亨丁頓舞蹈症患者之錯誤記憶研究

False Memory in Patients with Huntington's Disease

陳奕雯(I-Wen Chen)

指導教授 ： 花茂棽

國立臺灣大學/理學院/心理學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.01499

摘要

文獻指出個體錯誤再認與學習項目「相關」或「無關」的分心項目，分別代表不同的心理運作機制與神經病理。同時檢驗上述兩類型錯誤項目的消長，能深入了解要旨記憶、逐項記憶與監控功能之運作，與額葉和顳葉功能是否異常。目前已有大量的研究結果顯示，亨丁頓氏舞蹈症患者（HD患者）易於再認記憶測驗中作出高度假警報反應（意即錯誤再認先前未學習過的新項目為曾經學習過），但未有文獻從記憶建構之角度剖析HD患者的錯誤記憶型態。基於上述，本研究欲透過DRM典範探討HD患者的錯誤記憶，分析逐項記憶、要旨記憶與監控的運作是否正常，並據此瞭解對應上述認知能力的腦部區域有無功能性缺損，同時建立國內HD患者之神經認知功能的資料。共25位HD患者和30位正常受試者參與本研究，HD患者再依其整體認知表現與生活功能分為輕度與中重度兩組（輕度患者13位、中重度患者12位）。每位受試者均接受神經心理功能檢查和DRM典範錯誤記憶作業。結果發現，輕度與中重度HD患者在執行功能、記憶力、語言功能、視知覺辨識力與心理運作速度等測驗表現均顯著較正常受試者差。在相關項目錯誤再認率方面，僅有中重度HD患者在語文DRM典範的表現顯著較正常受試者低；而輕度與中重度HD患者在圖片DRM典範的表現皆與正常受試者無顯著差異。在無關項目錯誤再認率方面，輕度HD患者僅在語文DRM典範的表現顯著高於正常受試者；而中重度HD患者則在語文和圖片DRM典範的表現皆較正常受試者高。在逐項記憶率方面，輕度與中重度HD患者在語文DRM典範的表現較正常受試者有偏低的趨勢；而輕度與中重度HD患者在圖片DRM典範的表現皆顯著較正常受試者差，且中重度HD患者的表現又低於輕度HD患者。本研究結果顯示，輕度與中重度HD患者的逐項記憶與監控功能皆有缺損，但中重度HD患者在兩者的受損程度又較輕度HD患者嚴重，反映HD患者於病程初期已呈現漸進式額葉功能異常；在要旨記憶方面，輕度HD患者具有形成要旨記憶的能力，中重度HD患者的要旨記憶功能雖有下降，但尚未整體瓦解，顯示病程初期HD患者的內側顳葉功能相對完整，然而其功能運作將於中後期呈現衰退。因此，建議應利用輕度HD患者相對正常的要旨記憶功能來發展合適的認知復健計畫。

關鍵字

亨丁頓氏舞蹈症 ； 假警報 ； 逐項記憶 ； 要旨記憶 ； 監控功能

並列摘要

Literature shows that false recognition of new items that are related or unrelated to previously studied items arise from different underlying psychological mechanism and neuropathology respectively. Examining the amount of these two types of memory errors simultaneously can provide insights into whether the operation of gist memory, verbatim memory, and monitoring functioning is normal, and the functions of corresponding neural substrates (e.g., mesial temporal regions and frontal-related structures) operate adequately. The issue regarding elevated false alarm memory recognition errors in patients with Huntington’s disease (HD) has been widely reported. However, little has approached to HD patients’ pattern of false recognition for understanding their constructive processes of memory. Using the Deese-Roediger-McDemott (DRM) false memory paradigm, the present study was to explore gist memory, verbatim memory, and monitoring functioning in patients with HD, and to investigate the functioning of corresponding neural substrates based on the preceding results. Meanwhile, this study made an attempt to document neurocognitive functions in our Taiwan patients with HD. Twenty-five HD patients and thirty healthy normal controls participated in the study, and HD patients were further partitioned into mild and moderate to severe groups based on their general cognitive and living functioning (thirteen mild HD patients and twelve moderate to severe HD patients). All subjects were given a battery of neuropsychological tests and the DRM paradigm tasks. The results revealed that both mild and moderate to severe HD patients evidenced significant deficits of executive function, episodic memory, language function, visuoperceptual function, and psychomotor speed. HD patients’ performances on the DRM paradigm tasks were as follows: (1) On the related false recognition indices, only moderate to severe HD patients exhibited poor score compared with normal controls on the verbal DRM task while performance of both HD patient groups was compatible with that of normal controls on the pictorial DRM task. (2) On the unrelated false recognition indices, mild HD patients showed significantly more error scores only on the verbal DRM task compared with normal controls, whereas moderate to severe HD patients exhibited more error scores on both the verbal and pictorial DRM tasks compared with normal controls. (3) On the verbatim memory indices, both HD patient groups showed significantly poorer performances than the normal controls only on the pictorial DRM task; moreover, moderate to severe HD patients’ performances were even poorer than mild HD patients. Based on these results, it appears that defective verbatim memory and monitoring functioning are early signs in HD patients and may deteriorate across the stages of the disease. However, gist memory is a relative robust functioning and only partially decline at the advanced stages of HD. These findings might further reflect that the functioning of the mesial temporal regions seems to be preserved compared with that of the frontal-related structures in early HD patients. We thus suggest developing cognitive rehabilitation programs based on relatively normal gist functioning for patients with early HD.

並列關鍵字

false alarm ； verbatim memory ； gist memory ； monitoring

參考文獻

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