2010 年指標數值 100%
3. 介入內容
Martinez-Alcala 2018 研究中 iBeni apps 是以神經心理學為基礎的應用程式，
認知刺激包含多種領域，如記憶、注意力、理解力、知覺和視覺與空間等，且此
Savulich 2017 的研究，Game Show 開發的主要改善目標為事件記憶(episodic memory)，應用程式使用具吸引力的視覺效果與音效，並且針對年長者提供趣味 取訓練(spaced-retrieval training)，介入組為一週兩次，每次 30 分鐘，共計 8 次的 認知訓練。空間提取訓練藉由不斷在增加時間內回憶某種資訊來學習和保留記憶
的方法。例如提供病患一些資訊，然後在一段時間後對該資訊進行反複測試，如 果回憶成功，則下一次再次要求回憶的間隔會增加，如果回憶失敗將告知病患正 確的答案並會再要求重複一次[69]，而對照組為常規門診介入。試驗進行四週後 將有兩週的清除期(wash-out period)，接著再交叉接受不同的介入。
4. 誤差風險
在 3 篇研究中，Martinez-Alcala 2018 為非盲性非隨機之試驗，而 Savulich 2017 與 Han 20172 篇研究為隨機對照試驗，因此這兩篇研究將使用 Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)做為風險評估工具。
圖 4- 9 誤差風險圖
除了Savulich 2017 由於在文中沒有提及隨機化的方法，也無法得知是否隱匿 分派，因此判定為風險不明，其他項目之誤差皆屬於低風險。
圖4- 10 誤差風險摘要圖
5. 介入效果：
三篇研究共 75 名介入組與 74 名對照組，Han 2017 的研究中使用 USMART 介入的個案其 MMSE 由 25.49 增加至 26.37，而接受常規護理的個案由 25.83 變 化至 25.76。Martinez-Alcala 2018 使用 iBeni 介入組個案其 MMSE 自 28.54 增加 至 29.45，對照組則由 28.72 增加至 28.90。Savulich 2017 研究中，介入組平均 MMSE 由 26.6 上升至 27.4，而對照組由 26.8 下降至 26.1。
三個研究以隨機效果模式綜合計算兩組前後測改變值之差異，結果顯示介入 對於提升MMSE 的效果雖然不大，但達統計顯著性(mean difference 0.88, 95 % CI 0.25-1.51)。
圖4- 11 手機應用程式與常規門診改善認知功能效果森林圖
討論
本篇研究以三大資料庫搜尋，並以滾雪球方試搜尋相關文獻，經過篇名摘要 篩選、全文閱讀篩選後，符合本研究目的最後僅3 篇文獻納入統合分析。最後結 果顯示，手機應用程式的使用可提升輕微認知障礙或失智症患者其認知功能，
MMSE 分數增加雖然達統計顯著，但上升幅度不大。
過去有幾篇文獻回顧探討科技介入對於減緩認知功能退化的研究多使用電 腦設備[70-72]，而非手機應用程式。Gates 等人於 2019 年發表三篇分別針對健康 的中年人、老年人，以及輕度認知功能障礙，以至少持續 12 週以上的電腦認知訓 練介入，對認知功能維持或改善的效果，結果顯示電腦認知訓練對於健康人群之 認知改善效果有限[70, 71]；而對於輕度認知障礙者的試驗文獻因多小樣本、且具 有風險等，作者指出依照現有的文獻證據，不能確定電腦化的認知訓練是否能預 防臨床失智症、改善或維持已經有認知障礙者的認知功能[72]。
雖過去有幾篇探討科技軟體對於改善認知功能的研究，但本篇文獻回顧將介 入方式限縮在平板或手機等移動裝置、介入目標族群為長者以及結果含有認知功 能之測量值條件下，可能使用之介面螢幕太小不易長者使用、或是年長者較沒有 自行尋找相關的 apps 並下載使用的能力、失智症患者仍需要專業醫療服務提供 者的協助及醫療介入等，因此導致符合本研究統合分析條件的文獻相當有限。
美國一篇以科技介入認知訓練及認知復健之系統性文獻回顧指出，各研究使 用的工具各不相同，包括電腦、平板電腦、VR 和遊戲機等。而電腦最為廣泛使 用於輔助認知訓練之介入，多數介入過程均需要治療師或醫護人員協助指導操作，
但也因介入措施間極大的差異性，無法在此研究中比較各不同工具的效果[73]。
另一篇 2017 年美國發表，主要探討不同應用程式對於輕度認知功能障礙之 健康結果影響研究，將介入形態可分為認知訓練與嚴肅遊戲(Cognitive Training and Serious Games)、運動介入(Exercise Intervention)等六大類，但最後作者指出，
依目前的文獻回顧結果，沒有足夠證據證實應用程式可改善認知障礙患者之健康 狀態[74]。
雖然目前發展出許多與健康相關的應用程式，大多數的使用對象為認知功能 正常的對象，且較著重於使用者可自主管理的健康目標，如輔助戒菸、提高服藥 配合度、健康飲食、增加身體活動、糖尿病患之生活型態管理等。雖然根據上述 結果，以平板或手機應用程式作為認知功能改善的介入存在著相當大的挑戰，但
隨著失智症患者人數的增加，照顧者與醫療服務提供者的需求將大幅上升，未來 的文獻回顧的研究方向，可改為探討以新興科技輔助失智症照護與個案管理，，
或是作為遠端醫療諮詢、照顧者教育訓練的工具等，對於降低照顧成本與提升照 護品質的效果。
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