࡜ࡶ♧ࡉࢀࡓࠋ㏆ᖺࡢ⬻ࡢྍረⓗኚ໬ࡢ≉ᚩ࠿ࡽ㸦Pascual-Leone et al., 2005㸧ࠊࡇࡢࡼ࠺࡞カ⦎ຠᯝࡣࠊ⬻༞୰ࡢᅇ᚟ᮇࡢࡳ࡞ࡽࡎࠊ࠸ࡘࡢẁ㝵࡛ࡶ⏕ࡌࡿྍ⬟ᛶࡀ࠶ࡾࠊࡓ
࡜࠼㏥⾜ⓗ࡞⬻⑓⌮ࡢὶࢀ࡟࠶ࡿㄆ▱⑕࡛࠶ࡗ࡚ࡶࠊ⬻ࡢྍረⓗኚ໬࡟ࡼࡿㄆ▱ᶵ⬟ࡢᨵၿࡣࠊ࠶ࡿ⛬ᗘ⏕ࡌࡿྍ⬟ᛶࡣ࠶ࡿࠋ
ᮏᖺᗘࡢ✲஦ᴗ࡛ࡣࠊࡇࡢⅬࢆ᫂ࡽ࠿࡟ࡍࡿࡓࡵ࡟ࠊྠࡌㄢ㢟ࢆ౑࠸ࠊᑐ㇟ࢆ᪋タධᒃ୰ࡢㄆ▱⑕ᝈ⪅ࢆᑐ㇟࡟ࠊὀពᶵ⬟㞀ᐖࡢᨵၿ࡟ྥࡅ࡚㛤Ⓨࡋࡓㄢ㢟ࢆ⏝࠸࡚ࡑࡢຠ
ᯝ࡟ࡘ࠸࡚᫂ࡽ࠿࡟ࡋࡓࠋᮏ◊✲࡛⏝࠸ࡓㄢ㢟ࡣࠊὀពᶵ⬟ࢆせ⣲ࡈ࡜࡟ẁ㝵௜ࡅࡋࡓㄢ㢟ࢆ⧞ࡾ㏉ࡋ⾜࠺ࡇ࡜࡛ࠊㄢ㢟ࡢ㐩ᡂᗘ࡟ࡼࡗ࡚┤᥋ࠊὀពᶵ⬟ࡢኚ໬ࢆほᐹ࡛ࡁࡿࣉࣟࢢ࣒ࣛ࡜࡞ࡗ࡚࠸ࡿࠋ2㸬᪉ἲ
1㸬2㸬ᑐ㇟⪅23ᑐ㇟⪅ࡣࠊ௓ㆤ⪁ேಖ೺᪋タࢆ฼⏝୰ࡢ୰➼ᗘ௨ୖࡢ⬻⾑⟶ᛶㄆ▱⑕ࢆ᭷ࡍࡿ 10 ྡ㸦ᖺ㱋: 83.6±9.7㸦mean±SD㸧ṓ㸧ࠊᛶู㸸⏨ᛶ 3 ྡࠊዪᛶ 7 ྡ࡛࠶ࡗࡓࠋᑐ㇟⪅ࡢ
Mini-Mental State Examination 㸦MMSE㸧ࡣᖹᆒ 19.3±5.3㸦SD㸧Ⅼ࡛࠶ࡗࡓࠋ⮫ᗋ⤒㐣ୖࠊ᫂ࡽ࠿࡜࡞ࡗ࡚࠸ࡿ⬻᱾ሰⓎ⑕⤒㐣᪥ᩘࡣࠊ1,569㸦4 ᖺ 109 ᪥㸧±1,564㸦4 ᖺ
104 ᪥ࠊmean±SD㸧᪥࡛࠶ࡗࡓࠋ

2㸬2㸬ὀពᶵ⬟ࢆᨵၿࡍࡿࡓࡵࡢㄢ㢟⏝࠸ࡓㄢ㢟ࡣࠊᖹᡂ 25 ᖺᗘࡢᮏሗ࿌᭩࡟ᥖ㍕ࡋࡓẁ㝵ⓗὀព㈿άㄢ㢟࡜ྠᵝ࡛࠶ࡿࠋὀពᶵ⬟ࡢ≉ᛶࢆ⪃៖ࡋࠊ㞴ᗘࡢ␗࡞ࡿ 13 ẁ㝵ࡢㄢ㢟ࢆタᐃࡋࡓ㸦⾲ 7㸧ࠋㄢ㢟 A ࡣࠊ༢⣧࡞ὀពࡢ㐃⥆ⓗ⛣ືࢆ⾜࠺ㄢ㢟࡜ࡋࡓࠋㄢ㢟 B ࡣࠊ✵㛫ⓗὀពࡢ⛣ື࡜㑅ᢥ࣭㌿᥮࣭㓄ศࢆᚲせ࡜ࡍࡿㄢ㢟࡜ࡋࡓࠋࠕỴࡵࡽࢀࡓⰍࢆᘚูࡋᢳฟࡍࡿࠖ࡜࠸࠺ὀពࡢ⛣ື࡜㑅ᢥࢆ⾜࠺ㄢ㢟ࢆ B-1ࠊࠕỴࡵࡽࢀࡓ㡰␒ࢆグ᠈ࡋ࡞ࡀࡽࠊࡑࡢ㏻ࡾ࡟Ⰽࢆᢳฟࡍࡿࠖ࡜࠸
࠺ὀពࡢ⛣ື࡜㑅ᢥ࣭㌿᥮࣭㓄ศࢆ⾜࠺ㄢ㢟ࢆ B-2ࠊࠕỴࡵࡽࢀࡓⰍ࡜㞄ࡾྜࢃࡏࡢࡶࡢ
ࡔࡅࢆᢳฟࡍࡿࠖ࡜࠸࠺ࠊࡼࡾ」㞧࡞ὀពࡢ㌿᥮࣭㓄ศࢆᚲせ࡜ࡍࡿㄢ㢟ࢆ B-3 ࡜ࡋࡓࠋㄢ㢟 C ࡣὀពࡢ‽ഛ࠿ࡽ⾜Ⅽ࡟⮳ࡿࣉࣟࢭࢫ࡟ࠊ⫈ぬ่⃭࡟ࡼࡿ㈿άࢆྵࡴ ከ㔜ࣔࢲࣜࢸ࢕࣮ࡢㄢ㢟࡜ࡋࡓࠋ༢⣧࡞ࣜࢬ࣒࡟ྜࢃࡏ࡚ὀពࡢ⛣ື࡜㑅ᢥࢆ⾜࠺ㄢ㢟ࢆ C-1ࠊ❺ㅴࡢࣜࢬ࣒࡟ྜࢃࡏ࡚ὀពࡢ⛣ື࡜㑅ᢥࢆ⾜࠺ㄢ㢟ࢆ C-2ࠊ❺ㅴࡢࣜࢬ࣒࡟ྜࢃࡏ࡚ὀ
ពࡢ⛣ື࡜㑅ᢥ࣭㌿᥮࣭㓄ศࢆ⾜࠺ㄢ㢟ࢆ C-3 ࡜ࡋࡓࠋ⾲ 7 ࡟ලయⓗ࡞ෆᐜࢆ♧ࡋࡓࠋㄢ㢟ᐇ᪋࡟ࡣࠊ㠃✚࡜࣌ࢢࡢᩘࡀ␗࡞ࡿ 2 ✀㢮ࡢ࣌ࢢ࣮࣎ࢻࢆ౑⏝ࡋࡓ㸦ᑠ㸸
22.5×30.5cmࠊ኱㸸45.0×60.0cm㸧㸦ᅗ 8㸧ࠋࡑࢀࡒࢀࠊ20 ᮏࠊ63 ᮏࡢ࣌ࢢࡀᆒ➼࡟୪ࡪࡶࡢ࡛࠶ࡿࠋࡲࡓࠊ༢⣧࡞⫈ぬⓗࣜࢬ࣒࡟ࡣ࣓ࢺࣟࣀ࣮࣒ࢆࠊ❺ㅴ࡟ࡼࡿ⫈ぬⓗࣜࢬ࣒࡟ࡣࠕࡩࡿࡉ࡜ࠖࢆ౑⏝ࡋࡓࠋ

2㸬3㸬ㄢ㢟ࡢᐇ᪋ᡭ㡰ㄢ㢟ࡣ 1 ᅇ 20㹼40 ศᐇ᪋ࡋࡓࠋ1 ᅇࡢ᫬㛫ෆ࡟ࠊㄢ㢟 A ࠿ࡽ㡰࡟ྛㄢ㢟ࢆ 2 ᅇࡎࡘᐇ᪋ࡋࠊࡑࢀࡒࢀࡢ࢚࣮ࣛ⋡ࢆグ㘓ࡋࡓࠋ࢚࣮ࣛ⋡ࡀ 0%࡜࡞ࡗࡓㄢ㢟ࡣ㐩ᡂ࡜ࡋࡓࠋᑐ㇟
⪅࡟ࡣࠊᐇ᪋๓࡟ㄢ㢟ࡢ┠ⓗࢆㄝ᫂ࡋࠊᐇ᪋ᚋ࡟ࡣ㐩ᡂࢆࣇ࢕࣮ࢻࣂࢵࢡࡋࡓࠋ

3㸬⤖ᯝ

24

ྛㄢ㢟ࡣ 10㹼20 ᅇ⧞ࡾ㏉ࡋ⾜࠸ࠊᅗ 2㹼4 ࡟♧ࡍㄢ㢟㐩ᡂ⤒㐣࡜࡞ࡗࡓࠋࡑࢀࡒࢀࡢ
ㄢ㢟࡟ࡘ࠸࡚ࠊᑐ㇟⪅࡟ࡼࡗ࡚⛬ᗘ࡜᫬㛫⤒㐣ࡢᕪࡣ࠶ࡗ࡚ࡶࠊᨵၿࡀㄆࡵࡽࢀࠊㄢ㢟ࡢᑟධࡀྍ⬟࡛࠶ࡗࡓᑐ㇟⪅࡟ࡣᨵၿࡀㄆࡵࡽࢀࡓࠋ

ᅗ 8㸬ㄢ㢟࡟౑⏝ࡋࡓⰍ௜࣌ࢢ࡜࣌ࢢ࣮࣎ࢻ
㸦ᑠ㸸ୖࠊ኱㸸ୗ㸧ࠋ⾲ 1 ࡢࡈ࡜ࡃࠊㄢ㢟ࡈ࡜ࡢᣦ♧࡟ࡼࡗ࡚࣌ࢢࢆ࡜ࡾྑୖࡢ⟽ࡢ୰࡟⛣ືࡍࡿࠋ

25

⾲ 7㸬ẁ㝵ⓗὀពᶵ⬟㈿άㄢ㢟ࡢᴫせㄢ㢟 A㸸༢⣧࡞ὀពࡢ㐃⥆ⓗ⛣ືㄢ㢟㞴ᗘA-1ࠕ࣌ࢢࢆ⟽࠿ࡽ⟽࡬㡰␒࡟⛣ࡍ㸦 20 ಶ㸧ࠋࠖ1

ㄢ㢟 B㸸✵㛫ⓗὀពࡢ⛣ື࡜㑅ᢥ࣭㌿᥮࣭㓄ศࢆᚲせ࡜ࡍࡿㄢ㢟B-1-1ࠕ࣌ࢢ࡟ࣛࣥࢲ࣒࡟Ⰽࢩ࣮ࣝ㸦㉥㸧ࢆ௜ࡅ࡚࠾ࡁ㸦 10 ಶ㸧ࠊⰍࢩ࣮ࣝࡢ௜࠸ࡓࡶࡢࡔࡅࢆ⟽2࡟⛣ࡍࠋࠖ
B-1-2ࠕ࣌ࢢࢆ㓄⨨ࡍࡿ㡿ᇦࢆᗈࡃࡋࠊᩘࢆቑࡸࡍࠋ B-1-1 ࡜ྠᵝ࡟⾜࠺㸦㉥ 30 ಶ㸧ࠋࠖ3

B-1-3ࠕⰍࢩ࣮ࣝࢆ 2 ✀㢮㸦㉥࣭㟷

4

ྛ 15 ಶ㸧࡜ࡋࠊ㟷ࡢࡳ⟽࡟⛣ࡍࠋࠖ

B-2-1ࠕⰍࢩ࣮ࣝࢆ 3 ✀㢮㸦㉥࣭㯤࣭㟷

ྛ 15 ಶ㸧࡜ࡋࠊỴࡵࡽࢀࡓ㡰␒㸦㉥ ń㟷㸧࡛⟽࡟⛣ࡍࠋࠖ 5

B-2-2ࠕB-2-1 ࡜ྠᵝࡢタᐃ࡛ࠊỴࡵࡽࢀࡓ㡰␒㸦㉥ ń㟷ń㯤㸧࡛⟽࡟⛣ࡍࠋࠖ

6

B-3

7

ࠕB-2-1 ࡜ྠᵝࡢタᐃ࡛ࠊ㉥࡜㞄ࡾྜࢃࡏࡢ㟷㸦ྛ 15 ಶࡢ࠺ࡕ 10 ಶ㸧ࡢࡳ⟽࡟⛣ࡍࠋࠖㄢ㢟 C㸸ὀពࡢ‽ഛ࠿ࡽ⾜Ⅽ࡟⮳ࡿࣉࣟࢭࢫ࡟ࠊ⫈ぬ่⃭࡟ࡼࡿ㈿άࢆྵࡴㄢ㢟C-1-1ࠕ༢⣧࡞⫈ぬⓗࣜࢬ࣒㸦 4 ⛊㛫㝸㸧࡟ྜࢃࡏ࡚ࠊㄢ㢟 A-1 ࢆ⾜࠺ࠋࠖ

8

C-1-2ࠕ༢⣧࡞⫈ぬⓗࣜࢬ࣒㸦 4 ⛊㛫㝸㸧࡟ྜࢃࡏ࡚ࠊㄢ㢟 B-1-3 ࢆ⾜࠺ࠋࠖ

9

C-2-1ࠕ❺ㅴ࡟ࡼࡿ⫈ぬⓗࣜࢬ࣒㸦⣙ 3 ⛊㛫㝸㸧࡟ྜࢃࡏ࡚ࠊㄢ㢟 A-1 ࢆ⾜࠺ࠋࠖ

10

C-2-2ࠕ❺ㅴ࡟ࡼࡿ⫈ぬⓗࣜࢬ࣒㸦⣙ 3 ⛊㛫㝸㸧࡟ྜࢃࡏ࡚ࠊㄢ㢟 B-1-3 ⾜࠺ࠋࠖ11

C-3-1ࠕ❺ㅴ࡟ࡼࡿ⫈ぬⓗࣜࢬ࣒㸦⣙ 3 ⛊㛫㝸㸧࡟ྜࢃࡏ࡚ࠊㄢ㢟 B-2-2 ࢆ⾜࠺ࠋࠖ

12

C-3-2ࠕ❺ㅴ࡟ࡼࡿ⫈ぬⓗࣜࢬ࣒ 㸦⣙ 3 ⛊㛫㝸㸧࡟ྜࢃࡏ࡚ࠊㄢ㢟 B-3 ࢆ⾜࠺ࠋࠖ

13

26

B-2-1(㞴᫆ᗘ5)௓ධ⤒㐣㸦ᐇ᪋ᅇᩘ࡟ࡼࡿ㸧

a

120.0

b

B-2-1 ࢚࣮ࣛ⋡㸦㸣㸧

c
100.0

d
e

80.0

f
60.0

g
h

40.0

i
j

20.0
0.0
1

3

5

7

9

11 13 15 17 19 21 23 25 27 29

B-2-2(㞴᫆ᗘ6)௓ධ⤒㐣㸦ᐇ᪋ᅇᩘ࡟ࡼࡿ㸧b

30.0
B-2-2 ࢚࣮ࣛ⋡㸦㸣㸧

a

c
25.0

d

20.0

e
f

15.0

g
10.0

h

5.0

i
j

0.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20ᅗ 9㸬Ⰽ௜࣌ࢢࡢ㡰␒㸦B-2-1㸸2 ✀㢮ࠊB-2-2㸸3 ✀㢮㸧࡝࠾ࡾ࡟⛣ືࡍࡿㄢ㢟࡛ࡢ⤒᫬ኚ໬ࢆ♧ࡍࠋከࡃࡢ⿕㦂⪅࡛࢚࣮ࣛ⋡ࡢపୗ࡜ࡋ࡚ㄢ㢟㐙⾜ࡢᨵၿࡀㄆࡵࡽࢀ ࡓࡀࠊ1౛࡛ࡣᨵၿࢆㄆࡵ࡞ࡗࡓ㸦ᑐ㇟⪅ h㸸B-2-1 ࡛ᨵၿࡀ↓ࡃࠊB-2-2 ࡟㐍ࡵ࡞࠿ࡗࡓ㸧ࠋ

27

B-3(㞴᫆ᗘ7)௓ධ⤒㐣㸦ᐇ᪋ᅇᩘ࡟ࡼࡿ㸧
90.0

b

80.0
B-3 ࢚࣮ࣛ⋡㸦㸣㸧

a

c

70.0

d

60.0

e

50.0

f

40.0

g

30.0

h

20.0

i

10.0

j

0.0
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425

ᅗ 10㸬ど✵㛫఩⨨㛵ಀࢆຍ࠼ࡓ࣌ࢢࡢ⛣ື㸦 B-3㸧ࠋᶵ⬟ᨵၿ࡟ᕪࡣ࠶ࡿࡶࡢࡢࠊ⧞ࡾ㏉ࡍㄢ㢟࡟ࡼࡗ࡚࢚࣮ࣛ⋡ࡢపୗࡀㄆࡵࡽࢀ ࡓࠋ

28

C-1-1(㞴᫆ᗘ8)௓ධ⤒㐣㸦ᐇ᪋ᅇᩘ࡟ࡼࡿ㸧ab

C-1-1 ࢚࣮ࣛ⋡㸦㸣㸧

35.0

c
d

30.0

e
25.0

f

20.0

g
h

15.0

i
j

10.0
5.0
0.0
1

2

3

4

5

6

7

8

9 10 11 12 13 14 15 16 17 18

C-1-2(㞴᫆ᗘ9)௓ධ⤒㐣㸦ᐇ᪋ᅇᩘ࡟ࡼࡿ㸧abc

C-1-2 ࢚࣮ࣛ⋡㸦㸣㸧

120.0

d
e

100.0

f
80.0

g
h

60.0

i
j

40.0
20.0
0.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25ᅗ 11㸬❺ㅴࡢࣜࢬ࣒࡟ྜࢃࡏࡓ༢⣧࡞࣌ࢢࡢ⛣ື㸦C-2-1㸧࡜Ⰽ௜࣌ࢢࡢ⛣ື㸦C-2-2㸧ࠋᐇ᪋ྍ⬟࡞ሙྜࡣࠊ࢚࣮ࣛ⋡ࡢపୗ࡜ࡋ࡚ㄢ㢟㐙⾜ࡢᨵၿࡀㄆࡵࡽࢀࡓࠋ ᐇ᪋ᙜึࡼ࢚
࣮ࣛ⋡ࡢప࠸ᑐ㇟⪅ࡣ⤒᫬ⓗኚ໬ࡣ᫂ࡽ࠿࡛ࡣ࡞࠿ࡗࡓ ࠋ29ㄢ㢟㐩ᡂᗘࡢኚ໬
10
9
8

a

7

b

ㄢ 6
㢟
㐩 5
ᡂ
ᗘ 4
3

c
d
e
f
g

2

h

1

i

0
ึᮇ

᭱⤊

j

ᅗ 12㸬ㄢ㢟㛤ጞ᫬Ⅼ࡜᭱⤊฿㐩᫬Ⅼ࡛ࡢㄢ㢟㞴᫆ᗘ㸦㐩ᡂᗘ㸧ࠋ1 ౛㸦h㸧ࢆ㝖࠸࡚ࠊὀពㄢ㢟ࡢ㐩ᡂ㞴᫆ᗘࡀ㧗ࡃ࡞ࡗࡓࠋ

MMSEᚓⅬࡢኚ໬
30
25

MMSE㸦Ⅼ㸧

a
b

20

c
d

15

e
f

10

g
5

h
i

0

j
ึᮇ

᭱⤊

ᅗ 13㸬ㄢ㢟㛤ጞ᫬Ⅼ࡜᭱⤊฿㐩᫬Ⅼ࡛ࡢ MMSEࠋㄢ㢟㛤ጞ᫬࡜⤊஢᫬࡛ MMSE Ⅼᩘࡢୖࡀࡗࡓ౛ࡣ࠶ࡿࡶࡢࡢࠊ⤫ィⓗ᭷ពᕪࡣ↓࠿ࡗࡓࠋ

30

FIMᚓⅬࡢኚ໬
120

100
a
b

FIM㸦Ⅼ㸧

80

c
d

60

e
f

40

g
20

h
i

0

j
ึᮇ

᭱⤊

ᅗ 14㸬ㄢ㢟㛤ጞ᫬Ⅼ࡜᭱⤊฿㐩᫬Ⅼ࡛ࡢ FIM ࡢኚ໬ࠋㄢ㢟㛤ጞ᫬࡜⤊஢᫬࡛ࡢ FIM ࡟⤫ィⓗ᭷ពᕪࡣ↓࠿ࡗࡓࠋ4㸬⪃ᐹศᢸ◊✲⪅ࡽࡣᖹᡂ 25 ᖺᗘ࡟⬻༞୰ᅇ᚟ᮇ࡟ὀពᶵ⬟㈿άㄢ㢟ࢆᐇ᪋ࡋࠊẁ㝵ⓗ࡞ὀពᶵ⬟ࡢᨵၿ࡜ホ౯ࢆ⾜ࡗࡓࠋᮏᖺᗘࡣྠᵝ࡞ࣉࣟࢺࢥ࣮ࣝ࡟ࡼࡗ࡚⬻༞୰ᚋ㑇⑕៏ᛶᮇ࡛࠶ࡾ⬻⾑⟶ᛶㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅ࢆᑐ㇟࡟ὀពᶵ⬟㈿άㄢ㢟ࢆ⾜ࡗࡓࠋᅇ᚟ᮇ
࡟࠾ࡅࡿㄢ㢟カ⦎ࡣ඲౛࡛ὀពᶵ⬟ᨵၿࡢ⤖ᯝࢆᚓࡓࠋ ᮏᖺᗘ࡛ᐇ᪋ࡋࡓ⬻⾑⟶ᛶㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅࡛ࡣࠊᨵၿࡣ඲౛࡛ࡣ࡞ࡃࠊMMSE ᚓⅬࡀ 10 Ⅼ௨ୗࡢ 1 ౛ࡣᨵၿࡀ
ㄆࡵࡽࢀ࡞࠿ࡗࡓࠋMMSE ᚓⅬࡀ 15 Ⅼ௨ୖࡢᑐ㇟⪅࡛ࡣࠊㄢ㢟㐩ᡂᗘࡣྥୖࡋ㸦ᅗ 12㸧ࠊ៏ᛶᮇ࡟࠾࠸࡚ࡶㄢ㢟࡟ࡼࡿຠᯝࡀㄆࡵࡽࢀࡓࠋ
ࡋ࠿ࡋ࡞ࡀࡽࠊㄢ㢟ࡢㄝ᫂࡜ᡭ㡰ࡢ⌮ゎࡀྍ⬟࡛࠶ࡿࡇ࡜ࢆ⪃៖ࡍࡿ࡜ MMSE ᚓⅬࡀ 10 Ⅼ௨ୗࡢㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅ࢆᑐ㇟࡜ࡋ࡚ᐇ᪋ࡍࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡗࡓࠋᮏ◊✲ࡢᑐ㇟⪅࡟ྵࡲࢀࡓ 1 ౛ࡣ㞴᫆ᗘ 5 ࠾ࡼࡧࡑࢀ௨ୖࡢㄢ㢟ࡣᅔ㞴࡛࠶ࡗࡓࠋ㞴᫆ᗘ 5

31ࡣ⛣ືࡍࡿ࣌ࢢࡢⰍࡢ㡰␒ࢆᣦᐃࡋ࡚࠸ࡿㄢ㢟࡛࠶ࡾࠊᐇ᪋࡟ᚲせ࡞グ᠈ᶵ⬟ࡀపୗࡋ࡚࠸ࡓࡇ࡜࡛㐩ᡂࡀᅔ㞴࡛࠶ࡗࡓྍ⬟ᛶࡣ㧗࠸ࠋ MMSE ᚓⅬࡢ 10 Ⅼ௜㏆࡜࡞ࡿグ᠈ᶵ⬟࡜ᮏㄢ㢟ࡢ㐙⾜࡟ᚲせ࡞グ᠈ᶵ⬟࡜ࡀ㏆࠸ࡶࡢ࠿ࡶࡋࢀ࡞࠸ࠋ
ㄢ㢟ࡢ㛤ጞ᫬࡜᭱⤊㐩ᡂ᫬࡛ࡢ MMSE ᚓⅬࡣ඲య࡛ࡣ᭷ពᕪࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࡶ
ࡢࡢࠊMMSE ᚓⅬࡀᨵၿࡋࡓ౛ࡀᏑᅾࡋࡓࠋMMSE ࡣㄆ▱⑕ࢫࢡ࣮ࣜࢽࣥࢢ࡟⏝࠸ࡿㄢ㢟࡛࠶ࡿࡀࠊᮏ◊✲ࡢᑐ㇟⪅ࡀ⬻⾑⟶ᛶㄆ▱⑕࡛࠶ࡗࡓࡇ࡜࠿ࡽࠊ⾑ὶࡢኚືᛶ࡞࡝ࡢせᅉ࡛ᚓⅬࡀኚືࡋࡓྍ⬟ᛶࡣṧࡿࠋᮏㄢ㢟࡟ࡼࡿ MMSE ᚓⅬࡢᨵၿ࡜ࡍࡿ࡟ࡣ᭦࡟᳨ウࡀᚲせ࡛࠶ࡿࠋᖹᡂ 26 ᖺᗘ࡟ᐇ᪋ࡋࡓࠊ⬻༞୰ᚋࡢᅇ᚟ᮇࡢᑐ㇟⪅࡛ࡣㄢ㢟௓ධ๓ࡢㄢ㢟ࣞ࣋ࣝࡣ
MMSE ࡜ࠊ㐩ᡂࣞ࣋ࣝࡣ᪥ᖖ⏕ά⮬❧ᗘ㸦functional independence measure, FIM㸧࡜┦㛵ࡀ࠶ࡗࡓࠋࡋ࠿ࡋࠊᮏ◊✲ࡢᑐ㇟⪅࡛ࡣㄢ㢟㐩ᡂᗘࡀୖࡀࡗ࡚ࡶ㸦ᅗ 12㸧ࠊFIM ᚓ
Ⅼ࡟ኚ໬ࡀ↓ࡃ㸦ᅗ 14㸧ὀពㄢ㢟࡛ࡢㄢ㢟㐩ᡂࡀ᪋タ࡟࠾ࡅࡿ᪥ᖖ⏕ά࡛ࡢ⬟ຊࡢᨵၿ࡟ࡘ࡞ࡀࡗ࡚࠸ࡿ࠿࡝࠺࠿ࠊ࡟ࡘ࠸࡚ࡣ௒ᚋ ࡢ◊✲࡟ࡼࡿ᳨ウࡀᚲせ࡛࠶ࡿࠋᮏ◊✲⤖ᯝࡢ⠊ᅖ࡛ࡣࠊ᪋タධᡤ୰ࡢ㧗㱋⪅࡟࠾࠸࡚ࠊㄆ▱⑕ࡀ㸦MMSE ᚓⅬ࡛ 15 Ⅼ௨ୖ࡞࡝㸧࠶ࡿ⛬ᗘࡢグ᠈ᶵ⬟ࡀಖࡓࢀ࡚࠸ࢀࡤࠊㄆ▱ᶵ⬟ࡢᇶ┙࡜࡞ࡿὀពᶵ⬟ࡀ㈿άㄢ㢟࡟ࡼࡗ࡚ᨵၿኚ໬ࡍࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ⬻⾑⟶㞀ᐖࡢ៏ᛶᮇ࡟࠾ࡅࡿ ㄆ▱ᶵ⬟࡟ࡘ࠸࡚ᶵ
⬟ࡢኚ໬ࡀஈࡋ࠸࡜⪃࠼ࡽࢀࡿࡼ࠺࡞ㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅࡟࠶ࡗ࡚ࡶࠊὀពᶵ⬟ࢆྵࡴㄢ㢟㐙⾜ࡢᏛ⩦ຠᯝࡣ࠶ࡿ࡜⪃࠼ࡽࢀࡓࠋ௓ㆤ᪋タ࡟࠾ࡅࡿ᪥ᖖάື࡛ࡣࠊ1 ᪥ࡢࣜࢬ࣒ࢆࡘࡃࡿࡇ࡜ࢆ┠ⓗ࡜ࡋࡓࡾࠊయຊࡸ㌟
యⓗ࡞ᶵ⬟⥔ᣢࢆ┠ᣦࡋࡓࡾࡍࡿ௓ධࡀ୰ᚰ࡜࡞ࡿࡇ࡜ࡀከ࠸ࠋ ᮏ◊✲࡛⾜ࡗࡓᐇ㦂ⓗ࡞ㄢ㢟ࡸពᅗࡋࡓ஧㔜ㄢ㢟ࢆྲྀࡾධࢀࡿࣉࣟࢢ࣒ࣛࢆ సᡂࡍࡿࡇ࡜ࡣࠊ⌧≧ࡢከࡃࡢ᪋タ࡛ࡣ୍⯡ⓗ࡛ࡣ࡞࠸࡜⪃࠼ࡽࢀࡿ ࠋᮏ◊✲࡟ཧຍࡋࡓ᪋タ฼⏝⪅ࡣᮘୖࢤ࣮࣒ࡢࡼ࠺
࡟ㄢ㢟ࢆ⾜ࡗ࡚࠾ࡾࠊ⡆༢࡞㐨ලࢆ౑ࡗࡓㄢ㢟࡛࠶ࢀࡤ↓⌮࡞ࡃᐇ᪋࡛ࡁࡿࡶࡢ࡜⪃࠼ࡽࢀࡓࠋࣞࢡ࢚࣮ࣜࢩࣙࣥࡸࡑࡢ௚ࡢ࢔ࢡࢸ࢕ࣅࢸ࢕࣮࡟ㄆ▱ᶵ⬟ࡸࡑࡢᇶ┙࡜࡞ࡿὀពᶵ⬟ࡢ㈿άせ⣲ࢆྲྀࡾධࢀࡿࡇ࡜ࡣࠊㄆ ▱ᶵ⬟ࡢ⥔ᣢ࠶ࡿ࠸ࡣᨵၿࡀᮇᚅࡉࢀࡿⅬ࡛ࡣ᭷⏝࡛࠶ࡿ࡜⪃࠼ࡓࠋ㸨㸨㸨㸨㸨㸨㸨㸨㸨㸨32◊✲஦ᴗմ ௓ㆤ᪋タ࡟࠾ࡅࡿ㡢ᴦ⒪ἲ

ᮏ◊✲ศᢸ◊✲⪅ࢢ࣮ࣝࣉࡣᮏ◊✲஦ᴗ࡟ཧຍࡋ࡚௨᮶ࠊ௓ㆤ᪋タ࡛ࡢ㡢ᴦ⒪ἲࡢᐇ㝿࡟ࡘ࠸࡚ࡢᇶ♏ⓗࠊ⮫ᗋⓗ◊✲ࢆ㔜ࡡ࡚ࡁࡓࠋࣜࢬ࣒ࡸ㡢ᴦ࡜⬻ᶵ⬟࡜ࡢ㛵ಀ ࡢᇶ♏
ⓗ◊✲㸦Jomori et al., 2011, 2013㸧ࡢ࡯࠿ࠊ᪋タ࡛ࡢᐇ㊶ࢆ⾜ࡗ࡚ࡁࡓࠋ㡢ᴦ⒪ἲࡣ㡢ᴦࢆ௓ᅾ࡜ࡋ࡚ᑐ㇟⪅࡟ᵝࠎ࡞ാࡁ࠿ࡅࢆ⾜࠺ᡭἲ࡛࠶ࡿࡀࠊ1㸧ㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅࡛ࡶẚ㍑ⓗᶵ⬟ࡀಖࡓࢀࡿ⫈ぬⓗ่⃭ࢆ୰ᚰ࡜ࡋ࡚⾜࠺ࡇ࡜ࠊ2㸧㡢ᴦ⒪ἲኈ࡜ࡢࢥ࣑ࣗ
ࢽࢣ࣮ࢩࣙࣥ࡜࡜ࡶ࡟㐍ࡴࡇ࡜ࠊ3㸧࡞ࡌࡳࡢḷࡸ᭤ࢆ㏻ࡋ࡚ཧຍ⪅┦஫ࡢࢥ࣑ࣗࢽࢣ࣮
ࢩࣙࣥࡀࡣ࠿ࢀࡿࡇ࡜ࠊ࡞࡝┦஫ࢥ࣑ࣗࢽࢣ࣮ࢩࣙࣥࡢሙࡢᥦ౪࡜࠸࠺どⅬ࠿ࡽࡶ ฼Ⅼࡀ࠶ࡿࡶࡢ࡜⪃࠼࡚࠸ࡿࠋ㏆ᖺ࡛ࡣࠊㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅ࡢ㡢ᴦ⒪ἲ࡬ࡢཧຍࡣࠊ௓
ㆤ⪅࡜ඹ࡟ཧຍࡍࡿ࡜ࠊ཮᪉࡬ࡢຠᯝࢆྵࡵ࡚ QoL ࡀ㧗ࡲࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ
㸦Rosness et al., 2011; Cupidi et al., 2012; Bruvik et al., 2012㸧ࠋ㡢ᴦ⒪ἲ࡟ࡣࠊ㡢ᴦࡑࡢࡶࡢࡢຠᯝࢆᮇᚅࡋ࡚ಶูࡢᑐ㇟⪅࡟₇ዌࡸḷၐࢆ⪺࠿ࡏࡿᙧែࡶ࠶ࡿࡀࠊ௓ㆤ᪋タ࡛ࡣࠊᩘே㹼༑ᩘேࡢ ཧຍ⪅ࡀ㞟ᅋ࡛ཧຍࡍࡿᙧᘧࡢ㡢ᴦ⒪ἲ
ࡀከ࠸ࠋ㡢ᴦࢆ࡜ࡾ࠸ࢀࡓ௓ධ࡜ࡋ࡚ࠊ᪋タࡢࢫࢱࢵࣇࡸ௓ㆤ⪅ࡀᣦᑟࡍࡿᙧ࡛ཧຍ⪅ࡢḷၐࡸᴦჾ₇ዌࢆ⾜࠺ሙྜࡀ࠶ࡿࡶࡢࡢࠊࡇࢀࡽࡣࣞࢡ࢚࣮ࣜࢩࣙࣥ࡜ࡋ࡚ࡢຠᯝࢆ
ᮇᚅࡍࡿࡶࡢ࡛ࠊᮏ◊✲࡛ᐇ᪋ࡋࡓ㡢ᴦ⒪ἲ࡜ࡣᮏ㉁ⓗ࡟␗࡞ࡿࠋ
㡢ᴦ⒪ἲࡣ㡢ᴦ⒪ἲኈࡀ⾜࠺≉໬ࡋࡓ௓ධ࡛࠶ࡾࠊ௓ㆤ᪋タ࡛ࡢᐇ᪋ࢆ౛࡟࡜ࡿ࡜ࠊ
ୗグࡢせ⣲ࢆྵࢇ࡛࠸ࡿࠋ
1㸧㡢ᴦ⒪ἲࡢᑟධ࠿ࡽ⤊ࢃࡾࡲ࡛ࠊィ⟬ࡉࢀࡓᵓᡂ࡟ࡼࡿࣉࣟࢢ࣒ࣛ࡟ἢࡗ࡚࡞ࡉࢀࡿࠋ
2㸧ࡑࡢሙࡢཧຍ⪅ࡢ཯ᛂࡸཧຍ≧ἣ࡟⮫ᶵᛂኚ࡟ᑐᛂࡋࡓෆᐜ࡜ࡋࡘࡘ㐍ࡵࡽࢀࡿࠋ
3㸧⏝࠸ࡿ₇ዌࡸḷၐࡣཧຍᑐ㇟⪅௨እࡢ⫈⾗࡟ᑐࡋ࡚ࡶ㡢ᴦࡢᥦ౪࡜ࡋ࡚ࠊ㡢ᴦᢏ⾡࡜ࡋ࡚㉁ࡢ㧗࠸ෆᐜ࡛࠶ࡿࠋ
ᮏ◊✲஦ᴗ࡛ࡣᑓ㛛㡢ᴦ⒪ἲኈ࡟ࡼࡿࣉࣟࢢ࣒ࣛࡢ᳨ウࢆ㔜ࡡࠊ᪋タ࡛㡢ᴦ⒪ἲࢆᐇ᪋ࡍࡿ㝿࡟᭷⏝࡞᝟ሗࡸ᪋タ࡛㡢ᴦ⒪ἲࢆᐇ᪋ࡍࡿ㝿࡟⪃៖ࡍࡿⅬࡢ᳨ウࢆ⥆ࡅ࡚ࡁࡓࠋ
ᮏᖺᗘࡣࠊᮏ◊✲஦ᴗ࡛⾜ࡗ࡚ࡁࡓ௚ࡢ◊✲ᡂᯝ࡜ྲྀࡾධࢀࡘࡘ㡢ᴦ⒪ἲࡢຠᯝ࡟ࡘ࠸᳨࡚ウࡋࡓࠋ

33

1㸬㡢ᴦ⒪ἲ࡬ࡢཧຍᗘ௓ㆤ᪋タ࡛ࡢ㡢ᴦ⒪ἲࡣᕼᮃ⪅ࡢཧຍࡢ࡯࠿ࠊ ࡑࡢຠᯝࢆᮇᚅࡋ࡚ࠊ㔜ᗘࡢㄆ▱⑕ࢆ᭷ࡍࡿ᪋タ฼⏝⪅ࡸάືᛶࡢప࠸ධᒃ⪅ࡀಁࡉࢀ࡚ཧຍࡍࡿሙ ྜࡶᑡ࡞ࡃ࡞࠸ࠋ≉࡟㡢ᴦ⒪ἲࡀከேᩘ࡟ᥦ౪ࡉࢀࡿሙྜࠊ✚ᴟⓗ࡞ཧຍ⪅ࡶ࠶ࢀࡤࠊࡑ࠺࡛ࡣ࡞࠸ཧຍ⪅ࡶΰᅾࡍࡿࡇ࡜࡟࡞ࡿࠋ㡢ᴦ⒪ἲࢆ௓ධࡢࣉࣟࢢ࣒ࣛ࡜ࡋ࡚⏝࠸ࡿሙྜࠊཧຍ⪅ࡀ࡝ࡢࡼ࠺
࡟ཧຍࡋࡓ࠿ࢆᢕᥱࡋ᪋タࢫࢱࢵࣇ࡟᝟ሗ࡜ࡋ࡚ሗ࿌ࡍࡿሙྜࡶ࠶ࡿࠋᮏ◊✲஦ᴗ࡛ࡣࠊ௓ㆤ᪋タࡢ୰࡛ࡢᐇ᪋࡜࠸࠺Ⅼࢆ㔜せ࡜⪃࠼ࠊᐇ᪋ࡍࡿ㡢ᴦ⒪ἲኈ࡜᪋タࢫࢱࢵࣇ࡜᝟
ሗඹ᭷ࡢࡓࡵ㡢ᴦ⒪ἲ࡬ࡢཧຍ≧ἣᣦᩘ㸦 Minimum Assesment for Music Therapy,
MAMT㸧ࢆ⪃᱌ࡋ⏝࠸ࡓ㸦ᅗ 15㸧ࠋ
MAMT ࡣ㡢ᴦ⒪ἲ୰ࡢཧຍ⪅ࡢ≧ἣࢆほᐹࡍࡿࡇ࡜࡛⡆౽࡟Ⅼᩘ໬ࡋࡓࡶࡢ࡛࠶ࡿࠋ
㡢ᴦ࡟㛵ࡍࡿཧຍᗘࡢホ౯ࡀ୰ᚰ࡜࡞ࡗ࡚࠾ࡾࠊグ᠈ᶵ⬟ࡸᅄ⫥ࡢ㐠ືࡸឤぬࡢせ⣲࡞࡝ࡣྵࡲࢀ࡚࠸࡞࠸ࠋㄆ▱⑕ࡢ⛬ᗘࡸ㞀ᐖࡢ⛬ᗘࠊ௓ㆤᚲせᗘࠊ᪥ᖖ⏕άάື࡜ࡣ␗࡞
ࡗࡓάືᛶ࡟ࡘ࠸࡚ぢ࡚࠸ࡿ࡜⪃࠼ࡽࢀࡿࠋMAMT ࡢᚓⅬせ⣲ࡣࠊཧຍ⪅ࡀ㡢ᴦ⒪ἲࡢ
ሙ࡟࡝ࢀࡔࡅධࡾ㎸ࢇ࡛࠸ࡿ࠿ࠊࡍ࡞ࢃࡕࠊ㡢ᴦࢆ௓ࡋࡓࢥ࣑ࣗࢽࢣ࣮ࢩࣙࣥ࡟ຍࢃࡗ
࡚࠸ࡿ࠿࡝࠺࠿ࠊࢆぢࡿࡶࡢ࡛࠶ࡾࠊ㡢ᴦ⒪ἲࡢຠᯝࢆㄽࡌࡿୖ࡛ࡣ㔜せ࡞せ⣲࡛࠶ࡿ࡜⪃࠼ࡓࠋ⾲ 8㸬ྠ୍᪋タ࡛」ᩘᅇ⾜ࡗࡓ㡢ᴦ⒪ἲ࡟࠾ࡅࡿ㸦㡢ᴦ⒪ἲ࡬ࡢཧຍ≧ἣᣦᩘ㸧MAMT
࡜㸦㛗㇂ᕝᘧ⡆᫆ㄆ▱⑕ࢫࢣ࣮ࣝᨵゞ∧㸧 HSD-Rࠋ㡢ᴦ⒪ἲࢭࢵࢩࣙࣥᅇᩘ࡟࠾ࡅࡿ
MAMT Ⅼᩘ

ᑐ㇟⪅

HSD-R

3 ᅇ┠

8 ᅇ┠

A

16

13

14

B

15

19

21

C

18

18

19

D

29

25

26

34

ᅗ 15㸬㡢ᴦ⒪ἲ࡬ࡢཧຍ≧ἣᣦᩘ㸦Minimum Assesment for Music Therapy, MAMT㸧

35

MAMT Ⅼᩘࡣㄆ▱⑕ࡢ⛬ᗘ࡟ᙳ㡪ࡉࢀࡿࠋྠ୍᪋タ࡛」ᩘᅇ⾜ࡗࡓ㡢ᴦ⒪ἲ࡛ࡢグ㍕
౛ࢆ⾲ 8 ࡟♧ࡍࠋMAMT Ⅼᩘࡢ෌⌧ᛶࡣⰋዲ࡛࠶ࡾࠊ㛗㇂ᕝᘧ⡆᫆ㄆ▱⑕ࢫࢣ࣮ࣝᨵゞ∧㸦HSD-R㸧࡛ࡢㄆ▱⑕ࡢ␲࠸㸦20-21 Ⅼ௨ୗ㸧࡛ࡣ MAMT Ⅼᩘࡀపࡃ࡞ࡗ࡚࠸ࡿࠋ㡢ᴦ⒪ἲ୰ࡢࣉࣟࢢ࣒ࣛ㸦ᴦჾࡢ₇ዌࡸḷၐ㸧࡟ཧຍࡍࡿࡓࡵࡢ᥼ຓ࡜ MAMT Ⅼᩘ࡜ࡢ㛵ಀࡣᅗ 16 ࡢࡈ࡜ࡃ࡛࠶ࡾࠊ᥼ຓࡣᴦჾࢆ୍⥴࡟ື࠿ࡍࠊḷࢆࡘ࠸୍࡚⥴࡟ḷ࠺ࠊഐࡽ࡟
ࡘ࠸࡚ࡢಁࡋࠊ࡞࡝࡛࠶ࡿࠋ

ᅗ 16㸬MAMT Ⅼᩘ࡜㡢ᴦ⒪ἲ୰ࡢཧຍ᥼ຓࠋMAMT Ⅼᩘࡢ 20 Ⅼ௜㏆ࢆቃ࡟ࠊཧຍ୰
ࡢ᥼ຓࡀᚲせ࡜࡞ࡿࠋ2㸬᪉ἲᮏᖺᗘࡣࠊ⪁ே௓ㆤಖ㝤᪋タ࡟ධᒃ୰ࡢㄆ▱⑕㧗㱋⪅ࡢ࠺ࡕࠊ≉࡟άືᛶࡢᑡ࡞࠸᪋タ฼⏝⪅ 10 ྡࢆ㑅ࢇ࡛ཧຍࡢ༠ຊࢆᚓࡓࠋཧຍ⪅ࡣẖ㐌 1 ᅇࠊỈ᭙᪥ࡢ༗๓ 10 ᫬㹼11᫬࡟ᐇ᪋ࡉࢀࡓ 10 ᅇ㸦2 ࣨ᭶༙㸧ࡢࢢ࣮ࣝࣉ㡢ᴦ⒪ἲ࡟ཧຍࡋࡓࠋᮏ◊✲஦ᴗ࡛⾜ࡗࡓ௓ㆤ᪋タ࡛ࡢㄆ▱⑕ศ㢮࡜ HSD-R ࡢᚓⅬ࡟ࡼࡗ࡚ 2 ⩌࡟ศࡅ࡚ほᐹࡋࡓ㸦⾲ 9㸧ࠋ36

⾲ 9㸬㡢ᴦ⒪ἲཧຍ⪅
ᖺ㱋

HSD-R

ㄆ▱⑕ศ㢮㸦ᅗ 1㸧

97

19

B

HSD-R

93

14

D

㧗ᚓⅬ⩌

92

23

D

63

22

D

72

24

D

83.4

20.4

80

0

D

HSD-R

80

10

D

పᚓⅬ⩌

76

10

A

87

0

D

81

8

D

80.8

5.6

ᖹᆒ

ᖹᆒ

㡢ᴦ⒪ἲࡣ 2 ྡࡢ㡢ᴦ⒪ἲኈ࡟ࡼࡗ࡚ᐇ᪋ࡋࡓࠋඹ᭷ࢫ࣮࣌ࢫࡢࣇࣟ࢔࡟࡚ᐇ᪋ࡋࠊ
฼⏝⪅ࡢཧ㞟࡟ࡣ᪋タࢫࢱࢵࣇࡢ༠ຊࢆᚓࡓࡀࠊ㡢ᴦ⒪ἲࡢᐇ᪋࡜ㅖほᐹࡣ㡢ᴦ⒪ἲኈ
ࡀ⾜ࡗࡓࠋ1 ᅇࡢ㡢ᴦ⒪ἲ㸦1 ࢭࢵࢩࣙࣥ㸧ࡢᵓᡂࢆ⾲ 10 ࡟♧ࡍࠋ඲య࡛ 35 ศ⛬ᗘࡢᵓᡂ࡜ࡋࡓࠋ㡢ᴦ⒪ἲࡢᵓᡂࠋࡑࢀࡒࢀࡢෆᐜࡣࠊẖᅇ␗࡞ࡗ࡚࠾ࡾࠊཧຍ⪅ࡢ཯ ᛂࢆぢ࡞ࡀࡽ㐺ษ࡞㑅᭤ࠊᴦჾࡢ㑅ᢥ࡞࡝ࢆ⾜ࡗ࡚ᐇ᪋ࡋࡓࠋホ౯ࡣཧຍᣦᩘࡢ MAMT ࡢ࡯࠿ࠊᚑ᮶ࡢ visual-analog-scale ᘧࡢ㡢ᴦ⒪ἲホ౯⾲㸦MiDAS㸧ࢆ⏝࠸ࡓ㸦⾲ 11㸧ࠋ௓ㆤ࡜ࡢ㛵ಀࡣࠊNeuropsychiatricInventory-Questionnaire㸦NIP-Q, Cummings et al., 1994ࠊᅗ 18㸧ࡢኚ໬ࢆ㡢ᴦ⒪ἲ
ᐇ᪋๓ࠊᐇ᪋୰ࡢ㸯ࣨ᭶⤒㐣ᚋ࠾ࡼࡧ㛤ጞᚋ 2 ࣨ᭶⤒㐣ࢆほᐹࡋࡓࠋNIP-Q ࡣ௓ㆤ⪅ࡀ௓ㆤࡋ࡚࠸ࡿᑐ㇟⪅࡟ࡘ࠸࡚௓ㆤ⪅⮬㌟࡛グධࡍࡿ㉁ၥ⣬ἲ࡜ࡋ࡚ࢹࢨ࢖ࣥࡉࢀ࡚࠸ࡿࠋ
NPI-Q ࡣྛ㡯┠ࡢⅬᩘࡢྜィࡀ㔜⑕ᗘ࠾ࡼࡧ௓ㆤ㈇ᢸᗘ࡜ࡋ࡚⾲ࡉࢀࡿࠋ

37

⾲ 10㸬ࢭࢵࢩࣙࣥࡢᵓᡂ࡛⏝࠸ࡓᴦ᭤ࡸෆᐜࡢ౛
ᐇ᪋ձ

ᐇ᪋ղ

ᐇ᪋ճ

ࡇࢇ࡟ࡕࡣࡢḷࡇࢇ࡟ࡕࡣࡢḷࡇࢇ࡟ࡕࡣࡢḷ㸦࢜ࣜࢪࢼࣝ㸧㸦࢜ࣜࢪࢼࣝ㸧㸦࢜ࣜࢪࢼࣝ㸧

ḷၐ

ࡶࡳࡌ

὾㎶ࡢḷ

ᐩኈᒣ

ᑠᴦჾࢆ⏝࠸ࡓ

ୖࢆྥ࠸࡚Ṍࡇ࠺᫂᪥ࡀ࠶ࡿࡉ

㡢ᴦ๰ࢁ࠺

ᑟධ

ࣜࢬ࣒⾲ฟ
ḷㅴ᭤

㸦࢜ࣜࢪࢼࣝ㸧
⨾ࡋ࠸༑௦

ୣࢆ㉺࠼࡚

㉥࡜ࢇࡰ

ࡾࢇࡈࡢḷ

Ꮫ⏕᫬௦

┿ࡗ㉥࡞ኴ㝧

ࢶ࣮ࣜࢳࣕ࢖࣒

࢜ࣜࢪࢼࣝ

࢜ࣜࢪࢼࣝ

࢜ࣜࢪࢼࣝ

ࢡ࣮ࣝࢲ࢘ࣥ

ࡉࡼ࡞ࡽࡢḷ

ࡉࡼ࡞ࡽࡢḷ

ࡉࡼ࡞ࡽࡢḷ

㸦࢜ࣜࢪࢼࣝ㸧㸦࢜ࣜࢪࢼࣝ㸧㸦࢜ࣜࢪࢼࣝ㸧⾲ 11㸬㡢ᴦ⒪ἲࡢホ౯⾲㸦MiDAS㸧

38ᅗ 17㸬 10 ᅇࡢ㡢ᴦ⒪ἲࡢᐇ᪋ࡢኚ໬࡜ MAMT㸦ୖẁ㸧࡜ MiDAS㸦ୗẁ㸧ኚ໬ࠋ⾲ 9
ࡢ 2 ⩌࡟ศࡅ࡚⾲♧ࡋ࡚࠸ࡿࠋHSD-RMAMT ࠾ࡼࡧ MiDAS ⅬᩘࡣࠊHSD-R 㧗ᚓⅬ⩌࡛

ᅗ 18㸬Neuropsychiatric Inventory-Questionnaire㸦NIP-Q, Cummings et al., 1994㸧

39

ᅗ 19㸬Neuropsychiatric Inventory-Questionnaire㸦NIP-Q㸧ࡢ㡯┠ྜィⅬ࡟ࡼࡿ㔜⑕
ᗘ࡜௓ㆤ㈇ᢸᗘࡢ㡢ᴦ⒪ἲ㸦MT㸧୰ࡢኚ໬ࠋHSD-R పᚓⅬ⩌㸦⾲ 9㸧ࡢཧຍ⪅࡟ࡘ࠸
࡚ࡢ್ࠋ

3㸬⤖ᯝ
㡢ᴦ⒪ἲࡣྜィ 10 ᅇ⾜ࢃࢀࡓࠋHSD-R 㧗ᚓⅬ⩌࡟ࡘ࠸࡚ࡣᅇࢆ㔜ࡡࡿࡈ࡜࡟ MAMT
࠾ࡼࡧ MiDAS ࡛⾲ࡉࢀࡿཧຍᗘࡸ⾜ືࠊ཯ᛂࡣホ౯Ⅼᩘ࡛ୖࡀࡿഴྥࢆㄆࡵࡓࠋࡋ࠿
ࡋࠊHSD-R పᚓⅬ⩌࡛ࡣ୍ᐃࡢഴྥࢆ♧ࡉ࡞࠿ࡗࡓ㸦ᅗ 17㸧ࠋHSD-R పᚓⅬ⩌࡟࠾࠸࡚ࠊNIP-Q ࡢྜィⅬ࡛⌧ࡉࢀࡿ㔜⑕ᗘ࡜௓ㆤ㈇ᢸᗘࡣࡸࡸ㍍ῶࡍࡿഴྥࢆㄆࡵࡓࡀᑡᩘ
౛ࡢࡓࡵ࡟⤫ィⓗ࡟ࡣ᭷ព࡛ࡣ࡞࠿ࡗࡓࠋ

4㸬⪃ᐹㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅࡟ᑐࡍࡿ㡢ᴦ⒪ἲࡢຠᯝࡣࠊ ձ㌟యࡢ㐠ືࡸⓎኌ࡟ࡼࡿάືᛶ
ࡢ⥔ᣢࠊղࢢ࣮ࣝࣉ࡜ࡋ࡚ࡢཧຍ࡟ࡼࡿཧຍ⪅┦஫ࡸ㡢ᴦ⒪ἲኈ࡜ࡢࢥ࣑ࣗࢽࢣ࣮ࢩࣙ

40ࣥࡢ⥔ᣢࠊճ⢭⚄ⓗ㈿άຠᯝࠊ࡞࡝ࡀ⪃࠼ࡽࢀ࡚࠸ࡿ㸦㈏, 1996㸧㡢ᴦ⒪ἲࡢཧຍ⪅࡬ࡢຠᯝࢆ♧ࡍࡇ࡜ࡣᐜ࡛᫆ࡣ࡞ࡃࠊཧຍ⪅ࡢ୺ほⓗ࡞ឤ᝿࡟ࡼࡿഴྥ࡜࡞ࡾࠊࡲࡓࠊཧ
ຍ⪅ࡀㄆ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅࡛࠶ࡿሙྜࠊ⮬ぬⓗ࡞ኚ໬ࢆఏ࠼ࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡿࠋㄆ
▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅ࡀ㡢ᴦ⒪ἲ࡟ཧຍࡋࠊάືᛶࡸㄆ▱ᶵ⬟ࠊ᪥ᖖࡢ⏕άάື ࡢᨵၿࡀ࠶ࡿࡇ࡜ࡀᮇᚅࡉࢀࡿࡶࡢࡢࠊ▷᫬㛫ࡢ௓ධ࡛ࡢ㔞ⓗ࡞ኚ໬ࡢᢕᥱࡣ㞴ࡋ࠸ࠋࡑࢀ࡛ࡶࠊ
ᮏ◊✲஦ᴗ࡛ほᐹࡉࢀࡓࡼ࠺࡟ࠊ」ᩘᅇࡢ㡢ᴦ⒪ἲࢆ⧞ࡾ㏉ࡍࡇ࡜࡛ࠊཧຍᗘࡸ⏕άࣜࢬ࣒࡟ኚ໬ࡀ⏕ࡌࡿྍ⬟ᛶࡣ࠶ࡿࠋࡲࡓࠊᖹᡂ 25 ᖺᗘࡢᡃࠎࡢሗ࿌ࡢࡼ࠺࡟ࠊࢣ࢔ࢠ
ࣂ࣮ࢆྵࡵࡓ௓ㆤ⎔ቃࡢᨵၿ࡟ࡣࠊ༢Ⓨ࡛࠶ࢀᑓ㛛໬࡟ࡼࡿ㠀᪥ᖖⓗ࡞㡢ᴦ⎔ቃࢆᥦ౪ࡍࡿࡇ࡜ࡀ᭷ຠ࠿ࡶࡋࢀ࡞࠸ࠋ

㸨㸨㸨㸨㸨㸨㸨㸨㸨㸨ϫ㸬ࡲ࡜ࡵᖹᡂ 26 ᖺᗘࡣࠊ௓ㆤ᪋タࢆ୰ᚰ࡜ࡋࡓ⌧ሙ࡛ࡢࢹ࣮ࢱ཰㞟࡜ゎᯒࡢ◊✲࡟ຊࢆධࢀࡓࠋ
௒ᚋ 10 ᖺ㛫ࡣ㧗㱋⪅ࡢቑຍࡣ⥆ࡁࠊࡑࢀ࡟కࡗ࡚ㄆ ▱⑕ࢆ᭷ࡍࡿ㧗㱋⪅ࡣࡇࢀࡲ࡛࡟࡞
࠸ᩘ࡜࡞ࡗ࡚࠸ࡃࡇ࡜ࡀ☜ᐇ࡛࠶ࡿࠋ ከࡃࡢ㧗㱋⪅࡟࡜ࡗ࡚ࡣࠊ་Ꮫⓗ࡞デ᩿ࡸ἞⒪ࡀ
୰ᚰ࡜࡞ࡿ་Ꮫⓗ࡞⎔ቃ࠿ࡽ௓ㆤ୰ᚰࡢ⎔ቃ࡬࡜ࠊ࠸ࢃࡺࡿ་⒪ࡢ୰ᚰⓗෆᐜࡀ⛣⾜ࡋ࡚࠸ࡃࠋ㧗㱋⪅ࡀㄆ▱⑕ࡸ㌟యⓗ㞀ᐖࢆక࠸ࡘࡘ௓ㆤ⎔ቃ࡬࡜⛣ࡗ࡚࠸ࡃ㐣⛬࡛ ་Ꮫⓗデ᩿࡜ࡣ␗࡞ࡗࡓどⅬ࡛ࠊᑐ㇟⪅ࡢ⑌ᝈࡸ㞀ᐖࡢᑐᛂࡍࡿᚲせࡀฟ࡚ࡃࡿࡶࡢ࠿ࡶࡋࢀ
࡞࠸ࠋࡲࡓ◊✲ศᢸ⪅ࡽࡣࠊ᪋タࢫࢱࢵࣇࡸ௓ㆤ⪅ࡢ㈇ᢸࢆ㍍ῶࡍࡿࡇ࡜ࡀ⤖ᯝⓗ࡟ࡣ௓ㆤࢆཷࡅࡿㄆ▱⑕㧗㱋⪅ࡢ QoL ࡶ㧗ࡵࡿࠊ࡜࠸࠺Ḣ⡿࡛୰ᚰⓗ࡜࡞ࡾࡘࡘ࠶ࡿᇶᮏⓗ⪃࠼᪉࡟ᇶ࡙࠸࡚◊✲ィ⏬ࢆ⟇ᐃࡋ࡚ࡁ࡚࠸ࡿࠋ㔞ⓗ࠾ࡼࡧ㉁ⓗ࡞ேⓗ㈨※࡜ ⤒῭ⓗ㈨※ࡣ௒ᚋ࡜ࡶ༑ศ࡜ࡣゝ࠼࡞࠸≧ἣࡀ⥆ࡃࡇ࡜ࡀᠱᛕࡉࢀࡿࠋ ◊✲࡛ࡣࠊከࡃࡢ㧗㱋⪅ࡀ㔜ᗘࡢㄆ▱⑕ࡸ㞀ᐖࢆ᭷ࡍࡿ≧ἣ࡛࠶ࡗ࡚ࡶࠊ㧗㱋⪅࠾ࡼࡧ㧗㱋⪅࡜ ᫬㛫ࢆඹ᭷ࡍࡿ
ேࠎ཮᪉ࡢ QoL ࡀ⥔ᣢࡉࢀࡿ௓ㆤ⌧ሙࢆ๰⏕࡛ࡁࡿ᪉⟇ࢆᥦ᱌ࡋ࡚࠸ࡃࡇ࡜ࡣ௒ᚋ࡜ࡶ
㔜せ࡜⪃࠼ࡿࠋ

41ཧ⪃ᩥ⊩
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ཌ⏕ປാ┬㸬ᖹᡂ 26 ᖺ∧ཌ⏕ປാⓑ᭩ ೺ᗣ㛗ᑑ♫఍ࡢᐇ⌧࡟ྥࡅ࡚㹼೺ᗣ࣭ண㜵ඖᖺ㹼 㸬 ೺ ᗣ ᑑ ࿨ ࡢ ᘏ ఙ ࡟ ྥ ࡅ ࡓ ᭱ ㏆ ࡢ ྲྀ ⤌ ࡳ 㸬 2014 㸬
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㈏ ⾜Ꮚ㸬㧗㱋⪅ࡢ㡢ᴦ⒪ἲ㸬㡢ᴦஅ཭♫. 1996.

㩷ᐔᚑ  ᐕᐲ⠧ੱ଻ஜஜᐽჇㅴ╬੐ᬺߦࠃࠆ⎇ⓥႎ๔ᦠᐔ ᚑ  ᐕ ᐲ  ⹺ ⍮ ∝ ੺ ⼔ ⎇ ⓥ ႎ ๔ ᦠ ᣉ⸳ߦ߅ߌࠆ⹺⍮∝㜞㦂⠪ߩ 31. ะ਄ߩߚ߼ߩᄙర⊛ࠕࡊࡠ࡯࠴࡮
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