半側空間無視(Neglect)を有する脳卒中患者の生活障害評価尺度―the Catherine Bergego Scale(CBS)日本語版の作成とその検討

Neglect and Related Disorders among Right Brain-Damaged Stroke Patients：Toward Development for Japanese Version of the Catherine Bergego Scale

要旨

　本研究は, 半側空間無視 (以下, Neglect)を有する脳卒中患者の生活障害評価尺度の開発に向けた研究である. 本邦で初めて, the Catherine Bergego Scale 日本語版 (以下, CBS-J) による生活障害の評価とその利用可能性を検討することを目的とし, 3 基準 (初発, 右大脳半球, 入院時に Neglect あり) を満たし, 同意が得られた脳卒中患者20名を対象に, 退院後1カ月の機能評価, CBS-J による行動観察, 面接調査を実施した. 対象を脳卒中重症度尺度により3群, すなわち, 軽度群 (6名), 中等度群 (10名), 重度群 (4名) に分類し, CBS-J-観察得点, CBS-J-自己評価得点, CBS-J-Anosognosia得点にっいて 3 群比較を行ったところ, 3 群間の属性, CBS-J-自己評価得点に有意差はなかったが, CBS-J-観察得点, CBS-J-Anosognosia 得点には重症度による有意差があった. これは, 脳卒中の重症度に応じて, Neglect行動, 病態失認が強くなることを示し, Neglect 行動があるにもかかわらず, そのことを気づくことができないことを示唆している．

　CBS-J は, Neglect による生活障害を評価するうえで有用な尺度と考えられる．

Abstract

　The purpose of this study is to develop and evaluate the daily life difficulties among right brain-damaged (RBD) stroke patients with neglect and related disorders (NRD) using the Catherine Bergego Scale Japanese version (CBS-J) for the first time in Japan.

　Twenty RBD first-ever stroke patients with NRD were classified into 3 groups, mild (6), moderate (10), severe (4), according to the National Institutes of Health Stroke Scale score at 1 month after discharge. Subjects were measured by their function and observation, interviewed using CBS-J. Three groups were compared by one-way ANOVA in CBS-J-Observation score (CBS-J-0), CBS-J-Self-evaluation score (CBS-J-SE), and CBS-J-Anosognosia score (CBS-J-A). Among 3 groups, no difference was observed in neither attribution nor CBS-J-SE. On the other hand, significant difference higher was observed in both CBS-J-0 and CBS-J-A. The severer the stroke was, the higher the score of CBS-J-0 and CBS-J-A were observed. The discrepancy between CBS-J-SE and CBS-J-A suggests that RBD patients with NRD can not recognize their neglect behavior of their daily life when their stroke is moderate or sever.

　In conclusion, CBS-J is considered to be an available and useful scale for evaluating neglect behavior and unawareness of daily life difficulties.