阿茲海默型失智症老人之事件記憶的知感研究

Episodic Memory Feeling-of-Knowing in Early Demented Patients with Alzheimer's Disease

臨床上「知感」判斷正確性有助於醫療人員正確的診療。目前文獻對阿茲海默型失智症的「知感」研究很少，且方法上有其缺失。阿茲海默型失智症早期出現記憶障礙，但執行功能是否於早期亦有缺損目前仍看法不一。另外「知感」心理機制與記憶或執行功能的關係亦未有定論。本研究改善之前研究方法上的缺失，將早期阿茲海默型失智症病人，更細分為疑似失智症患者及輕度失智症患者，探討以下的研究問題，包括：（1）疑似失智症及輕度失智症患者的「知感」功能是否缺損？（2）早期阿茲海默型失智症除了記憶障礙之外，執行功能是否亦有缺損？（3）若患者「知感」功能缺損，是否與記憶、執行功能表現缺損有關？本研究包括疑似失智症病人、輕度失智症病人各30名、控制組30名，接受研究「知感」現象的Recall-Judgment-Recognition（RJR）派典及一系列神經心理功能評估。研究結果顯示疑似失智症及輕度失智症病人，在記憶、執行功能及「知感」功能皆顯著較控制組為差。本研究結果除了證實目前文獻報告早期阿茲海默失智症患者之事件記憶「知感」功能缺損，進一步更發現疑似阿茲海默失智症患者「知感」功能已出現缺損。此外，本研究結果推論阿茲海默型失智症在「事件記憶」的「知感」功能，可能會受到記憶及執行兩種能力的影響。

Literature regarding whether the early demented patients with Alzheimer's disease (AD) have deficits in the feeling of knowing (FOK) function of episodic memory is scanty, and issues of whether these patients evidence executive dysfunction and of the underlying neuropsychological mechanism for FOK function have been controversial. The present study was thus made an attempt to explore these issues in questionably and mildly demented patients with AD. A total of 90 adult participants including, 30 questionably and 30 mildly demented patients with AD, and 30 normal healthy controls participated in this study. Each subject received a recall-judgment-recognition (RJR) paradigm task and a battery of neuropsychological tests, mainly including memory and executive function measures. The results revealed that both questionably and mildly demented patients' performance on the FOK judgment task was significantly poorer than that of normal control counterparts, and these demented patients evidenced deficits of executive function other than memory impairment. Most of the demented patients with defective function of FOK also manifested impairments of memory and executive function. These results partially confirm findings evident in the literature, and we further suggest that deficits of both memory and executive function might account for the impairment of FOK in our demented patients.