研究背景:工作記憶缺損是各類腦部疾患病人常見的功能障礙之一,近年來,工作記憶的概念愈來愈受到重視。過去研究中用來評估工作記憶的工具相當多樣,其中在國外的研究中發現魏氏成人智力測驗中的「數—字序列分測驗」具有良好的信效度與臨床實用價值。然而,國人,尤其是老年人口,對英語字母有欠熟悉,大大降低了該分測驗在台灣的實用性。雖然彭鍾伃和花茂棽在2009年發展出『台大數字奇偶序列測驗』來取代數-字序列分測驗。但由於缺乏臨床病人的研究資料佐證,此測驗在臨床實務上的應用性仍未確知。因此,本研究目的主要為:一、收集分析臨床精神分裂症病人資料,重新檢驗台大數字奇偶序列測驗的心理計量特性;二、進一步探討奇偶測驗在當前和未來實務工作方面的實用性;三、探討工作記憶與臨床症狀之相關性。實驗設計:病例對照研究法。研究場所:台大醫院精神部門診。參與者:32位精神分裂症患者及32位年齡和性別相配之健康受試者。主要結果變項:運用國內常用的工作記憶測驗了解精神分裂症患者的工作記憶缺損,並比較患者在各個測驗的表現。並以智力和其他神經心理測驗評估患者的神經認知功能。結果:患者在各種工作記憶測驗表現皆較正常對照組低,同時在奇偶測驗表現有缺損的患者,在其他工作記憶測驗上也表現出類似的缺損,但患者在中文版數—字序列分測驗之表現與其他工作記憶測驗較不一致。進一步分析比較不能完成中文版數—字序列分測驗的患者和能夠完成的患者,發現不能完成的患者在其他神經心理功能(如:記憶力、執行功能)有較多的功能缺損。工作記憶與臨床症狀無顯著相關。結論:在排除人口學因素的影響之後,精神分裂症患者確實有工作記憶功能的損傷。台大奇偶測驗擁有良好的效度亦能廣泛的運用在臨床實務上。中文版數—字序列分測驗在實務的使用上確有其限制,奇偶測驗能排除語言的影響,其後續發展與推廣確有其必要性。
Importance: To investigate brain function of patients with brain diseases, an efficient tool to assessing working memory (WM) function is needed. The National Taiwan University Odd-Even Number Sequencing Test (TOENS) had developed to minimize culture and linguistic bias, and the present study was thus to explore the construct validity and the practical utility of this test assessing the WM function in patients with schizophrenia. Objective: (1) Re-examining the validity of the TOENS measuring WM in patients with schizophrenia. (2) To Investigate the clinical application of the TOENS and examine the possibility of replacing the Letter-Number-Sequencing (LNS) subtest in the WAIS-IV Taiwan version. (3) Investigating the relationship between clinical symptoms and WM function. Design: Case-control study. Setting: Outpatient clinic of the Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan. Participants: Thirty-two patients with schizophrenia and demographically matched controls. Main Outcome Measures: Patients’ WM function and neurocognitive function (including general IQ, executive function, and memory function) were assessed and compare by neuropsychological tests. Results: Patients performed worse on all WM tests. Patients’ performance on LNS of the WAIS-III-Taiwan version was less consistent with the other WM tests. There were significant correlations between the TOENS and other neuropsychological tests involved frontal function. There was no significant correlation between demographic data, illness duration, clinical symptoms and the TOENS performance. Conclusions: Based on the present results, our patients generally have working memory deficits. This study confirmed that the TOENS has a good validity and indicated the TOENS can be a candidate to replace the LNS subtest of the WAIS-III Taiwan version.