Gua Harimau (gua = cave) is a crucial site for understand the prehistory of Sumatra and its relationship to the peopling of Insular Southeast Asia. A large number of archaeological records has been discovered at the western part of the cave, including human burials, lithic artefacts, potteries, and faunal remains that have been anthropogenically altered. The chronological stratigraphy of these records extends to the Late Pleistocene Period, enabling us to reconstruct the dynamics of prehistoric culture in Sumatra. At least three episodes of human occupation have been recognized in the cave: The Preneolithic, Neolithic, and Paleometalic (early metal age). However, the distributional pattern of various archaeological remains, such as mollusk shells, ground tools, unifacially-shaped pebble tools, and bone artefacts, reveals significant differences. These differences provide insight into the cultural development that occurred in Sumatra during the prehistoric occupation of Gua Harimau, and demonstrate changes in cultural affinity that may correspond to past environmental conditions and human adaptation.