• 생물정신의학
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• 제9권2호
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• pp.103-111
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• 2002

Neurocognitive research focusing on cognitive deficits in Depression has resulted in several important but yet potentially contradictory findings. Much literature documents the presence of significant neurocognitive impairments in depressive patients. Studies have shown that dysthymic disorder patients demonstrate a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal braindamaged patients. Some reports have suggested that there is a focal pattern of deficit, such as anterior cingulate dysfunction, frontal lobe impairment, or dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate the neurocognitive functions in dysthymic disorder patients, and to compare the functions with those of major depressive disorder patients. The subjects are 17 dysthymic disorder patients. And their neurocognitive functions are compared with those of 23 major depressive episode patients. Patients with a history of neurologic disease, alcohol dependence, substance abuse and mental retardation are excluded. They are assessed with a part of Vienna Test System which is computerized neurocognitive function tests and can evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. There are no other specific difference between two groups, except the result of cognitrone test. This study provides information about the neurocognitive functions and some difference between major depressive disorder patients and carefully diagnosed dysthymic disorder patients.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제8권2호
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• pp.242-255
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• 1997

본 연구는 비엔나 검사총집의 전산화된 검사를 포함한 다양한 주의력검사도구를 통해 주의력결핍/과잉운동장애의 특징적인 주의력결핍유형을 알아보기 위해 시행되었다. 총 9가지의 검사를 실시하여 얻어진 결과를 통해 다음과 같은 사실을 알 수 있었다. 주의력결핍/과잉운동장애아동들이 정상대조군에 비해 전반적인 경계도가 낮으며 시간이 흐름에 따른 경계도의 저하가 심하며 반응에 대한 준비도 역시 감퇴되어 있었다. 또한 감시력 검사를 통해 주의력결핍/과잉운동장애아동이 선택적 주의력의 결함을 가짐을 알 수 있었으나 지속적 주의력의 결함은 관찰되지 않았다. 이들은 정보처리용량을 초과하는 자극이 주어지는 상황에서 정상 아동들에 비해 충동적으로 반응하여 오경보오류수가 증가하였다. 전두엽기능부전에 민감한 세 가지 신경심리검사를 통하여 주의력결핍/과잉운동장애아동들의 실행능력에 결함이 있음을 알 수 있었다. 주의력결핍/과잉운동장애아동에서 나타나는 다양한 주의력의 측면에서의 결함은 이 장애가 뇌간 망상체 형성및 전두엽을 포함한 뇌의 여러 부위의 통합적인 기능이상에 의한 것이라는 가설을 지지하는 것이라고 하겠다.

• 수면정신생리
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• 제5권2호
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• pp.155-169
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• 1998

Attentional dysfunction is considered as one of the core deficits in schizophrenic process. The findings, pathophysiological mechanisms, and their clinical implications of clinical and experimental neurocognitive tests for the attentional impairment in schizophrenics are reviewed. The influences of psychopathology, antipsychotic treatment, and chronic institutionalization are also included in the review. In contrast, there are only a few evidences that attentional dysfunction would be a core deficit of depressive, manic, and anxiety disorders. Some recent findings of attentional impairment in these disorders are reviewed.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.191-198
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• 2010

Objective : This study is planned to determine the neurocognitive difficulties of hydrocephalic adults. Methods : The research group contained healthy adults (control group, n : 15), and hydrocephalic adults (n : 15). Hydrocephalic group consisted of patients with idiopathic aquaduct stenosis and post-meningitis hydrocephalus. All patients were followed with shunted hydrocephalus and not gone to shunt revision during last two years. They were chosen from either asymptomatic or had only minor symptoms without motor and sensorineural deficit. A neuropsychological test battery (Raven Standart Progressive Matrices, Bender-Gestalt Test, Cancellation Test, Clock Drawing Test, Facial Recognition Test, Line Orientation Test, Serial Digit Learning Test, Stroop Color Word Interference Test-TBAG Form, Verbal Fluency Test, Verbal Fluency Test, Visual-Aural Digit Span Test-B) was applied to all groups. Results : Neuropsychological assessment of hydrocephalic patients demonstrated that they had poor performance on visual, semantic and working memory, visuoconstructive and frontal functions, reading, attention, motor coordination and executive function of parietal lobe which related with complex and perseverative behaviour. Eventually, these patients had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results. Conclusion : This prospective study showed that adult patients with hydrocephalus have serious neuropsychological problems which might be directly caused by the hydrocephalus; and these problems may cause serious adaptive difficulties in their social, cultural, behavioral and academic life.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제28권2호
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• pp.123-131
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• 2017

Objectives: Executive dysfunction including working memory deficit has been suggested to be one of the major neuropsychological etiologies of attention-deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate the augmentative effects of Cogmed working memory training on the symptoms and neurocognitive functions in medicated children and adolescents with ADHD. Methods: Twenty-five children with ADHD, aged 7 to 19 years, taking ADHD medication participated in this study. The participants were trained for 5 weeks with a commercially available and computerized working memory program ($Cogmed^{(R)}$) without any changes to their medication. The Korean version of the ADHD Rating Scale, Clinical Global Impression Scale, and Comprehensive Attention Test were administered before training and 4 weeks and 7 months after training, respectively. Results: After completing the training, the clinical symptoms and function, rated by the parents and clinician, were improved. In addition, the level of commission errors was significantly reduced in the selective attention (visual/auditory) task, sustained attention to response task, and flanker task. The untrained visuospatial short-term memory and working memory were also improved. These effects were still observed 7 months after the training. Conclusion: Cogmed working memory training can be a promising training option for the additional improvement of the symptoms and deficits in working memory and response inhibition in medicated children with ADHD.

• 생물정신의학
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• 제21권2호
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• pp.65-73
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• 2014

Objectives This study aimed to identify the differences and the profiles of cognitive deficits in remitted patients with schizophrenia and first-degree relatives of schizophrenic probands. Methods A total of 26 remitted states of schizophrenia patients were included in the study and the same number of unaffected first-degree relatives of schizophrenic probands and healthy controls were matched for age, sex, years of education. Cognitive function of all participants was measured by using the Digit span test, the Continuous performance test, the Rey auditory & visual learning test, the Complex figure test, the Verbal fluency test, the Wisconsin card sorting test and the Finger tapping test. The effects of subsyndromal symptomatology and general intelligence score were controlled. Results Schizophrenia patients' group showed more significant impairment than other groups in verbal memory (learning, immediate recall, delayed recall), visual memory (copy, immediate recall, delayed recall) and cognitive flexibility domains. The family group and the patient group commonly performed significantly worse than healthy controls in working memory and verbal fluency (category) tests. There were no differences in sustained attention, psychomotor performance. Conclusions Our research shows that the deficit in working memory and verbal fluency could be strong candidates of endophenotypic marker in schizophrenia.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제22권4호
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• pp.253-261
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• 2011

Objectives : This study aimed to investigate the efficacy and safety of Metadate CD (MCD) when given to Korean children and adolescents with attention-deficit hyperactivity disorder (ADHD). We also explored the effects of the drug on diverse neuro-cognitive functions. Methods : Ninety-one subjects with ADHD (mean age 8.6${\pm}$2.2 years) were recruited at 6 outpatient clinics in Seoul, Korea. We used the ADHD Rating Scale (ARS), Clinical Global Impression (CGI), and comprehensive attention test (CAT) to measure the drug's effects. Results : After 0.92${\pm}$0.32mg/kg/day of MCD were administered for 57.4${\pm}$7.6 days, there was a 48.5% reduction in the mean total ARS scores (p<.001). Fifty-seven subjects (64.8%) showed either much improved or very much improved outcomes on the CGI-Improvement scale. The CGI-Severity scale also decreased from an average of 4.7 to an average of 2.9 (p<.001). Errors and response time standard deviations of the CAT, sustained attention test-to-response tasks, the flanker test, and divided attention test scores decreased after treatment (p<.05). The forward memory span of the spatial working memory test scores increased (p<.05). Thirty-five patients (39.8%) experienced side effects, of which the most common were headache (14.8%), nausea (12.5%), and anorexia (9.1%). Conclusion : This open-label study suggests that MCD is effective and safe in improving the symptoms and neurocognitive functions of Korean children and adolescents with ADHD.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제16권2호
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• pp.160-172
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• 2005

ADHD는 소아정신질환 가운데 가장 흔한 신경발달학적 질환으로 간주되고 있다. ADHD의 원인은 아직 명확하게 밝혀지지는 않았지만 다양한 유전적 및 신경학적 요인들이 관여하는 것은 틀림없고, 이들이 신경계의 특정 부위와 경로에 이상을 초래하는 것으로 알려져 있다. 이 논문에서는 최근의 연구들을 중심으로 ADHD의 원인과 관련한 신경발달학적 측면을 고찰하고자 한다. 방법은 Medline검색을 통해 최근 발표된 논문들, ADHD관련 단행본, ADHD를 특집으로 한 몇 개의 잡지에 실린 종설 논문들 및 연관 참고문헌 등을 토대로 조사하였다. 결과는 ADHD의 신경발달학적 측면에서 일부 유전적인 요인과 임신 및 출생전후의 환경적 요인 등이 복합적으로 작용하여 발달하는 뇌를 변형시킴으로서 주로 대뇌의 prefrontal cortex-striatal network를 구조적으로 혹은 기능적으로 저하되어 발생하는 것으로 생각할 수 있다. 임신 2기에 ADHD의 발생과 관련한 대뇌 및 소뇌 이상을 초래한다는 주장을 하기도 하였으며, 이들 이상은 더 이상 진행하지 않고 고정된 것이라는 주장도 있지만, ADHD의 원인과 관련하여 신경발달학적으로 어떤 시기에, 어떤 손상이나 영향에 의해, 어떤 이상이 초래하여 발생하는지에 대해서는 아직 연구가 매우 부족하다. 결론적으로 주의력 체계와 관련한 신경전달회로의 차이, 도파민계와 노에피네프린계의 기능이나 증상과 관련한 차이 등 을 포함하여 신경발달학적인 면에 대한 보다 심도 있는 연구들이 시행되어야 할 것이다.

• 생물정신의학
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• 제8권2호
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• pp.258-265
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• 2001

Objectives : Chronic alcohol consumption has been known to result in various neurocognitive deficits. Many neuropsychological studies revealed that the major disturbances occurred in the executive function, learning and short-term memory, visuospatial performance function, perceptuo-motor skills, and abstraction and problem solving abilities. This study was done to identify which cognitive areas might be mainly affected. Methods : The cognitive disturbance was evaluated using the Korean Version of the Mini Mental State Examination(MMSEK) and the 7 Minute Screen(7MS) in male inpatients with alcohol dependence(N=3 : as well as in age and education level matched healthy male controls(N=30). Four individual tests of the 7MS were consisted of the Benton Temporal Orientation Test, the Enhanced Cued Recall, the Clock Drawing and the Category Fluency. Results : 1) The average scores of four individual test of the 7MS for the alcoholics were $2.77{\pm}4.38$ for the Benton Temporal Orientation Test, $13.90{\pm}2.02$ for the Memory Test(the Cued Recall $6.77{\pm}1.94$, the Uncued Recall $7.10{\pm}2.45$), $5.84{\pm}1.86$ for the Clock Drawing, and $12.58{\pm}3.29$ for the Category Fluency. Except the Benton Temporal Orientation Test, there were statistically significant differences between test scores of alcoholics and those of controls(p<0.01). 2) The alcoholics who had MMSE-K score <24 were 9.68%. The average(${\pm}S.D.$) score of the MMSE-K for the patient group($27.23{\pm}2.62$) was significantly(p<0.001) lower than that of the healthy controls($29.20{\pm}1.24$). There were no statistically significant differences between four individual test scores of the 7MS of alcoholics with the MMSE-K score <24(N=3) and those of alcoholics with the MMSE-K score ${\geq}24$(N=28). 3) Four individual test scores of the 7MS seemed to have statistically significant association with such variables as MMSE-K, duration of alcohol drinking, blood magnesium concentration, liver function and thyroid function. Conclusion : Mild deficits of cognitive areas such as orientation, memory, visuospatial abilities and verbal fluency could be found in alcohol dependence.

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.315-322
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• 2015

Intracranial germ cell tumors (ICGCT) occur in 2-11% of children with brain tumors between 0-19 years of age. For treatment of germinoma, relatively low radiation doses with or without chemotherapy show excellent 10 year survival rate of 80-100%. Past studies showed that neoadjuvant chemotherapy combined with focal radiotherapy resulted in unacceptably high rates of periventricular tumor recurrence. The use of generous radiation volume which covers the whole ventricular space with later boost treatment to primary site is considered as standard treatment of intracranial germinomas. For non-germinomatous germ cell tumors (NGGCT), 10-year overall survival rate is still much inferior than that of intracranial germinoma despite intensive chemotherapy and high-dose radiotherapy. Craniospinal radiotherapy combined with cisplatin-based chemotherapy provides the best treatment outcome for NGGCT; 60-70% of overall survival rate. There is a debate on the surgical role whether surgery can contribute to improved treatment outcome of NGGCT when added to combined chemoradiotherapy. Because higher dose of radiotherapy is required for treatment of NGGCT than for germinoma, it is tested whether whole ventricular irradiation can replace craniospinal irradiation in intermediate risk group of NGGCT to minimize radiation-related late toxicity in the recent studies. To minimize the treatment-related neural deficit and late sequelae while maintaining long-term survival rate of ICGCT patients, optimized administration of chemotherapy and radiotherapy should be selected. Use of technically upgraded radiotherapy modalities such as intensity-modulated radiotherapy or proton beam therapy is expected to bring an improved neurocognitive outcome with longitudinal assessment of the patients.