한국 치매 환자의 건강보험 의ㆍ한의 진료 비용에 관한 연구

이정배,강형원,김재욱,김가혜,김남권 대한한방신경정신과학회 2019 동의신경정신과학회지 Vol.30 No.1

Objectives: To identify the cost effectiveness of early dementia diagnosis using the 2014 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS).Methods: The medical costs of dementia between Western medical care and Korean medical care were compared through the reimbursement and non-reimbursement item code for dementia examination. In addition, the medical expenses of patients with dementia and mild cognitive impairment were com-pared and analyzed with respect to Western and Korean medical care.Results: There were 87,434 claims, of which 16,101 patients were diagnosed with dementia and 38,680,789,560 won was found to be the medical expenses. 12,881 patients (80.0%) with dementia, 3,144 patients (19.5%) with mild cognitive impairment, and 76 patients (0.5%) progressing from mild cognitive impairment to dementia. The proportion of medical expenses was 97.6% for dementia pa-tients, 2.3% for mild cognitive impairment, and 1% for patients progressing from mild cognitive im-pairment to dementia. 86,070 claims (98.4%) were from Western medical care, with16,824 patients (98.2%), and the medical expenses was 38,546,895,400 won (99.7%). 1,361 claims (1.6%) were from Korean medical care, with 303 patients (1.8%), and the medical expenses was 133,894,160 won (0.3%). Conclusions: This study compared and analyzed the medical costs of dementia patients and the diag-nosis of both Korean and Western medical care. The results of this study are expected to be used as ba-sic research data for investigating cost effectiveness of developing early diagnosis of dementia.

Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems

김상순,장승민,유경호,이병철,강연욱 대한치매학회 2018 Dementia and Neurocognitive Disorders Vol.17 No.3

Background and Purpose: Although the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia. Methods: Patients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems. Results: On all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE. Conclusions: The results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.

시계 그리기 검사의 채점방법에 따른 치매 및 경도인지장애 선별에 대한 신뢰도 및 타당도

이강수,정해관,오병훈,홍창형,이동우 대한치매학회 2009 Dementia and Neurocognitive Disorders Vol.8 No.1

Background: In order to evaluate the suitability of the clock drawing test (CDT) for a detection of dementia and mild cognitive impairment (MCI), we assessed interrater reliabilities, correlations, and validity of four common scoring methods of the CDT. Methods: The study subjects consisted of 524 community elderly aged between 60 and 85 yr. Clock drawings were scored independently and blindly by three raters according to four different methods (Freedman, Rouleau, Todd, and CERAD-CDT). Subjects were assessed of their cognitive function and activity of daily life. Dementia was assessed by a psychiatrist using DSM-IV or NINCDS-ADRDA criteria. Sensitivity and specificity of the each scoring methods was estimated. By comparing area under the curve, the diagnostic efficiency of the CDT methods for dementia and MCI were evaluated. Results: Inter-rater and intra-rater reliabilities were high for all four scoring methods. The area under the curve was 82.0-89.7% for the dementia and 65.3-66.9% for the mild cognitive impairment. Sensitivity of clock drawing test was between 0.75 and 0.85 for dementia and 0.41 and 0.85 for mild cognitive impairment, and specificity was between 0.80 and 0.84 for dementia and 0.43 and 0.83 for mild cognitive impairment. Conclusions: The reliability and validity of CDT for dementia and MCI in the elderly living in the community was not high. Therefore, CDT is not recommended to be used alone to screen for possible prodromal stages of dementing illnesses and dementia.

경도인지장애와 경도 치매의 감별을 위한 대면 이름대기와 범주 이름대기의 예측 성능 비교

변해원 한국융합학회 2020 한국융합학회논문지 Vol.11 No.5

The present study identify the predictive power of confrontational naming and generative naming as screening tests for normal and early cognitive impairment. The subjects were analyzed for 203 healthy elderly, 106 mild cognitive impairment (MCI), 31 mild dementia. The confrontational naming was measured by the short-term Korean Boston Name Waiting Test, and the generative naming was measured by the Control Associative Word Test. As a result of polynomial logistic regression, both confrontational naming and generative naming had a significant effect on discriminating cognitive impairment (MCI, mild dementia) in general elderly (p<0.05). On the other hand, when distinguishing mild dementia from mild cognitive impairment, the generative naming-phonetic test had no significant odds ratio. The results of this study suggest that when discriminating mild dementia in mild cognitive impairment group, it is not meaningful to look only at the total score of generative naming test. 본 연구는 정상 노인과 초기 단계의 노년기 인지 장애(경도인지장애(MCI), 경도 치매)의 선별검사인 대면 이름대기와 범주 이름대기의 예측력을 파악하였다. 노년기 인지장애로 진단을 받은 340명(정상 노인 203명, MCI 106명, 경도 치매 31명)을 분석하였다. 대면 이름대기는 단축형 한국판 보스턴 이름대기 검사로 측정하였고, 범주 이름대기는 통제연상단어검사의 의미검사와 음소검사를 이용하여 측정하였다. 이름대기 검사의 예측 성능을 비교하고자 다항 로지스틱 회귀분석을 수행한 결과, 대면 이름대기와 범주 이름대기 검사 모두 일반노인에서 MCI와 경도 치매를 감별하는 데 유의미한 효과가 확인되었다(p<0.05). 반면, MCI에서 경도 치매를 감별할 때, 범주 이름대기의 음소검사는 교차비가 유의미하지 않았다. 본 연구의 결과는 MCI에서 경도 치매를 감별할 때, 범주 이름대기의 총점만을 측정기준으로 분석하는 것은 유의하지 않을 가능성이 높음을 시사한다.

한국형 치매임상진료지침 소개

구본대,김신겸,이준영,박기형,신준현,김광기,윤영철,이영민,홍창형,서상원,나덕렬,김성윤,정해관,김도관,이재홍,김상윤,연병길,김수영,한설희 대한의사협회 2011 대한의사협회지 Vol.54 No.8

The Clinical Research Center for Dementia of South Korea (CREDOS), a nation-wide clinical dementia research group, has prepared clinical practice guidelines (CPG) for dementia tailored to the Korean population. In this article, a summary of the CREDOS CPG is presented with the Korean and English version of full report included in the appendix. The CREDOS CPG in intended not only for psychiatrists and neurologists, but also internists, family physicians, and other primary care physicians involved in the prevention and early diagnosis of dementia. While our CPG for dementia mainly covers Alzheimer's disease (AD) and vascular dementia (VaD), it also includes mild cognitive impairment (MCI) and vascular MCI, which are currently known to be the preclinical stages of AD or VaD, respectively, with emphasis placed on early diagnosis. The CREDOS CPG aims to achieve the following goals by developing CPG for dementia: to establish evidence-based, objective and clear clinical standards for dementia; to improve the clinical decision-making process for patients with dementia; to provide scientific and systematic scales to aid in the work of dementia specialists; to suggest comprehensive and systematic healthcare services tailored to each dementia subtype. The CREDOS CPG focuses on diagnosis and evaluation of clinical practice available domestically, and provides useful concepts of dementia. Its emphasis is on etiologies and epidemiology, diagnostic criteria and evaluation, neuropsychological tests, behavioral and psychological symptoms, the activities of daily living, laboratory tests,and brain imaging.

치매간호중재 프로그램이 경증 치매노인의 인지기능, 우울 및 사회적 행동에 미치는 효과

지혜련,최순희,조명숙 노인간호학회 2003 노인간호학회지 Vol.5 No.2

Purpose : This study was conducted to investigate the effects of a nursing intervention program on levels of cognitive function, depression, and social behavior in elderly people with mild dementia. Methods : The participants in this study were 18 senior residents who had scores ranging from 15 to 23 on the MMSE-K. were 60 years of age or older and living in the city of G, Korea. The length of time for the intervention and data collection was from July 4 to August 29, 2002. The dementia nursing intervention program consisted of hand exercise to enhance brain function, music therapy, art therapy, and cognitive therapy. The program was administered twice a week for 90 minutes per session for eight weeks. Measurement tools were the MMSE-K developed by Kwon & Park (1989), Korean version of the SODS standardized by Bae (1996), and the social behavior measurement tool developed by Dastoor (1975). The data were analysed by frequency, percentage, mean, SD, and Wilcoxon signed ranks test using SPSS/PC+. Results : Cognitive function (z=-3.421, p= .001) in elderly people with dementia improved significantly after receiving the nursing intervention program. After being in the program, elderly people in the intervention group were significantly less depressed than before the intervention (z=-2.584, p= .010). But there was no significant difference between scores before and after the program for social behavior (z=-l .613, p= .107). Also orientation (z=-2.448, p= .014), function of language (z=-2.257, p= .024), and understanding and judgement (z=-3.317, p=.001) in the elders with dementia were significantly improved after receiving the nursing intervention program. Conclusions : These findings confirmed that the nursing intervention program for dementia made a contribution towards improving cognitive function and to reducing depression in the elderly people with mild dementia. Therefore, it is recommended that this program be used in clinical practice as an effective nursing intervention for elderly people with mild dementia.

지속적인 치매간호중재프로그램이 지역사회 경증치매노인의 인지기능 및 우울에 미치는 효과

지혜련,최순희,조명숙,주리애 노인간호학회 2004 노인간호학회지 Vol.6 No.2

Purpose : This study was conducted to investigate the effects of the program on the levels of cognitive function and depression in the elderly with mild dementia in the community. Method : The subjects of this study were 32 senior residents who had scores ranging from 15 to 23 on the MMSE-K, who were 60 years of age or older in the city of G, Korea. The first dementia nursing intervention program consisted of hand exercise to enhance brain function, music therapy, art therapy, and cognitive therapy from Oct.24 to Dec.17, 2002. The program was administered twice a week for 90 minutes totally 16 times. After the program, the second program which consisted of hand exercise, horticultural therapy was administered to the experimental group whose scores were less than 24 on the MMSE-K, twice a week for 90 minutes totally 10 times from Jan.7 to Feb.11, 2003. Measurement tools were the MMSE-K developed by Kwon & Park (1989), Korean version of the SGDS standardized by Bae (1996). The data were analysed by frequency, percentage, x²-test, Fisher's exact probability test, Wilcoxon signed ranks test, Mann-Whitney and ANCOVA using SPSS/PC +. Result: Cognitive function(z=-4.39, p= .000) in the elderly with dementia after receiving the first nursing intervention program was significantly more improved than before the intervention. Also, depression was significantly more reduced than before the intervention (z=-3.87, p=.000). In terms of comparing with two groups, the levels of cognitive function in the experimental group were significantly higher than those of the control group with no second nursing intervention program. Especially, orientation(F=14.443, p=.001) and recall of memory(F=4.738, p=.038) in the elderly with dementia after receiving the second nursing intervention program were significantly more improved than the control group. Also, the level of depression in the experimental group was significantly lower than the control group (F=13.628, p= .001). Conclusion: These findings confirmed that the continuous dementia nursing intervention program made a contribution in improving cognitive function and in reducing depression in the elderly with mild dementia. Therefore, it is recommended that this program be used in clinical practice as an effective nursing intervention for the elderly with mild dementia in the community.

경증 치매 노인을 위한 애플리케이션 디자인기획

이윤희(Yun-Hui Lee),조성환(Seong-Hwan Jo) 한국콘텐츠학회 2017 한국콘텐츠학회논문지 Vol.17 No.3

우리 사회는 고령화에 따라 치매 유병률이 지속적으로 증가하여 사회적으로 큰 문제가 되고 있다. 국가적으로 장기 요양 보험 제도를 시행하고 있으나, 조건이 안되는 치매 노인은 기본적인 요양서비스도 이용할 수 없는 상황이다. 이러한 사회적 배경 아래 스마트폰 사용이 보편화되는 환경 하에서 현재 서비스되는 애플리케이션의 기능 분석과 대상자 설문조사를 토대로 초기(경증) 치매 노인에게 질병 관리 및 가족 간의 소통에 도움을 주는 애플리케이션에 대해 연구하고자 하였다. 연구 방법은 연구주제와 관련된 이론 연구를 배경으로 경증 치매 노인을 위해 서비스되는 애플리케이션 사용 환경을 분석하였으며, 이 분석을 통해 치매 노인을 위한 앱이 없다는 사실을 알게 되었다. 이 기본연구를 바탕으로 경도 치매 노인에게 필요한 약물복용 관리, 신체 활동 관리, 두뇌 활동 관리, 치매 정보, 메모 등의 기능이 포함된 애플리케이션의 디자인기획 방향을 제시하였다. 나라에서 시행하는 제도적 지원에 이와 같은 서비스가 확대된다면, 애플리케이션 사용을 통해 수집된 데이터를 기반으로 경증 치매의 제도적 관리 선진화에 기여를 할 것으로 기대한다. Due to aging society, the prevalence of dementia is continually increasing and, thereby, causing a serious issue. Although Long Term Care Insurance is provided on a national level, it is not available for the elderly with dementia who do not satisfy the requirements. As the use of smartphones becomes widespread, this study investigated an application that can help disease management of the elderly with the early-stage (mild) dementia and communication among the family members based on analysis of the functions found in currently-available applications and survey among the relevant subjects. As a research method, based on review of the relevant theoretical studies, the service environment of applications available for the elderly with mild dementia was analyzed. Through this analysis, it found out that there is no application for the eldery with mild dementia. On the basis of the results, this study proposed a direction for design planning of an application included many functions like managements of taking medicine, physical activity, brain activity, information on dementia and notes. for dementia management aimed to help the patients with mild dementia manage the disease on their own. If this type of services are expanded in addition to the systemic support from the government, the data collected from these applications can contribute to improving management of mild dementia.

Effects of Dual-Task Training with Cognitive Tasks on Cognitive Function and β-amyloid Levels in the Elderly with Mild Dementia

( Do-youn Lee ),( Seung-min Nam ) 대한물리의학회 2020 대한물리의학회지 Vol.15 No.2

PURPOSE: The purpose of this study was to examine the effects of dual-task training with cognitive tasks on cognitive functions and β-amyloid levels in the elderly with mild dementia. METHODS: The subjects were 36 elderly inpatients diagnosed with mild dementia at S Hospital located in Gyeongsangbuk-do, South Korea. The patients were randomly divided into a dual-task training group (DTG; n = 18) or a single-task training group (STG; n = 18). DTG performed dual-task training with cognitive tasks while STG performed only exercise tasks. These groups performed their respective exercises during a 30-minute session occurring three times a week over an 8-week period. MMSE-K and GDS were used to measure the subjects’ cognitive function. To assess the subjects’ dementia-related factors, their β-amyloid levels were measured by blood analysis. RESULTS: The results of the experiment were as follows: DTG showed statistically significant differences between their MMSE-K scores and β-amyloid levels before and after training (p < .05), whereas they exhibited no statistically significant differences in their GDS scores. MMSE-K scores and β-amyloid levels were significantly different between DTG and STG after training. CONCLUSION: The present study’s overall results indicate that dual-task training with cognitive tasks is more effective than single-task training in improving cognitive functions and β-amyloid levels in the elderly with mild dementia. In other words, regular dual-task training can be considered as effective in improving cognitive function and dementia-related factors in the elderly with mild dementia and thus may be suggested as an effective exercise method for the treatment and early prevention of dementia.

Validation Study of the Chinese Version of Addenbrooke’s Cognitive Examination III for Diagnosing Mild Cognitive Impairment and Mild Dementia

Xiao-Jia Li,Lili Yang,Jia Yin,Nengwei Yu,Fang Ye 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.3

Background and Purpose There are only a few cognitive screening tests for the Chinesespeaking population, and so this study aimed to validate the Chinese version of Addenbrooke’s Cognitive Examination III (ACE-III) for detecting mild cognitive impairment (MCI) and mild dementia. Its diagnostic accuracy was compared with the Chinese versions of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Methods The 176 included individuals were divided into 3 groups: mild dementia group, MCI group, and normal control group. MMSE, MoCA, and ACE-III were administered to all participants by researchers who were blinded to the clinical grouping. The receiver operating characteristic (ROC) curves were analyzed. Results ACE-III exhibited good internal consistency and convergent validity. Age and education level significantly influenced the total ACE-III scores. When screening MCI, the area under the ROC curve (AUC) was significantly larger for ACE-III than for MMSE (0.88 vs. 0.72, p<0.05) and MoCA (0.88 vs. 0.76, p<0.05). ACE-III showed higher sensitivity (0.75) and specificity (0.89) than MMSE (0.64 and 0.63, respectively) and MoCA (0.67 and 0.77) at the optimal cutoff score of 88/89. For detecting mild dementia, ACE-III yielded satisfactory sensitivity (0.94) and specificity (0.83) at the optimal cutoff score of 74/75. The AUC of ACE-III was 0.95, which was comparable to those of MMSE (0.95) and MoCA (0.91). In participants with ≥12 years of education, the AUC was significantly larger for ACE-III than for MMSE when detecting MCI (0.90 vs. 0.68, p<0.05) and mild dementia (0.97 vs. 0.90, p<0.05). Conclusions The present study has verified that ACE-III is a reliable and accurate tool for screening MCI and mild dementia in the Chinese-speaking population, and is significantly superior to MMSE and MoCA for detecting MCI.