目的：過去文獻指出時序記憶缺損常見於額葉損傷的患者。基底核損傷之巴金森氏病患者因基底核與額葉間的迴路受損，其額葉功能亦受到影響。過去針對巴金森氏病患者的時序記憶研究並未獲得一致結論，可能因其缺乏患者疾病嚴重度、失智與時序記憶關係的完整探討。本研究試圖探索非失智巴金森氏病患者之時序記憶功能，且此功能與其他變項，如疾病嚴重度與其他神經心理功能的關係。

方法： 47位經神經內科醫師診斷為原發性巴金森氏病患者在服藥狀態下評估其侯葉等級，將之分成侯葉等級一、侯葉等級二與侯葉等級三或以上三組，人數各為17、19、11名。22位正常人控制組與各組患者在年齡、教育程度、簡短式智能評估以及魏氏成人智力量表修訂版之語文智商的表現上予以配對。每位受試者均接受時間次序記憶作業與神經心理功能檢查。

結果：採用母數統計與無母數統計進行資料分析後發現，患者較正常人有較多時序辨別上的困難。雖然以時序錯誤指標來看僅發現侯葉等級三以上的患者與正常人具有顯著差異，但若考慮其他指標如假警報數時，發現患者於侯葉等級一便與正常人有顯著差異。時序記憶缺損與概念形成能力、語意聯想語文流暢能力與抽象思考能力等執行功能有顯著負相關，但與非語文項目記憶無關。在患者之神經心理功能方面，侯葉等級一的患者未呈現缺損，侯葉等級二的患者在屬於執行功能的概念形成能力受損，侯葉等級三以上的患者在近期記憶、屬於執行功能的語意聯想語文流暢性以及概念形成能力受損。

結論：依上述資料分析的結果，巴金森氏病患者存在時序記憶上的問題。其他神經心理功能未受損之侯葉等級一患者便已呈現時序記憶缺損，且此缺損到侯葉等級三更為明顯。因此，時序記憶工具對於早期巴金森氏病患者臨床上腦部功能偵測，特別是前額葉功能是否缺損具有特殊意義。然而，本研究結果建立在較小的樣本數，未來臨床上實際應用需要更大樣本來加以驗證。

Objective: Review of literature shows that deficits of temporal order memory have often been evident in patients with lesions of frontal lobes. Since the basal ganglia have reciprocal connection with frontal lobes, it would be expected that lesions of the basal ganglia might also evidence temporal memory problem. In fact, some studies revealed that patients with Parkinson’s disease (PD) manifested such a memory deficit. However, the findings were not confirmed by others. Methodological drawbacks, such as confounding variables of the disease severity and demented problem might contribute to these inconsistent results. The present study thus was to explore temporal order memory function in nondemented PD patients with varying degree of motor disabilities..

Method: A total of 69 adult subjects, including three groups of nondemented PD patients with varying degree of motor disabilities based on Hoehn & Yahr (H&Y) motor staging under “on” condition and one normal control group, participated in the study. Twenty-two normal subjects, matched for age, education level, MMSE score and VIQ of the WAIS-R, served as controls. Both groups received temporal order memory tasks and a battery of neuropsychological tests.

Result: The results revealed that our PD patients exhibited difficulties in temporal order discrimination mainly reflected by score index of temporal context confusion and/or of false positive error Patients with H&Y motor staging III had remarkably higher temporal context confusion and false positive error scores while patients with stagings I and II were only manifested significant false positive errors in comparison with their normal counterparts. The results further revealed that our temporal order memory function measures were significantly associated with executive function tests but were not related to nonverbal memory task. With respect to otherwise neuropsychological function, our patients with motor staging I did not evidence any deficit while patients with motor staging II were defective in concept formation and patients with motor staging III were impaired in recent memory, concept formation and semantic association of verbal fluency.

Conclusion: Based on the present results, it appeared that our patients with PD had temporal order memory dysfunction, even patients with motor staging I. Accordingly, it is suggested that temporal order memory examination might be contributory to the early detection of brain dysfunction, particularly malfunction of prefrontal lobes, in patients with PD,. However, since our results were based on a small sample, further investigation on a large-scale to re-examine this issue for clinical implication is necessary.

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