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알츠하이머와 혈관성 치매 환자 선별에서의 작업기억 능력 관련 구어유창성 및 이야기이해 능력의 차이

Differences in Verbal Fluencies and Discourse Comprehension Abilities associated with Working Memory in Alzheimer's Disease and Vascular Dementia

  • 여한결 (광주대학교 임상언어치료학과) ;
  • 김충명 (광주대학교 언어치료학과)
  • Yeo, Hangyeol (Department of Clinical Speech-Language Therapy, Gwangju University) ;
  • Kim, Choong-Myung (Department of Speech-Language Therapy, Gwangju University)
  • 투고 : 2020.10.14
  • 심사 : 2020.12.20
  • 발행 : 2020.12.28

초록

본 연구는 알츠하이머와 혈관성 치매 환자를 대상으로 구어유창성과 이야기이해 과제 수행능력의 차이 및 작업기억 처리수준과의 상관 그리고 언어능력 관련 요인선별을 위해 시행되었다. 전반적인 인지능력에서 차이를 보이지 않는 각기 15명의 환자를 대상으로 구어유창성 내 음소유창성 및 이야기이해 그리고 작업기억 하위과제인 지연회상과 재인과제에서 두 그룹 간 유의한 수행능력의 차이를 보였다. 상관 및 회귀분석에서는 알츠하이머 그룹이 작업기억 내역행 숫자기억 과제와 이야기이해 과제에서만 유의한 상관을 보인 반면, 혈관성 치매 그룹은 추가적으로 재인 점수에서도 이야기이해 능력과의 유의한 상관이 나타났다. 한편, 회귀분석에서는 혈관성 치매 그룹에서만 언어적 작업기억 능력이 이야기이해 능력의 예측 요인임을 확인하였다. 결론적으로 두 유형의 치매를 구분하는 데 있어 음소유창성 과제 외에 이야기이해 및 작업기억 과제가 유의한 도구임이 확인되었는데, 이를 통해 두 유형의 치매에 대한 분류기준을 제고함은 물론 적절한 치료계획 및 효율적인 중재에 부가적인 기여를 할 것으로 보인다.

The present study was conducted to examine the differences and correlations between verbal fluency and story comprehension according to the working memory(WM) capacity, and to find out what WM factors influence the linguistic competence in Alzheimer's disease(AD) and vascular dementia(VaD) groups each consisting of 15 patients. The results of their performance produced firstly significant differences in phonemic fluency, story comprehension, delayed recall and recognition task between the two groups. Further analysis shows that VaD group had significant correlations between the scores of story comprehension and the recognition test scores additionally. These findings suggest that it is possible to differentiate the two groups even by story comprehension tasks and WM. In conclusion, the clinical application of the results is likely to contribute to appropriate treatment plans and effective interventions for elderly with AD and VaD as well as to improve the classification criteria for both types of dementia.

키워드

참고문헌

  1. Y. Jeong, S. J. Kang & D. L. Na. (2002). Vascular Dementia. Journal of the Korean Academy of Rehabilitation Medicine, 26(6), 639-646.
  2. R. L. Spitzer, M. G. Skodol & J. B. W. Williams. (1994). Diagnostic and statistical manual of mental disorders, Washington DC. American Psychiatric Association.
  3. A. Jorm, A. Korten & A. Henderson. (1987). The prevalence of dementia: a quantitative integration of the literature. Acta psychiatrica scandinavica, 76(5), 465-479. https://doi.org/10.1111/j.1600-0447.1987.tb02906.x
  4. I. Kang, J. Park, Y. Lee, S. Seo, K. Kim & S. Choi. (2005). Socioeconomic cost analysis fordementia patients. Seoul: National Health Insurance Co.
  5. J. L Cummings & D. F. Benson. (1992). Dementia: a clinical approach. Boston, MA: Butterworth-Heinemann.
  6. Korea Ministry of Health and Welfare. (2012). Prevalence of dementia. http: //www.mohw. go.kr/front_new/al/sal0301vw.jsp?
  7. G. C. Roman. (2005). Clinical forms of vascular dementia. Vascular Dementia, Springer: 7-21.
  8. J. V. Bowler, M. Eliasziw, R. Steenguis & D. G. Munoz. (1997). Comparative evolution of Alzheimer disease, vascular dementia, and mixed dementia. Archives of neurology, 54(6), 697-703. https://doi.org/10.1001/archneur.1997.00550180021007
  9. C. Ballard, J. O'Brien, C. M. Morris, R. Barber, A. Swann, D. Neill & I. McKeith. (2001). The progression of cognitive impairment in dementia with Lewy bodies, vascular dementia and Alzheimer's disease. International Journal of Geriatric Psychiatry, 16(5), 499-503. https://doi.org/10.1002/gps.381
  10. P. R. Solomon, A. Hirschoff, B. Kelly, M. Relin, M. Brush, R. D. DeVeaux & W. W. Pendlebury. (1998). A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Archives of neurology, 55(3), 349-355. https://doi.org/10.1001/archneur.55.3.349
  11. J. D. Henry & J. R. Crawford. (2004). A meta-analytic review of verbal fluency performance following focal cortical lesions. Neuropsychology, 18(2), 284. https://doi.org/10.1037/0894-4105.18.2.284
  12. S. Jones, E. J. Laukka & L. Backman. (2006). Differential verbal fluency deficits in the preclinical stages of Alzheimer's disease and vascular dementia. Cortex, 42(3), 347-355. https://doi.org/10.1016/S0010-9452(08)70361-7
  13. J. C. Looi & P. S. Sachdev. (1999). Differentiation of vascular dementia from AD on neuropsychological tests. Neurology, 53(4), 670-670. https://doi.org/10.1212/WNL.53.4.670
  14. M. Laine, E. Vuorinen & J. O. Rinne. (1997). Picture naming deficits in vascular dementia and Alzheimer's disease. Journal of clinical and Experimental Neuropsychology, 19(1), 126-140. https://doi.org/10.1080/01688639708403842
  15. K. Fahlander, A. Wahlin, O. Almkvist & L. Backman. (2002). Cognitive functioning in Alzheimer's disease and vascular dementia: further evidence for similar patterns of deficits. Journal of clinical and Experimental Neuropsychology, 24(6), 734-744. https://doi.org/10.1076/jcen.24.6.734.8404
  16. H. Chertkow & D. Bub. (1990). Semantic memory loss in dementia of Alzheimer's type: What do various measures measure? Brain, 113(2), 397-417. https://doi.org/10.1093/brain/113.2.397
  17. R. J. Welland, R. Lubinski & D. J. Higginbotham. (2002). Discourse comprehension test performance of elders with dementia of the Alzheimer type. Journal of Speech, Language, and Hearing Research, 45(6), 1175-1187.
  18. C. Hudon, S. Belleville, C. Souchay, M.-C. Gely-Nargeot, H. Chertkow & S. Gauthier. (2006). Memory for gist and detail information in Alzheimer's disease and mild cognitive impairment. Neuropsychology, 20(5), 566. https://doi.org/10.1037/0894-4105.20.5.566
  19. D. A. Robertson, M. A. Gernsbacher, S. J. Guidotti, R. R. Robertson, W. Irwin, B. J. Mock & M. E. Campana. (2000). Functional neuroanatomy of the cognitive process of mapping during discourse comprehension. Psychological science, 11(3), 255-260. https://doi.org/10.1111/1467-9280.00251
  20. T. Trabasso & J. P. Magliano. (1996). Conscious understanding during comprehension. Discourse Processes, 21(3), 255-287. https://doi.org/10.1080/01638539609544959
  21. M. Daneman & P. A. Carpenter. (1980). Individual differences in working memory and reading. Journal of verbal learning and verbal behavior, 19(4), 450-466. https://doi.org/10.1016/S0022-5371(80)90312-6
  22. D. Caplan & G. Waters. (2005). The relationship between age, processing speed, working memory capacity, and language comprehension. Memory, 13(3-4), 403-413. https://doi.org/10.1080/09658210344000459
  23. G. McKhann, D. Drachman, M. Folstein, R. Katzman, D. Price & E. M. Stadlan. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS‐ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34(7), 939-939. https://doi.org/10.1212/WNL.34.7.939
  24. G. C. Roman, T. K. Tatemichi, T. Erkinjuntti, J. Cummings, J. Masdeu, J. Garcia, L Amaducci, J.-M. Orgogozo, A. Brun & A. Hofman. (1993). Vascular dementia: diagnostic criteria for research studies: report of the NINDS‐AIREN International Workshop. Neurology, 43(2), 250-250. https://doi.org/10.1212/WNL.43.2.250
  25. Y. Kang. (2006). A normative study of the Korean Mini-Mental State Examination (K-MMSE) in the elderly. Korean Journal of Psychology, 25, 1-12.
  26. Y. Kang, D. Na & S. Hahn. (2003). Seoul neuropsychological screening battery. Incheon: Human brain research & consulting co.
  27. C. Choi & H. Choi. (2013). Story comprehension ability in patients with MCI and DAT. Journal of Speech-Language and Hearing Disorders, 22(22), 159-180. https://doi.org/10.15724/jslhd.2013.22.4.010
  28. Y. Kang, J. Chin & D. Na. (2002). A normative study of the digit span test for the elderly. Korean Journal of Clinical Psycholoy, 21(4), 911-922.
  29. J. L .Cummings, H. V. Vinters, G. M. Cole & Z. S. Khachaturian. (1998). Alzheimer's disease: etiologies, pathophysiology, cognitive reserve, and treatment opportunities. Neurology, 51(1 Suppl 1), S2-S17.
  30. M. F. Mendez, M. M. Cherrier & K. M. Perryman. (1997). Differences between Alzheimer's disease and vascular dementia on information processing measures. Brain and Cognition, 34(2), 301-310. https://doi.org/10.1006/brcg.1997.0923
  31. H. Choi. (2016). Working Memory and Verbal Memory's Relationship to Discourse Comprehension in Patients with Amnestic Mild Cognitive Impairment and with Alzheimer's Disease. Communication Sciences & Disorders, 21(2), 324-332. https://doi.org/10.12963/csd.16299
  32. R. L. Hester, G. J. Kinsella & B Ong. (2004). Effect of age on forward and backward span tasks. Journal of the International Neuropsychological Society, 10(4), 475-481. https://doi.org/10.1017/s1355617704104037