研究目的：檢驗不同兒茶酚氧位甲基轉移酶(Catechol-O-Methyltransferase, COMT)基因型（Val同型合子、Met同型合子、異型合子）之巴金森氏病（巴病）患者於各執行功能測驗之表現。過去研究顯示COMT基因型與巴病患者之執行功能表現有關，考量執行功能並非單一建構，本研究透過三個執行功能核心部件來檢驗巴病患者不同執行功能表現。此外，本研究利用多巴胺受體活化程度之觀點，檢視多巴胺與執行功能表現之關係。
方法：參與者為54名原發性巴病患者，於有藥效狀態下進行包含抑制能力、模組轉換能力、工作記憶之執行功能測驗，並接受血液樣本之採集。
結果：三組於模組轉換能力測驗的比較上達顯著差異(χ2 (2, N = 54) = 7.175, p = 0.028, ε2 = 0.14 )，事後分析顯示Val同型合子巴病患者組表現顯著較異型合子組差( z = -2.216, p = 0.027)。工作記憶測驗亦達顯著(χ2 (2, N = 54) = 7.694, p = 0.021, ε2 = 0.15)，事後分析顯示Met同型合子組顯著較Val同型合子組佳( z = 2.514, p = 0.036)。三組於注意力測驗亦達顯著差異(χ2 (2, N = 54) = 6.22, p = 0.045, ε2 = 0.12)，事後分析顯示Met同型合子組反應時間顯著較Val同型合子組低( z = 2.49, p = 0.038)。
結論：不同COMT基因型之巴病患者於執行功能測驗表現確實存在差異，且此差異在不同執行功能測驗上亦呈現不同樣貌。推測Val同型合子巴病患者相對其他二型之巴病患者在模組轉換能力、工作記憶、及注意力表現較差係因其多巴胺受體活化程度相對不足，因此其表現相對較差；且三種基因型巴病患者於工作記憶表現符合倒U型多巴胺受體—工作記憶關係圖之左側。三種基因型巴病患者之抑制能力並未顯示差異，推測此能力與前額葉多巴胺較無關，與其他神經傳導物質有關。

Executive dysfunction is one of the most common non-motor symptoms of Parkinson’s disease. The catechol-O-methyltransferase (COMT) Val158Met polymorphism has been proposed to affect executive function through modulating the level of dopamine and further modulating the activity of dopamine receptor in prefrontal cortex. The present study investigated the effect of the polymorphism on different components of executive function in Parkinson’s disease patients. The Digit Span Subtest of Wechsler Adult Intelligence Scale-Chinese Revision, Working Memory Index of Wechsler Adult Intelligence Scale-Chinese Revision, Modified Wisconsin Card Sorting Test, Semantic Verbal Fluency Test, Stroop Word-Color Test, Color Trail Making Test were used to assess three core components of executive function, including working memory, set shifting, and inhibition. Neuropsychological assessment and COMT genotyping were performed in 54 patients of Parkinson’s disease from outpatient hospitals in Taiwan. We employed Kruskal-Wallis test to determine the associations between the COMT Val158Met genotype and executive function. Our results demonstrate that differences between the COMT genotypes groups were observed on task of set shifting and task of working memory. Post hoc tests showed that the performance of the group of Val homozygotes was significantly poorer than the group of Val/Met heterozygotes on set shifting test, and the performance of the group of Val homozygotes was significantly poorer than the group of Met homozygotes on working memory test. These results supported that putative activities of prefrontal dopamine receptors influenced working memory in an “inverted U” shaped manner, and influenced set shifting in a “crutch-like” shaped curve.

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