記憶型輕度認知障礙及阿茲海默症患者之內容記憶與情境脈絡記憶

Abstract

背景： 阿茲海默症為失智症常見病因，此類病患經常出現主體記憶與情境脈絡記憶缺損，然而過去研究較少探討主體記憶及情境脈絡記憶在阿茲海默症病程之退化型態。主體記憶及情境脈絡記憶相關的神經心理機制與阿茲海默症的神經病理機制有其相對應之處，其兩者皆與內側顳葉功能相關，而情境脈絡記憶又與前額葉功能相關。記憶型認知功能障礙被認為是阿茲海默症的前驅期，而臨床上常見記憶型認知功能障礙伴隨執行功能缺損之病患。綜合上述，了解主體記憶及情境脈絡記憶在記憶型輕度認知障礙及阿茲海默症之退化型態，可能有助於阿茲海默症之早期偵測及後續復健計畫之發展。 目的： 探討單一面向記憶型輕度認知障礙、記憶型輕度認知功能障礙伴隨執行功能缺損及阿茲海默症病患之主體記憶與情境脈絡記憶表現。 方法： 本研究收集38位單一面向記憶型輕度認知障礙之病患、34位記憶型輕度認知功能障礙伴隨執行功能缺損之病患、36位阿茲海默症病患，以及38位健康成年人，並比較不同族群之受試者在修訂版家庭圖片測驗中各項測驗分數之表現。 結果： 主體記憶在阿茲海默症早期即有退化之跡象，而情境脈絡記憶之缺損則與執行功能之退化有關。 結論： 本研究討論記憶型輕度認知障礙及阿茲海默症病患在主體記憶及情境脈絡記憶之不同表現型態，有助於阿茲海默症病患之早期偵測及後續復健計畫之發展。未來應持續收集腦影像資料並長期追蹤阿茲海默症病患以確立此類疾病在內容記憶及情境脈絡記憶之退化型態。

Background: Alzheimer's disease is the most common form of dementia. Impairments in content and context memory are often seen in patients with Alzheimer's disease. However, few studies have investigated this issue. Moreover, studies have shown that the deterioration of content and context memory are associated with the neuropathology of Alzheimer's disease. These two aspects of memory are associated with the mesial temporal structures, and, in addition, the context memory is also associated with the prefrontal lobe. Furthermore, amnestic mild cognitive impairment (aMCI) is seen as the prodromal stage of Alzheimer's disease, and patients with single domain aMCI plus executive function impairment are often seen in clinics. Therefore, to improve early detection of this devastating disease and the development of memory rehabilitation plan, it is important to understand the degenerative pattern of these two aspects of memory in patients with aMCI and Alzheimer's disease. Objective: The aim in this study was to measure content and context memory in patients with single domain amnestic mild cognitive impairment (aMCI-s) including those with and without executive function impairment, and in patients with Alzheimer's disease. Method: This retrospective study included 38 patients with single domain aMCI, 34 patients with single domain aMCI plus executive function impairment, and 36 patients with Alzheimer's disease. Thirty-eight healthy controls were also included. Modified Family Pictures subtest performance was assessed and compared across the four groups. Results: Content memory began to decline in the early stages of Alzheimer's disease while the deterioration of context memory paralleled that of executive function. Conclusion: The context memory performances of patients with aMCI might be heterogeneous. Determining whether a given patient has deficits in context memory has clinical utility for the development of individual memory rehabilitation. However, imaging and longitudinal studies in patients with aMCI and Alzheimer's disease are still needed.