• 생물정신의학
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• 제3권2호
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• pp.203-210
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• 1996

알쯔즈하이머형 치매 환자의 뇌자기공명영상(腦磁氣共鳴影像)에 나타난 뇌위축(腦萎縮) 및 백질병변(白質病變)과 치매 발병연령(發病年齡)과의 상관관계(相關關係)를 밝히기 위해, NINCDS-ADRDA 진단기준(診斷基準)에 의한 조발성(早發性)(n=9) 및 만발성(慢發性)(n=18) 알쯔하이머형 치매군과 각각의 정상대조군(n=10 : n=11)에서 뇌위축(腦萎縮)은 대뇌피질위축(大腦皮質萎縮)과 뇌실확장(腦室擴張)의 체적(體積)을 계측(計測)하고 백질병변(白質病變)은 뇌실주변, 심부백질, 기저핵 및 천막하영역의 백질(白質) 신호(信號) 고강도(高剛度)의 반정량적(半定量的) 평가척도(評價尺度)로 측정하였다. 조발성(早發性) 환자군의 뇌위축(腦萎縮)은 대조군보다 유의하게 컸고(p<0.05) 백질병변(白質病變)에서는 모든 영역에서 차이가 없었으며, 만발성(慢發性) 환자군은 뇌위축(腦萎縮) 정도에서는 대조군과 차이가 없었으나 백질병변(白質病變)은 심부백질 및 시상에서 유의한 차이(p<0.05)를 보였고 나머지 모든 영역에서도 대조군보다 심한 경향을 보였다. 알쯔하이머형 치매가 (1) 뇌위축(腦萎縮)을 주로 보이고 백질병변(白質病變)은 심하지 않은 조기발병군(早期發病郡)과, (2) 백질병변(白質病變)이 두드러지고 뇌위축(腦萎縮)은 심하지 않은 만기발병군(晩期發病郡)으로 나누어질 가능성과 양군의 병태생리(病態生理)가 상이(相異)할 가능성이 시사되었다.

• 동의신경정신과학회지
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• 제34권3호
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• pp.141-150
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• 2023

Objectives: This study aimed to comprehend the characteristics of Korean medicine patterns in relation to varying degrees of cognitive impairment in an elderly population. Methods: The dataset included 127 elderly individuals with cognitive impairment obtained from three Korean medicine hospitals between 2018 and 2021. The participants were categorized into two groups based on Clinical Dementia Rating-Sum of Boxes (CDR-SB) scores: those with questionable impairment (QI) and those with very mild dementia (VMD). A diagnostic framework for Korean medicine patterns encompassing Qi deficiency, Yin deficiency, Phlegm dampness, and Heat-fire was employed. Liver blood markers, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the AST/ALT ratio, were also analyzed. Results: The scores of the cognitive assessment tools (MoCA-K, MMSE-DS, and K-IADL) of the QI group significantly differed from those of the VMD group. CDR-SB exhibited a positive correlation with the scores of each pattern of Qi deficiency, Yin deficiency, Phlegm dampness, and Heat-fire, whereas ALT and AST values displayed negative correlations. Binomial logistic analysis, controlling for potential confounders, such as age, education years, body mass index, the presence of chronic disease, and the presence of medication, verified that the VMD group showed higher pattern scores and lower ALT and AST values than the QI group. Conclusions: Increases in pattern scores along with decreased AST and ALT levels might be indicative of more severe cognitive impairment.

• 보건행정학회지
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• 제20권1호
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• pp.19-36
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• 2010

Fee for long-term care insurance in Korea are determined in proportion to resources utilized according to severity rather than based on categorization of beneficiaries in consideration of the characteristics of resource utilization. This adoption is based on the assumption that as beneficiaries of long-term care insurance, characteristically, demands social services rather than needs medical treatments, the characteristics of beneficiaries and the quality of utilized resources are comparatively homogenous. Therefore, the proposition is that the size of resource consumed by beneficiaries in the same grade is identical. However, even in the same grade, the level of utilized resources is different depending on the characteristic of beneficiaries. In this regard, this study is to examine whether there are differences in the volumes of utilized resources depending on the characteristics of beneficiaries even in the same grade. We analyzed time study data for 2003, 2005, 2006 which conducted by the Korea Institute for Health and Social Affairs. To look at differences in the volumes of utilized resources, we identified characteristics of beneficiaries that influence utilized resource volumes and categorized services provided by facilities into the rehabilitation treatment category, the problematic behavior category, and the physical malfunction category. Then, we examined each service in consideration of service difficulty levels and wage weights. The result of examination showed that differences in utilized resource volumes exist in all three grades depending on the characteristics of beneficiaries. Especially, in the first grade with a high level of seriousness, utilized resource volumes were different for those three service categories and the problematic behaviour category considered dementia was found to consume the largest volume of resources. Moreover, there was the inversion phenomenon of utilized resources volumes between the grades. This result indicates that utilized resource volumes are different even in the same grade depending on the characteristics of beneficiaries and it is required to consider case-mix for reflection of the volumes of utilized resources depending on the characteristics of beneficiaries.

• The Korean Journal of Physiology and Pharmacology
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• 제18권6호
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• pp.447-456
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• 2014

Until now, a disease-modifying therapy (DMT) that has an ability to slow or arrest Alzheimer's disease (AD) progression has not been developed, and all clinical trials involving AD patients enrolled by clinical assessment alone also have not been successful. Given the growing consensus that the DMT is likely to require treatment initiation well before full-blown dementia emerges, the early detection of AD will provide opportunities to successfully identify new drugs that slow the course of AD pathology. Recent advances in early detection of AD and prediction of progression of the disease using various biomarkers, including cerebrospinal fluid (CSF) $A{\beta}_{1-42}$, total tau and p-tau181 levels, and imagining biomarkers, are now being actively integrated into the designs of AD clinical trials. In terms of therapeutic mechanisms, monitoring these markers may be helpful for go/no-go decision making as well as surrogate markers for disease severity or progression. Furthermore, CSF biomarkers can be used as a tool to enrich patients for clinical trials with prospect of increasing statistical power and reducing costs in drug development. However, the standardization of technical aspects of analysis of these biomarkers is an essential prerequisite to the clinical uses. To accomplish this, global efforts are underway to standardize CSF biomarker measurements and a quality control program supported by the Alzheimer's Association. The current review summarizes therapeutic targets of developing drugs in AD pathophysiology, and provides the most recent advances in the clinical utility of CSF biomarkers and the integration of CSF biomarkers in current clinical trials.

• 재활간호학회지
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• 제10권2호
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• pp.90-98
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• 2007

ression and quality of life of family caregivers of patients with Parkinson's disease(PD). Methods: A cross-sectional descriptive study was conducted in one neurology outpatient clinic in Seoul, Korea from March to June, 2006. Sixty eight family caregivers of PD patients were participated to the study, using CES-D and SF-36. Results: Mean scores of depression were $16.18{\pm}8.39$ (range: 0-48) and it was a little lower than caregiver's who took care of Dementia patients and were higher than primary caregivers of the patients with Stroke. Time for caregiving, perceived severity, duration of PD were significantly related with depression respectively. Higher ADL scores which mean greater motor disabilities were related to higher caregiver depression. Lower income and greater medical expenditure were closely related with the depression of family caregivers respectively. The mean scores of total QOL were $435.5{\pm}96.5$ and the mean scores of PF, SF, RE and MH were lower than general population. Time for caregiving, depression, patients' ADL scores were significantly associated with QOL respectively. People who were older and had lower educational background showed lower QOL scores respectively. Conclusion: Healthcare professionals should pay more attention to emotional aspects of caregivers who take care of PD patients, and develop comprehensive management strategies both for patients and their caregivers.

• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.349-357
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• 2022

Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality. Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17-0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100-4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362-6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795-22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

• 정신신체의학
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• 제31권2호
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• pp.89-99
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• 2023

연구목적 본 연구는 일 대학병원에 입원하여 정신건강의학과로 협진 의뢰가 된 65세 이상의 노인 입원 환자들을 연소노인, 고령노인, 초고령노인으로 분류하여, 각 연령대별로 초조(agitation) 양상에 기여하는 요인 및 차이, 초조 양상의 심각도에 대한 차이를 알아보기 위해 시행되었다. 방 법 2021년 7월 1일부터 2021년 12월 31일까지 인하대병원에 입원한 환자 중, 정신건강의학과에 협진 의뢰된 65세 이상 환자들의 의무기록을 후향적으로 검토하였다. 연령, 성별, 입원경로, 의뢰과, 의뢰 사유, 치료방법, 내외과적 질환여부, 혈액학적 검사자료 등을 조사하였다. 결 과 65-74세의 연소노인은 외과계열 협의진료 의뢰(OR 4.833, 95% CI 1.533-15.234, p=0.007), 높은 CRP수치(OR 2.111, 95% CI 1.007-4.426, p=0.048)에 해당될 경우, 75~84세의 고령노인은 외과계열 협의진료 의뢰(OR 3.568, 95% CI 1.334-9.544, p=0.011), 치매(OR 5.503, 95% CI 1.164-26.026, p=0.031), 저나트륨혈증(OR 0.344, 95% CI 0.149-0.791, p=0.012)에 해당될 경우, 85세이상의 초고령노인은 치매(OR 9.728, 95% CI 1.151-82.242, p=0.037)에 해당될 경우 초조와 유의한 관련성이 있었다. 또한 RASS 평균점수의 경우 65-74세의 연소노인은 1.22점, 75-84세의 고령노인은 1.54점, 85세이상의 초고령노인은 1.79점(F=5.368, p=0.005)으로 연령대 간의 초조 양상의 심각도에 대한 차이가 있었다. 결 론 연령대가 증가함에 따라 초조 양상의 심각도가 높게 나타났고, 초조 양상에 기여하는 여러 관련 요인들도 연령대 별로 차이가 있었다. 따라서, 고령 환자 진료시 연령대에 따라 초조에 영향을 미칠 수 있는 인자에 대한 주의가 필요하다.

• 정신신체의학
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• 제29권1호
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• pp.67-76
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• 2021

연구목적 본 연구는 알츠하이머병 및 경도인지장애 환자에서 뇌의 퇴행성 변화 (내측두엽 위축, 대뇌백질병변) 및 신경인지기능과 일상생활 수행능력과의 연관성을 살펴보고자 하였다. 방 법 본 연구는 단면 연구로서, 알츠하이머병 및 경도인지장애로 진단받은 111명을 대상으로 하였다. 내측두엽 위축은 표준화된 시각 기반 척도(Scheltens scale)에 의해 평가하였으며, 대상군을 두 그룹으로 분류하였다. 일상생활 수행능력은 한국어판 블레스트 치매 척도-일상생활 수행능력(Korean version of Blessed Dementia Scale-Activity of daily living, BDS-ADL)으로 평가하였으며 신경인지기능은 The Korean version of the consortium to establish a registry for Alzheimer's disease (CERAD-K)로 평가하였다. 내측두엽 위축의 정도에 따른 일상생활 수행능력의 차이를 보기 위해 독립표본 t-test를 시행하였으며, 일상생활 수행능력과 신경인지기능과의 상관관계를 분석하기 위해 피어슨 상관분석 및 계층적 다중회귀분석을 시행하였다. 결 과 내측두엽 위축이 심할수록, 그리고 단어목록재인 검사 점수가 낮을수록 BDS-ADL 점수가 높았다(p<0.05). 계층적 다중회귀분석 결과 MMSE-K, 단어목록 재인검사 점수가 BDS-ADL의 유의한 예측인자로 나타났다(Adjusted R²=0.442, F=44.611, p<0.001). 결 론 알츠하이머병과 경도인지장애 환자에서 일상생활 수행능력은 내측두엽 위축 및 단어목록재인 검사 점수와 유의한 상관관계를 보였다. 일상생활 수행능력과 관련된 인자를 분석한 본 연구는 임상 실제에서 유용한 정보를 제공할 것으로 생각된다. 일상생활 수행능력과 뇌의 구조 및 기능과의 연관성에 대해서 추가적인 연구가 필요할 것으로 보인다.

• 정신신체의학
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• 제24권2호
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• pp.184-190
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• 2016

연구목적 본 연구는 알츠하이머병(Alzheimer's disease, AD), 경도인지장애(Mild Cognitive Impairment, MCI), 정상군에서 체질량지수(Body Mass Index, BMI)의 차이를 분석하여 낮은 BMI 수치와 인지기능 저하와의 연관을 확인하고자 하였다. 또한, 한국판 간이정신상태검사(Mini Mental State Examination-Korean version, MMSEK), 치매임상평가척도(Clinical Dementia Rating, CDR), 전반적 퇴화척도(Global Deterioration Scale, GDS)과 BMI 사이에 연관성이 있는지도 알아보고자 하였다. 방 법 총 257명의 연구대상자들이 이 연구에 포함되었고, AD 및 MCI 진단을 위해 병력 청취, 정신상태검사, 신경인지기능검사, 신체 검사가 시행되었다. 대상자의 성별 및 연령과 신체 질환도 함께 조사하였다. 전반적인 인지기능과 질병의 심각도 단계 평가는 MMSE-K, GDS, CDR으로 측정하였다. 결 과 MMSE-K 점수는 정상군>MCI>AD 순이었으며 통계적으로 유의한 차이를 나타내었다(p=0.000). CDR과 GDS점수는 정상군이 가장 높았고, AD군이 가장 낮았으며 역시 통계적으로 유의한 차이를 나타내었다 BMI와 MMSE 점수 사이에는 유의한 양의 상관관계가 있었다(r=0.238, p=0.000). BMI와 CDR과는 음의 상관관계를 나타내었으며(r=-0.174, p=0.008), BMI와 GDS 역시, 음의 상관관계를 보였다(r=-0.233, p=0.000). 결 론 BMI와 인지기능과의 연관성이 있으므로, 치매나 경도인지장애 환자를 대상으로 BMI를 측정하는 것은 임상적 표지자로서 의미가 있을 것으로 예상된다. 본 연구는 AD의 진단 및 예방, 그리고 치료적 접근에 도움을 줄 수 있을 것으로 기대하며, 향후 이에 대한 대규모의 장기 추적 연구가 필요할 것으로 생각된다.

• 임상간호연구
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• 제26권2호
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• pp.207-216
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• 2020

Purpose: The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. Methods: Data were collected in the SICU of a tertiary hospital in ^⁎ city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients' characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. Results: Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium (12.7%). Conclusion: The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium.