認知障礙者有較差的口腔衛生，因此高齡者如罹患失智症，可能使口腔疾病急速惡化，增加吸入性肺炎的發生，影響他們的健康及生活品質。本研究目的在評價高齡失智症患者口腔照護介入之成效。以隨機對照試驗設計將罹患輕度失智症高齡患者隨機分派到實驗組與對照組。於高雄醫學大學附設醫院體系進行，由神經內科失智症門診主治醫師推薦適合參與研究之患者，最後共有實驗組32人及對照組31人完成前測、三個月後測、六個月後測。衛教介入方式，實驗組給予參加者與照護者診間口腔照護與口腔機能促進的衛生教育課程，內容包括口腔清潔技能指導、咀嚼吞嚥練習的方法、口腔功能重建訓練。此外，每兩週固定給予實驗組電話提醒與諮詢。使用結構式問卷訪談收集口腔健康相關生活品質、自覺口乾狀況、自覺吞嚥狀況、口腔保健行為。使用簡易智能狀態測驗(Mini-Mental Status Examination, MMSE)測量認知功能。由口腔衛生師測量患者的口腔機能(咀嚼機能測試、反覆吞嚥測試、口腔輪替運動次數與口腔濕度)、口腔衛生(牙菌斑指數與舌苔指數)。本研究也進行唾液相關指標收集，收集參加者之唾液回到實驗室以分析其唾液流速、唾液抗菌肽等級，包含乳鐵蛋白、防禦素、組氨素，以上唾液中蛋白濃度以酵素免疫分析法 (Enzyme- linked immunosorbent assay; ELISA)來加以定量。統計分析使用廣義估計方程式(Generalized Estimating Equations, GEE)來分析，介入的成效以Cohen's d之效果量(effect size)呈現。研究結果發現，實驗組相較於對照組的口腔輪替運動/pa/於六個月後測上升，β為4.8、效果量為0.58；/ta/於六個月後測上升，β為4.4、效果量為0.61；/ka/於六個月後測上升，β為3.6、效果量為0.45；反覆吞嚥測試於六個月後測上升，β為1.2、效果量為0.67；咀嚼表現於六個月後測上升，β為0.5、效果量為0.59。口腔衛生方面，實驗組相較於對照組的牙菌斑指數於六個月後測下降，β為－0.4、效果量為0.53；舌苔指數於六個月後測下降，β為－1.8、效果量為0.49；實驗組相較於對照組的唾液流速於六個月後測上升，β為0.7、效果量為0.83；口腔濕度於六個月後測上升，β為2.5、效果量為0.75；口腔健康相關生活品質於六個月後測上升，β為6.1、效果量為0.71；唾液抗菌肽方面，實驗組相較於對照組的乳鐵蛋白(Lactoferrin)於六個月後測上升，β為2.0、效果量為0.82；組氨素-5 (Histatin-5)於三個月後測下降，β為－1.1、效果量為0.82。口腔保健行為方面，實驗組相較於對照組的定期牙科就診於六個月後測增加，aOR為4.1；上次牙科就診目的檢查或洗牙於六個月後測增加，aOR為5.9；三餐後清潔活動假牙於六個月後測增加，aOR為7.4。此外，本研究發現以下變項的三個月後測改變可以預測六個月後測的口腔健康相關生活品質改變：乳鐵蛋白(β=1.7, p=0.009)、口腔輪替運動/ta/(β=0.4, p=0.021)、口腔輪替運動/ka/(β=0.5, p=0.006)、咀嚼表現(β=4.6, p=0.023)、牙菌斑指數(β=－8.5, p<0.001)、舌苔指數(β=－1.9, p=0.002)、「定期牙科就診」(β=13.5, p<0.001)、「上次牙科就診目的檢查或洗牙」(β=12.7, p<0.001)。然而，在認知功能方面，實驗組於所有追蹤時間點的MMSE分數改變皆與對照組沒有差異(p>0.05)。結論針對高齡失智症患者的口腔照護介入，可以有效改善口腔機能、口腔衛生、口腔健康相關生活品質、唾液中乳鐵蛋白及組氨素-5。

Cognitive function is related with oral health. People with mild cognitive impairment have worse oral health than healthy people. If the elderly suffers from dementia, it may cause the rapid deterioration of oral diseases and the incidence of aspiration pneumonia, further impact their health and quality of life. This study aims to evaluate the effects of the intervention of a new-designed method of oral care on oral function and oral hygiene for the elderly. A randomized controlled trial was used. The elderly patients with mild dementia and their caregivers recruited from Kaohsiung Medical University Hospital. All patients were recommended by the physicians of Neurology Dementia outpatient clinic. In total, there were 32 participants in the experimental group (EG) and 31 participants in control group (CG) completed baseline, 3-month and 6-month follow-ups. A brief one-on-one oral health education teaching module including oral hygiene skill, chewing and swallowing practices, and oral function rehabilitation training were conducted on EG patients and their caregivers by a well-trained dental hygienist. The participants were encouraged to do it themselves at home. Moreover, the EG participants received one reminder phone call every 2 weeks. The structured questionnaire was used to collect data regarding oral health-related quality of life (OHRQoL), oral health care behaviors, perceived dry mouth conditions and perceived swallowing conditions. Cognitive function was measured by the Mini-Mental Status Examination (MMSE). The data related to plaque index (PI), Winkel tongue coating index (WTCI) masticatory efficiency test, repetitive saliva swallowing test (RSST), the diadochokinetic (DDK) rate and humidity test was measured by a dental hygienist. For salivary indicators, collected saliva from participants took back to the laboratory to analyze their saliva flow rate, salivary antimicrobial peptide level, including lactoferrin, defensin, and histatin. These protein concentrations in saliva were analyzed by enzyme-linked immunosorbent assay (ELISA). Generalized Estimating Equations (GEE) were used to analyze, and Cohen's d was used to indicate effect sizes. The results of the study found that compared with the control group, oral DDK /pa/ increased after six months, with a β of 4.8 and an effect size of 0.58; /ta/ increased after six months, with a β of 4.4 , the effect size was 0.61; /ka/ increased after six months, β was 3.6, and the effect size was 0.45; the repeated swallowing test increased after six months, β was 1.2, and the effect size was 0.67; After one month, the test increased, β was 0.5, and the effect size was 0.59. In terms of oral hygiene, compared with the control group, the plaque index of the experimental group decreased after six months, with a β of -0.4 and an effect size of 0.53; the tongue coating index decreased after six months, with a β of -1.8 and an effect of Compared with the control group, the saliva flow rate of the experimental group increased after six months, β was 0.7, and the effect size was 0.83; the oral humidity increased after six months, β was 2.5, and the effect size was 0.75; Oral health-related quality of life increased after six months, with a β of 6.1 and an effect size of 0.71; in terms of salivary antimicrobial peptides, Lactoferrin in the experimental group increased after six months compared with the control group, with a β of 2.0 and an effect size of 0.71. was 0.82; Hisatin-5 decreased after three months, β was -1.1, and the effect size was 0.82. In terms of oral health behaviors, compared with the control group, the regular dental visits of the experimental group increased after six months, with an OR of 4.1; the last dental check-up or cleaning of teeth increased after six months, with an OR of 5.9; Cleaning dentures after meals increased at six months, with an aOR of 7.4. In addition, the study found that 3-month follow-up changes in the following variables could predict 6-month follow-up changes in OHRQoL: lactoferrin (β=1.7, p=0.009), oral DDK /ta/ (β=0.4, p=0.021), oral DDK/ka/(β=0.5, p=0.006), masticatory performance (β=4.6, p=0.023), PI (β=-8.5, p<0.001), WTCI (β=-1.9, p=0.002), "regular dental visits" (β=13.5, p<0.001), "dental visit for examination or scaling" (β=12.7, p<0.001). However, there were no difference between the EG and the CG in the change of MMSE scores in cognitive function at all follow-up points (p>0.05). In conclusion, oral care intervention for elderly patients with dementia can effectively improve oral function, oral hygiene, OHRQoL, salivary lactoferrin and histatin-5.

第一章 緒論 1
第一節 研究背景 1
第二節 研究動機與目的 3
第二章 文獻探討 5
第一節 失智症流行病學 5
第二節 口腔衰弱與口腔功能低下之定義 8
第三節 高齡者口腔機能問題及其影響 19
第四節 失智症與吞嚥困難的相關性 25
第五節 失智症對唾液抗菌肽之影響 27
第六節 失智症病程與早期介入的重要性 29
第七節 高齡者的口腔照護介入 32
第三章 研究方法 36
第一節 研究倫理審查 36
第二節 研究設計 37
第三節 研究對象 38
第四節 樣本數估計 39
第五節 研究架構 40
第六節 研究流程 41
第七節 研究工具發展 43
第八節 變項測量 46
第九節 口腔照護介入 52
第十節 資料收集方法 55
第十一節 資料統計分析 56
第四章 研究結果 59
第一節 參加者招募 59
第二節 基本人口學分佈 60
第三節 實驗組與對照組口腔與身體健康分佈 61
第四節 實驗組與對照組口腔健康與口腔機能指標前測分佈 62
第五節 實驗組與對照組生活品質與唾液抗菌肽前測分佈 63
第六節 實驗組與對照組口腔照護行為前測分佈 64
第七節 實驗組與對照組口腔健康與口腔機能指標組內前後測成效 66
第八節 實驗組與對照組生活品質與唾液抗菌肽組內前後測成效 77
第九節 實驗組口腔照護行為之組內前後測成效 85
第十節 實驗組與對照組口腔健康與口腔機能指標組間前後測成效 86
第十一節 實驗組與對照組生活品質與唾液抗菌肽組間前後測成效 89
第十二節 實驗組與對照組認知功能前後測成效 90
第十三節 實驗組與對照組口腔照護行為之組間前後測成效 91
第十四節 實驗組口腔機能、唾液抗菌肽及口腔照護行為三個月後測改變與生活品質六個月後測改變量之相關性 93
第五章 討論 94
第一節 失智症患者介入後對口腔機能之成效 95
第二節 失智症患者介入後對唾液抗菌肽之成效 97
第三節 失智症患者介入後對生活品質之成效 99
第四節 失智症患者介入後對口腔照護行為之成效 101
第五節 失智症患者介入後對認知功能之成效 103
第六節 研究限制 105
第六章 結論與建議 107
參考文獻 109
分析圖表 121
附錄 154

ADI. (2019). About dementia. Alzheimer's Disease International Retrieved from https://www.alzint.org/about/
Altman, K. W., Richards, A., Goldberg, L., Frucht, S., & McCabe, D. J. (2013). Dysphagia in stroke, neurodegenerative disease, and advanced dementia. Otolaryngol Clin North Am, 46(6), 1137-1149. https://doi.org/10.1016/j.otc.2013.08.005
Altpeter, M., Earp, J. A., Bishop, C., & Eng, E. (1999). Lay health advisor activity levels: definitions from the field. Health Educ Behav, 26(4), 495-512. https://doi.org/10.1177/109019819902600408
APA. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association
Aragon, F., Zea-Sevilla, M. A., Montero, J., Sancho, P., Corral, R., Tejedor, C., Frades-Payo, B., Paredes-Gallardo, V., & Albaladejo, A. (2018). Oral health in Alzheimer's disease: a multicenter case-control study. Clin Oral Investig, 22(9), 3061-3070. https://doi.org/10.1007/s00784-018-2396-z
Arzumanian, V. G., Foshina, E. P., Ojovan, I. M., Iksanova, A. M., Kolyganova, T. I., & Mironov, A. Y. (2021). Method of salivary histatins determination. Klin Lab Diagn, 66(6), 358-363. https://doi.org/10.51620/0869-2084-2021-66-6-358-363 (capital EM, Cyrillicsmall ie, Cyrillicsmall te, Cyrillicsmall o, Cyrillicsmall de, Cyrillic small o, Cyrillicsmall pe, Cyrillicsmall er, Cyrillicsmall ie, Cyrillicsmall de, Cyrillicsmall ie, Cyrillicsmall el, Cyrillicsmall ie, Cyrillicsmall en, Cyrillicsmall i, Cyrillicsmall ya, Cyrillic small ghe, Cyrillicsmall i, Cyrillicsmall es, Cyrillicsmall te, Cyrillicsmall a, Cyrillicsmall te, Cyrillicsmall i, Cyrillicsmall en, Cyrillicsmall o, Cyrillicsmall ve, Cyrillic small es, Cyrillicsmall el, Cyrillicsmall yu, Cyrillicsmall en, Cyrillicsmall yeru, Cyrillic.)
Atchison, K. A., & Dolan, T. A. (1990). Development of the Geriatric Oral Health Assessment Index. J Dent Educ, 54(11), 680-687. https://www.ncbi.nlm.nih.gov/pubmed/2229624
Becker, J., Tárraga, L., Ziolko, S., & Lopez, O. (2007). Gene-Environment Interactions With Cognition in Late Life and Compression of Morbidity. Am J Psychiatry, 164, 849-852. https://doi.org/10.1176/appi.ajp.164.6.849
Belafsky, P. C., Mouadeb, D. A., Rees, C. J., Pryor, J. C., Postma, G. N., Allen, J., & Leonard, R. J. (2008). Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol, 117(12), 919-924. https://doi.org/10.1177/000348940811701210
Blotnick, E., Sol, A., Bachrach, G., & Muhlrad, A. (2017). Interactions of histatin-3 and histatin-5 with actin. BMC Biochem, 18(1), 3. https://doi.org/10.1186/s12858-017-0078-0
Bruno, F., Malvaso, A., Canterini, S., & Bruni, A. C. (2022). Antimicrobial Peptides (AMPs) in the Pathogenesis of Alzheimer's Disease: Implications for Diagnosis and Treatment. Antibiotics (Basel), 11(6). https://doi.org/10.3390/antibiotics11060726
Budtz-Jorgensen, E., Mojon, P., Rentsch, A., & Deslauriers, N. (2000). Effects of an oral health program on the occurrence of oral candidosis in a long-term care facility. Community Dent Oral Epidemiol, 28(2), 141-149. https://doi.org/10.1034/j.1600-0528.2000.028002141.x
Carro, E., Bartolome, F., Bermejo-Pareja, F., Villarejo-Galende, A., Molina, J. A., Ortiz, P., Calero, M., Rabano, A., Cantero, J. L., & Orive, G. (2017). Early diagnosis of mild cognitive impairment and Alzheimer's disease based on salivary lactoferrin. Alzheimers Dement (Amst), 8, 131-138. https://doi.org/10.1016/j.dadm.2017.04.002
Cavalheiro, C. H., Abegg, C., Fontanive, V. N., & Davoglio, R. S. (2016). Dental pain, use of dental services and oral health-related quality of life in southern Brazil. Braz Oral Res, 30(1). https://doi.org/10.1590/1807-3107BOR-2016.vol30.0039
Cerutti-Kopplin, D., Feine, J., Padilha, D. M., de Souza, R. F., Ahmadi, M., Rompre, P., Booij, L., & Emami, E. (2016). Tooth Loss Increases the Risk of Diminished Cognitive Function: A Systematic Review and Meta-analysis. JDR Clin Trans Res, 1(1), 10-19. https://doi.org/10.1177/2380084416633102
Cho, M. J., & Kim, E. K. (2019). Subjective chewing ability and health-related quality of life among the elderly. Gerodontology, 36(2), 99-106. https://doi.org/10.1111/ger.12385
Cieslik, M., Baginska, N., Gorski, A., & Jonczyk-Matysiak, E. (2021). Human beta-Defensin 2 and Its Postulated Role in Modulation of the Immune Response. Cells, 10(11). https://doi.org/10.3390/cells10112991
Contini, C., Olianas, A., Serrao, S., Deriu, C., Iavarone, F., Boroumand, M., Bizzarro, A., Lauria, A., Faa, G., Castagnola, M., Messana, I., Manconi, B., Masullo, C., & Cabras, T. (2021). Top-Down Proteomics of Human Saliva Highlights Anti-inflammatory, Antioxidant, and Antimicrobial Defense Responses in Alzheimer Disease. Front Neurosci, 15, 668852. https://doi.org/10.3389/fnins.2021.668852
de Andrade, F. B., Lebrao, M. L., Santos, J. L., & Duarte, Y. A. (2013). Relationship between oral health and frailty in community-dwelling elderly individuals in Brazil. J Am Geriatr Soc, 61(5), 809-814. https://doi.org/10.1111/jgs.12221
Diamond, G., & Ryan, L. (2011). Beta-defensins: what are they really doing in the oral cavity? Oral Dis, 17(7), 628-635. https://doi.org/10.1111/j.1601-0825.2011.01799.x
Dibello, V., Zupo, R., Sardone, R., Lozupone, M., Castellana, F., Dibello, A., Daniele, A., De Pergola, G., Bortone, I., Lampignano, L., Giannelli, G., & Panza, F. (2021). Oral frailty and its determinants in older age: a systematic review. Lancet Healthy Longev, 2(8), e507-e520. https://doi.org/10.1016/S2666-7568(21)00143-4
Dodds, M. W., Johnson, D. A., & Yeh, C. K. (2005). Health benefits of saliva: a review. J Dent, 33(3), 223-233. https://doi.org/10.1016/j.jdent.2004.10.009
Dominy, S. S., Lynch, C., Ermini, F., Benedyk, M., Marczyk, A., Konradi, A., Nguyen, M., Haditsch, U., Raha, D., Griffin, C., Holsinger, L. J., Arastu-Kapur, S., Kaba, S., Lee, A., Ryder, M. I., Potempa, B., Mydel, P., Hellvard, A., Adamowicz, K., . . . Potempa, J. (2019). Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv, 5(1), eaau3333. https://doi.org/10.1126/sciadv.aau3333
Ferguson, J. W. (2005). The Palmer notation system and its use with personal computer applications. Br Dent J, 198(9), 551-553. https://doi.org/10.1038/sj.bdj.4812303
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12(3), 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
Fratiglioni, L., Launer, L. J., Andersen, K., Breteler, M. M., Copeland, J. R., Dartigues, J. F., Lobo, A., Martinez-Lage, J., Soininen, H., & Hofman, A. (2000). Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology, 54(11 Suppl 5), S10-15. https://www.ncbi.nlm.nih.gov/pubmed/10854355
Frenkel, H., Harvey, I., & Newcombe, R. G. (2001). Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial. Community Dent Oral Epidemiol, 29(4), 289-297. https://doi.org/10.1034/j.1600-0528.2001.290408.x
Fukushima, Y., Sano, Y., Isozaki, Y., Endo, M., Tomoda, T., Kitamura, T., Sato, T., Kamijo, Y., Haga, Y., & Yoda, T. (2019). A pilot clinical evaluation of oral mucosal dryness in dehydrated patients using a moisture-checking device. Clin Exp Dent Res, 5(2), 116-120. https://doi.org/10.1002/cre2.145
Fukushima, Y., Yoda, T., Araki, R., Sakai, T., Toya, S., Ito, K., Funayama, S., Enoki, Y., & Sato, T. (2017). Evaluation of oral wetness using an improved moisture-checking device for the diagnosis of dry mouth. Oral Science International, 14, 33-36.
Gonzalez-Fernandez, M., Humbert, I., Winegrad, H., Cappola, A. R., & Fried, L. P. (2014). Dysphagia in old-old women: prevalence as determined according to self-report and the 3-ounce water swallowing test. J Am Geriatr Soc, 62(4), 716-720. https://doi.org/10.1111/jgs.12745
Hama, Y., Kanazawa, M., Minakuchi, S., Uchida, T., & Sasaki, Y. (2014). Properties of a color-changeable chewing gum used to evaluate masticatory performance. J Prosthodont Res, 58(2), 102-106. https://doi.org/10.1016/j.jpor.2013.12.005
Hayasaka, K., Tomata, Y., Aida, J., Watanabe, T., Kakizaki, M., & Tsuji, I. (2013). Tooth loss and mortality in elderly Japanese adults: effect of oral care. J Am Geriatr Soc, 61(5), 815-820. https://doi.org/10.1111/jgs.12225
Horiguchi, S., & Suzuki, Y. (2011). Screening tests in Evaluating Swallowing Function. Japan Medical Association, 1, 31-34.
Iinuma, T., Arai, Y., Fukumoto, M., Takayama, M., Abe, Y., Asakura, K., Nishiwaki, Y., Takebayashi, T., Iwase, T., Komiyama, K., Gionhaku, N., & Hirose, N. (2012). Maximum occlusal force and physical performance in the oldest old: the Tokyo oldest old survey on total health. J Am Geriatr Soc, 60(1), 68-76. https://doi.org/10.1111/j.1532-5415.2011.03780.x
Ikebe, K., Matsuda, K., Kagawa, R., Enoki, K., Yoshida, M., Maeda, Y., & Nokubi, T. (2011). Association of masticatory performance with age, gender, number of teeth, occlusal force and salivary flow in Japanese older adults: is ageing a risk factor for masticatory dysfunction? Arch Oral Biol, 56(10), 991-996. https://doi.org/10.1016/j.archoralbio.2011.03.019
Ikeda, M., Hokoishi, K., Maki, N., Nebu, A., Tachibana, N., Komori, K., Shigenobu, K., Fukuhara, R., & Tanabe, H. (2001). Increased prevalence of vascular dementia in Japan: a community-based epidemiological study. Neurology, 57(5), 839-844. https://doi.org/10.1212/wnl.57.5.839
Iwamoto, T., Koshibu, J., Kikawada, M., Yoneda, Y., Uno, M., Takasaki, M., & Imamura, T. (2001). [Findings of bedside swallowing assessment and brain computerized tomography in patients with chronic cerebral infarction, and their outcome]. Nihon Ronen Igakkai Zasshi, 38(5), 651-658. https://doi.org/10.3143/geriatrics.38.651
Iwao, Y., Shigeishi, H., Takahashi, S., Uchida, S., Kawano, S., & Sugiyama, M. (2019). Improvement of physical and oral function in community-dwelling older people after a 3-month long-term care prevention program including physical exercise, oral health instruction, and nutritional guidance. Clin Exp Dent Res, 5(6), 611-619. https://doi.org/10.1002/cre2.226
Izuno, H., Hori, K., Sawada, M., Fukuda, M., Hatayama, C., Ito, K., Nomura, Y., & Inoue, M. (2016). Physical fitness and oral function in community-dwelling older people: a pilot study. Gerodontology, 33(4), 470-479. https://doi.org/10.1111/ger.12186
Jablonski, R. A., Kolanowski, A. M., Azuero, A., Winstead, V., Jones-Townsend, C., & Geisinger, M. L. (2018). Randomised clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care. Gerodontology, 35(4), 365-375. https://doi.org/10.1111/ger.12357
Jung, W. K., Park, S. B., Kim, H. R., Ryu, H. Y., Kim, Y. H., & Kim, J. (2021). Advanced Glycation End Products Increase Salivary Gland Hypofunction in d-Galactose-Induced Aging Rats and Its Prevention by Physical Exercise. Curr Issues Mol Biol, 43(3), 2059-2067. https://doi.org/10.3390/cimb43030142
Jurczak, A., Koscielniak, D., Papiez, M., Vyhouskaya, P., & Krzysciak, W. (2015). A study on beta-defensin-2 and histatin-5 as a diagnostic marker of early childhood caries progression. Biol Res, 48, 61. https://doi.org/10.1186/s40659-015-0050-7
Kikutani, T., Tamura, F., Takahashi, Y., Konishi, K., & Hamada, R. (2012). A novel rapid oral bacteria detection apparatus for effective oral care to prevent pneumonia. Gerodontology, 29(2), e560-565. https://doi.org/10.1111/j.1741-2358.2011.00517.x
Kikutani, T., Tamura, F., Tashiro, H., Yoshida, M., Konishi, K., & Hamada, R. (2015). Relationship between oral bacteria count and pneumonia onset in elderly nursing home residents. Geriatr Gerontol Int, 15(4), 417-421. https://doi.org/10.1111/ggi.12286
Kim, H. J., Lee, J. Y., Lee, E. S., Jung, H. J., Ahn, H. J., & Kim, B. I. (2019). Improvements in oral functions of elderly after simple oral exercise. Clin Interv Aging, 14, 915-924. https://doi.org/10.2147/CIA.S205236
Kim, M. J., Hong, J. Y., Lee, G., Yoon, T., Hwang, S. H., Kim, H. H., Jung, Y., & Park, J. S. (2020). Effects of chewing exercises on the occlusal force and masseter muscle thickness in community-dwelling Koreans aged 65 years and older: A randomised assessor-blind trial. J Oral Rehabil, 47(9), 1103-1109. https://doi.org/10.1111/joor.13036
Kohara, N., Yamanouchi, H., Kuzuhara, S., Yoshimura, M., & Toyokura, Y. (1989). [Progressive supranuclear palsy accompanied with progressive subcortical vascular encephalopathy of Binswanger type--a case report]. Rinsho Shinkeigaku, 29(2), 191-195. https://www.ncbi.nlm.nih.gov/pubmed/2752647
Kosaka, T., Ono, T., Kida, M., Kikui, M., Yamamoto, M., Yasui, S., Nokubi, T., Maeda, Y., Kokubo, Y., Watanabe, M., & Miyamoto, Y. (2016). A multifactorial model of masticatory performance: the Suita study. Journal of Oral Rehabilitation, 43(5), 340-347. https://doi.org/10.1111/joor.12371
Krall, E., Hayes, C., & Garcia, R. (1998). How dentition status and masticatory function affect nutrient intake. J Am Dent Assoc, 129(9), 1261-1269. https://doi.org/10.14219/jada.archive.1998.0423
Kugimiya, Y., Watanabe, Y., Shirobe, M., Motohashi, Y., Motokawa, K., Edahiro, A., Ohara, Y., Ryu, M., Igarashi, K., Hoshino, D., Nakajima, J., Ueda, T., Taniguchi, Y., Ogawa, T., Maekawa, K., Tamaki, K., Kuboki, T., Kitamura, A., Shinkai, S., & Hirano, H. (2021). A comparison of colorimetric and visual methods for the assessment of masticatory performance with color-changeable chewing gum in older persons. J Dent Sci, 16(1), 380-388. https://doi.org/10.1016/j.jds.2020.08.010
Li, X. L., Liu, M. Y., Cheng, L., Zhu, H. F., & Cui, D. (2018). [Impact of oral health promotion project on periodontal condition and life quality of the elderly in long-term care institutions]. Shanghai Kou Qiang Yi Xue, 27(3), 285-288. https://www.ncbi.nlm.nih.gov/pubmed/30411125
Liu, B., Dion, M. R., Jurasic, M. M., Gibson, G., & Jones, J. A. (2012). Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol, 114(1), 52-60. https://doi.org/10.1016/j.oooo.2011.11.014
Lobo, A., Launer, L. J., Fratiglioni, L., Andersen, K., Di Carlo, A., Breteler, M. M., Copeland, J. R., Dartigues, J. F., Jagger, C., Martinez-Lage, J., Soininen, H., & Hofman, A. (2000). Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology, 54(11 Suppl 5), S4-9. https://www.ncbi.nlm.nih.gov/pubmed/10854354
Lu, T. Y., Chen, J. H., Du, J. K., Lin, Y. C., Ho, P. S., Lee, C. H., Hu, C. Y., & Huang, H. L. (2020). Dysphagia and masticatory performance as a mediator of the xerostomia to quality of life relation in the older population. BMC Geriatr, 20(1), 521. https://doi.org/10.1186/s12877-020-01901-4
Matsubara, C., Shirobe, M., Furuya, J., Watanabe, Y., Motokawa, K., Edahiro, A., Ohara, Y., Awata, S., Kim, H., Fujiwara, Y., Obuchi, S., Hirano, H., & Minakuchi, S. (2021). Effect of oral health intervention on cognitive decline in community-dwelling older adults: A randomized controlled trial. Arch Gerontol Geriatr, 92, 104267. https://doi.org/10.1016/j.archger.2020.104267
McGrath, C., & Bedi, R. (1999). The importance of oral health to older people's quality of life. Gerodontology, 16(1), 59-63. https://doi.org/10.1111/j.1741-2358.1999.00059.x
Meijers, J. M., Schols, J. M., & Halfens, R. J. (2014). Malnutrition in care home residents with dementia. J Nutr Health Aging, 18(6), 595-600. https://doi.org/10.1007/s12603-014-0006-6
MHLW. (2009). The Manuals of the Evaluation for Ability to Perform Daily Activities on Preventive Care. Japan: Ministry of Health, Labour and Welfare, Japan Retrieved from https://www.mhlw.go.jp/topics/2009/05/dl/tp0501-1c_0001.pdf
Minakuchi, S., Tsuga, K., Ikebe, K., Ueda, T., Tamura, F., Nagao, K., Furuya, J., Matsuo, K., Yamamoto, K., Kanazawa, M., Watanabe, Y., Hirano, H., Kikutani, T., & Sakurai, K. (2018). Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology, 35(4), 317-324. https://doi.org/10.1111/ger.12347
Monograph, P. (2010). Solution for complex pathologies ! PRODUCT MONOGRAPH.
Morley, J. E. (2003). Anorexia and weight loss in older persons. J Gerontol A Biol Sci Med Sci, 58(2), 131-137. https://doi.org/10.1093/gerona/58.2.m131
Nakanishi, N., Fukuda, H., Takatorige, T., & Tatara, K. (2005). Relationship between self-assessed masticatory disability and 9-year mortality in a cohort of community-residing elderly people. J Am Geriatr Soc, 53(1), 54-58. https://doi.org/10.1111/j.1532-5415.2005.53010.x
Nakano, M., Yoshida, A., Wakabayashi, H., Tanaka, M., Yamauchi, K., Abe, F., & Masuda, Y. (2019). Effect of tablets containing lactoferrin and lactoperoxidase on gingival health in adults: A randomized, double-blind, placebo-controlled clinical trial. J Periodontal Res, 54(6), 702-708. https://doi.org/10.1111/jre.12679
Nishimoto, M., Tanaka, T., Hirano, H., Watanabe, Y., Ohara, Y., Shirobe, M., & Iijima, K. (2023). Severe Periodontitis Increases the Risk of Oral Frailty: A Six-Year Follow-Up Study from Kashiwa Cohort Study. Geriatrics (Basel), 8(1). https://doi.org/10.3390/geriatrics8010025
Okamoto, N., Morikawa, M., Okamoto, K., Habu, N., Iwamoto, J., Tomioka, K., Saeki, K., Yanagi, M., Amano, N., & Kurumatani, N. (2010). Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the Fujiwara-kyo study. Behav Brain Funct, 6, 77. https://doi.org/10.1186/1744-9081-6-77
Okamoto, N., Morikawa, M., Tomioka, K., Yanagi, M., Amano, N., & Kurumatani, N. (2015). Association between tooth loss and the development of mild memory impairment in the elderly: the Fujiwara-kyo Study. J Alzheimers Dis, 44(3), 777-786. https://doi.org/10.3233/JAD-141665
Papadopoulou, S. L., Exarchakos, G., Christodoulou, D., Theodorou, S., Beris, A., & Ploumis, A. (2017). Adaptation and Assessment of Reliability and Validity of the Greek Version of the Ohkuma Questionnaire for Dysphagia Screening. Int Arch Otorhinolaryngol, 21(1), 58-65. https://doi.org/10.1055/s-0036-1580613
Petersen, P. E., & Yamamoto, T. (2005). Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol, 33(2), 81-92. https://doi.org/10.1111/j.1600-0528.2004.00219.x
Prell, T., & Perner, C. (2018). Disease Specific Aspects of Malnutrition in Neurogeriatric Patients. Front Aging Neurosci, 10, 80. https://doi.org/10.3389/fnagi.2018.00080
Prince, M., Wimo, A., Guerchet, M., Ali, G., Wu, Y., & Prina, M. (2015). World Alzheimer Report 2015: The Global Impact of Dementia (World Alzheimer Report, Issue. https://www.alzint.org/resource/world-alzheimer-report-2015/
Reseco, L., Atienza, M., Fernandez-Alvarez, M., Carro, E., & Cantero, J. L. (2021). Salivary lactoferrin is associated with cortical amyloid-beta load, cortical integrity, and memory in aging. Alzheimers Res Ther, 13(1), 150. https://doi.org/10.1186/s13195-021-00891-8
Ryu, M., Ueda, T., Saito, T., Yasui, M., Ishihara, K., & Sakurai, K. (2010). Oral environmental factors affecting number of microbes in saliva of complete denture wearers. J Oral Rehabil, 37(3), 194-201. https://doi.org/10.1111/j.1365-2842.2009.02042.x
Sakayori, T., Maki, Y., Hirata, S., Okada, M., & Ishii, T. (2013). Evaluation of a Japanese "Prevention of long-term care" project for the improvement in oral function in the high-risk elderly. Geriatr Gerontol Int, 13(2), 451-457. https://doi.org/10.1111/j.1447-0594.2012.00930.x
Sawilowsky, S. S. (2009). New Effect Size Rules of Thumb. The Journal of Modern Applied Statistical Methods, 8.
Schou, L., Wight, C., Clemson, N., Douglas, S., & Clark, C. (1989). Oral health promotion for institutionalised elderly. Community Dent Oral Epidemiol, 17(1), 2-6. https://doi.org/10.1111/j.1600-0528.1989.tb01815.x
Schulz, K. F., Altman, D. G., Moher, D., & Group, C. (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ, 340, c332. https://doi.org/10.1136/bmj.c332
Seo, K., & Kim, H. N. (2020). Effects of oral health programmes on xerostomia in community-dwelling elderly: A systematic review and meta-analysis. Int J Dent Hyg, 18(1), 52-61. https://doi.org/10.1111/idh.12418
Shah, D., Son, K. N., Kalmodia, S., Lee, B. S., Ali, M., Balasubramaniam, A., Shukla, D., & Aakalu, V. K. (2020). Wound Healing Properties of Histatin-5 and Identification of a Functional Domain Required for Histatin-5-Induced Cell Migration. Mol Ther Methods Clin Dev, 17, 709-716. https://doi.org/10.1016/j.omtm.2020.03.027
Sheiham, A., Steele, J. G., Marcenes, W., Lowe, C., Finch, S., Bates, C. J., Prentice, A., & Walls, A. W. G. (2001). The relationship among dental status, nutrient intake, and nutritional status in older people. J Dent Res, 80(2), 408-413. ://WOS:000171026600002
Stewart, R., Stenman, U., Hakeberg, M., Hagglin, C., Gustafson, D., & Skoog, I. (2015). Associations between oral health and risk of dementia in a 37-year follow-up study: the prospective population study of women in Gothenburg. J Am Geriatr Soc, 63(1), 100-105. https://doi.org/10.1111/jgs.13194
Suzuki, T., Kumagai, H., Watanabe, T., Uchida, T., & Nagao, M. (1997). Evaluation of complete denture occlusal contacts using pressure-sensitive sheets. Int J Prosthodont, 10(4), 386-391. https://www.ncbi.nlm.nih.gov/pubmed/9484050
Swoboda, J., Kiyak, H. A., Persson, R. E., Persson, G. R., Yamaguchi, D. K., MacEntee, M. I., & Wyatt, C. C. (2006). Predictors of oral health quality of life in older adults. Spec Care Dentist, 26(4), 137-144.
Szekeres, M., Ivitz, E., Datki, Z., Kalman, J., Pakaski, M., Varhelyi, Z. P., Klivenyi, P., Zadori, D., Somogyvari, F., Szolnoki, Z., Vecsei, L., & Mandi, Y. (2016). Relevance of defensin beta-2 and alpha defensins (HNP1-3) in Alzheimer's disease. Psychiatry Res, 239, 342-345. https://doi.org/10.1016/j.psychres.2016.03.045
TADA. (2017). The estimation of population suffering from dementia in Taiwan. Taiwan Alzheimer Disease Association
Tada, A., & Miura, H. (2017). Association between mastication and cognitive status: A systematic review. Arch Gerontol Geriatr, 70, 44-53. https://doi.org/10.1016/j.archger.2016.12.006
Tanaka, T., Takahashi, K., Hirano, H., Kikutani, T., Watanabe, Y., Ohara, Y., Furuya, H., Tetsuo, T., Akishita, M., & Iijima, K. (2018). Oral Frailty as a Risk Factor for Physical Frailty and Mortality in Community-Dwelling Elderly. J Gerontol A Biol Sci Med Sci, 73(12), 1661-1667. https://doi.org/10.1093/gerona/glx225
Tanaka, Y., Nakano, Y., Yokoo, M., Takeda, Y., Yamada, K., & Kayashita, J. (2015). Examination about the Relation of Meal Form, Tongue Pressure, Grip and Walking State in Inpatient and Elderly Residents. The Japanese Journal of Dysphagia Rehabilitation, 19(1), 52-62. https://doi.org/10.32136/jsdr.19.1_52
Thomson, W. M., van der Putten, G. J., de Baat, C., Ikebe, K., Matsuda, K., Enoki, K., Hopcraft, M. S., & Ling, G. Y. (2011). Shortening the xerostomia inventory. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 112(3), 322-327. https://doi.org/10.1016/j.tripleo.2011.03.024
Ting, C. C., Ko, E. C., Chen, C. C., Chang, W. Y., Tu, H. P., & Chang, C. S. (2019). Effectiveness of an oral function intervention for older Taiwanese people. Gerodontology, 36(4), 374-381. https://doi.org/10.1111/ger.12412
Tonsekar, P. P., Jiang, S. S., & Yue, G. (2017). Periodontal disease, tooth loss and dementia: Is there a link? A systematic review. Gerodontology, 34(2), 151-163. https://doi.org/10.1111/ger.12261
Tsakos, G., Watt, R. G., Rouxel, P. L., de Oliveira, C., & Demakakos, P. (2015). Tooth loss associated with physical and cognitive decline in older adults. J Am Geriatr Soc, 63(1), 91-99. https://doi.org/10.1111/jgs.13190
Tsuga, K., Yoshikawa, M., Oue, H., Okazaki, Y., Tsuchioka, H., Maruyama, M., Yoshida, M., & Akagawa, Y. (2012). Maximal voluntary tongue pressure is decreased in Japanese frail elderly persons. Gerodontology, 29(2), e1078-1085. https://doi.org/10.1111/j.1741-2358.2011.00615.x
Uesugi, H., & Shiga, H. (2017). Relationship between masticatory performance using a gummy jelly and masticatory movement. J Prosthodont Res, 61(4), 419-425. https://doi.org/10.1016/j.jpor.2017.01.001
Utanohara, Y., Hayashi, R., Yoshikawa, M., Yoshida, M., Tsuga, K., & Akagawa, Y. (2008). Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia, 23(3), 286-290. https://doi.org/10.1007/s00455-007-9142-z
Wang, T. F., Chen, Y. Y., Liou, Y. M., & Chou, C. (2014). Investigating tooth loss and associated factors among older Taiwanese adults. Arch Gerontol Geriatr, 58(3), 446-453. https://doi.org/10.1016/j.archger.2014.01.002
Watanabe, Y., Arai, H., Hirano, H., Morishita, S., Ohara, Y., Edahiro, A., Murakami, M., Shimada, H., Kikutani, T., & Suzuki, T. (2018). Oral function as an indexing parameter for mild cognitive impairment in older adults. Geriatr Gerontol Int, 18(5), 790-798. https://doi.org/10.1111/ggi.13259
Watanabe, Y., Hirano, H., Arai, H., Morishita, S., Ohara, Y., Edahiro, A., Murakami, M., Shimada, H., Kikutani, T., & Suzuki, T. (2017). Relationship Between Frailty and Oral Function in Community-Dwelling Elderly Adults. J Am Geriatr Soc, 65(1), 66-76. https://doi.org/10.1111/jgs.14355
Wayler, A. H., & Chauncey, H. H. (1983). Impact of complete dentures and impaired natural dentition on masticatory performance and food choice in healthy aging men. J Prosthet Dent, 49(3), 427-433. http://www.ncbi.nlm.nih.gov/pubmed/6573489
WHO. (2013). Oral Health Surveys: Basic Methods. World Health Organization.
Williams, M. M., Storandt, M., Roe, C. M., & Morris, J. C. (2013). Progression of Alzheimer's disease as measured by Clinical Dementia Rating Sum of Boxes scores. Alzheimers Dement, 9(1 Suppl), S39-44. https://doi.org/10.1016/j.jalz.2012.01.005
Winkel, E. G., Roldan, S., Van Winkelhoff, A. J., Herrera, D., & Sanz, M. (2003). Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Periodontol, 30(4), 300-306. https://doi.org/10.1034/j.1600-051x.2003.00342.x
Yamada, A., Kanazawa, M., Komagamine, Y., & Minakuchi, S. (2015). Association between tongue and lip functions and masticatory performance in young dentate adults. J Oral Rehabil, 42(11), 833-839. https://doi.org/10.1111/joor.12319
Yamada, H., Nakagawa, Y., Nomura, Y., Yamamoto, K., Suzuki, M., Watanabe, N. Y., Saito, I., & Seto, K. (2005). Preliminary results of moisture checker for Mucus in diagnosing dry mouth. Oral Dis, 11(6), 405-407. https://doi.org/10.1111/j.1601-0825.2005.01136.x
Yamamoto, T., Kondo, K., Hirai, H., Nakade, M., Aida, J., & Hirata, Y. (2012). Association between self-reported dental health status and onset of dementia: a 4-year prospective cohort study of older Japanese adults from the Aichi Gerontological Evaluation Study (AGES) Project. Psychosom Med, 74(3), 241-248. https://doi.org/10.1097/PSY.0b013e318246dffb
Yang, Y. H., Wu, M. N., Chou, P. S., Su, H. C., Lin, S. H., & Sung, P. S. (2018). Longitudinal Neuropsychological Outcome in Taiwanese Alzheimer's Disease Patients Treated with Medication. Curr Alzheimer Res, 15(5), 474-481. https://doi.org/10.2174/1567205014666171010112518
Yoo, J. J., Yoon, J. H., Kang, M. J., Kim, M., & Oh, N. (2019). The effect of missing teeth on dementia in older people: a nationwide population-based cohort study in South Korea. BMC Oral Health, 19(1), 61. https://doi.org/10.1186/s12903-019-0750-4
Yoshida, M., Kikutani, T., Tsuga, K., Utanohara, Y., Hayashi, R., & Akagawa, Y. (2006). Decreased tongue pressure reflects symptom of dysphagia. Dysphagia, 21(1), 61-65. https://doi.org/10.1007/s00455-005-9011-6
Zenthofer, A., Dieke, R., Dieke, A., Wege, K. C., Rammelsberg, P., & Hassel, A. J. (2013). Improving oral hygiene in the long-term care of the elderly--a RCT. Community Dent Oral Epidemiol, 41(3), 261-268. https://doi.org/10.1111/cdoe.12007
Zenthofer, A., Meyer-Kuhling, I., Hufeland, A. L., Schroder, J., Cabrera, T., Baumgart, D., Rammelsberg, P., & Hassel, A. J. (2016). Carers' education improves oral health of older people suffering from dementia - results of an intervention study. Clin Interv Aging, 11, 1755-1762. https://doi.org/10.2147/CIA.S118330
Zhang, Y., Lu, C., & Zhang, J. (2021). Lactoferrin and Its Detection Methods: A Review. Nutrients, 13(8). https://doi.org/10.3390/nu13082492
于漱, 吳淑瓊, & 楊桂鳳. (2003). 失智症患者的長期照護服務模式 [Alzheimer's Disease and Related Dementia: Long-Term Care Services Model]. 長期照護雜誌, 7(3), 251-264.
吳淑瓊, & 莊坤洋. (2001). 在地老化：台灣二十一世紀長期照護的政策方向 [Aging in Place:the Direction of Taiwan Long-Term Care Policy in the 21st Century]. 台灣公共衛生雜誌, 20(3), 192-201. https://doi.org/10.6288/tjph2001-20-03-05
周俞辰. (2010). 驗證台灣版老人口腔健康評估（GOHAI）量表 (Publication Number 2010年) 高雄醫學大學]. AiritiLibrary.
范齡勻, 陳達夫, & 邱銘章. (2012). 阿茲海默症藥物治療的現在與未來 [Current and Future Pharmacological Treatment of Alzheimer's Disease]. 台灣醫學, 16(4), 397-403. https://doi.org/10.6320/fjm.2012.16(4).09
國民健康署. (2022). 民國108年中老年身心社會生活狀況長期追蹤調查. (14). 衛生福利部國民健康署 Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=242&pid=1282
國家發展委員會. (2022). 中華民國人口推估（2022至2070年）. Retrieved from https://www.ndc.gov.tw/nc_14813_36128
梁家欣, 程蘊菁, & 陳人豪. (2014). 失智症之重點回顧 [Dementia: A Focused Review]. 內科學誌, 25(3), 151-157. https://doi.org/10.6314/jimt.2014.25(3).04
陳志嘉. (2016). 口腔健康促進之介入對高齡者口腔機能及生活品質的成效-以苗栗縣為例 (Publication Number 2016年) 高雄醫學大學]. AiritiLibrary.
黃茂栓. (2016). 104-105 年度成年與老年人口健康調查計畫-全程計畫執行總報告.
劉議謙, & 葉炳強. (2011). 失智症整合照護. 華騰文化.
潘玉玲, 洪月霜, 徐允中蔣孟達, 陳可望, 羅子評, 郭亞倫, & 李忠興. (2014). 護理之家住民口腔健康狀況分析 [Oral Health Status of the Residents in Nursing Home]. 中華職業醫學雜誌, 21(4), 227-235.
蔡美玲, & 林素香. (2003). 居家護理長期臥床病患口腔照護之初探. 長期照護雜誌, 7(2), 171-171.
衛生福利部. (2018). 老人狀況調查報告. Retrieved from https://www.mohw.gov.tw/dl-70609-64499d44-6d1f-408e-a449-6af459b7cd17.html
盧亭妤. (2019). 以結構方程模式檢驗社區老年人口腔機能、身體功能與口腔健康生活品質之相關性 (Publication Number 2019年) 高雄醫學大學]. AiritiLibrary.
蕭兆廷. (2014). 新發失智症與共病之關係 (Publication Number 2014年) 中國醫藥大學]. AiritiLibrary.