알쯔하이머 치매·혈관성 치매·아밀로이드·면역·IL-1β·TNF-α, Alzheimer's discase·Vascular dementia·Amyloid·Immunity·IL-1β·Tnf-α.

채정호,백인호 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적 : 알쯔하이머 치매의 병인론에 면역성 기전이 개입된다는 가설을 확인하고자 본 연구를 행하였다. 방 법 : 알쯔하이머 치매 19명, 혈관성 치매 22명, 정상노인 19명에서 말초 혈액 단핵세포를 분리하여 phyohemagglutinin-P(PHA-P) 및 1-40의 β-아밀로이드(Aβ)로 자극하여 세포 증식 정도를 비교하였으며, 배양 상청액에서 interleukin-1β(IL-1β)와 tumor necrosis factor-α(TNF-α)를 효소결합면역흡착분석법으로 측정하였다. 결 과 : 1) PHA-P 자극에 의한 단핵 세포의 증식은 세 군에서 차이가 없었다. 2) Aβ 자극은 단핵세포의 증식에 현저한 영향이 없었으나, 알쯔하이머 치매군이 혈관성 치매군과 대조군에 비하여 유의하게 많이 증식되었다. 3) 배양한 단핵세포 알쯔하이머 치매상청액의 IL-1β는 혈관성 치매군이 가장 높았으며, Aβ자극 후에도 혈관성 치매군에서 가장 높았으나 자극 전후를 비교할 때, 알쯔하이머 치매군에서 가장 현저하게 자극 후 IL-1β 생성이 증가되었다. 4) 배양한 단핵세포 상청액의 TNF-α는 알쯔하이머 치매군이 대조군보다 유의하게 높았으며, Aβ 자극 후에도 알쯔하이머 치매군이 대조군보다 유의하게 높았다. 결 론 : 이상의 실험을 통하여 알쯔하이머 치매군의 말초 혈액 단핵세포가 Aβ 자극에 따라 나타내는 과도한 면역 반응을 관찰하였다. 이는 알쯔하이머 치매의 병태생리에서 Aβ침착에 따른 면역성 반응이 중요한 역할을 한다는 것을 시사한다. Objectives : Deposition of the β-amyloid(Aβ) peptide in the senile plaque has been thought as a major etiologic factor for the development of Alzheimer's disease. Among the hypotheses suggested to explain the mechanism by which Aβ causes Alzheimer's disease, the immune processes have been considered as crucial events in the pathophysiology of the Alzheimer's disease. This study examined the effects of Aβ on the proliferation and production of IL-1β(interleukin-1β) and TNF-α(tumor necrosis factor-α) in peripheral blood mononuclear cells isolated from the patients with Alzheimer's disease, vascular dementia, and normal elderly control subjects. Method : Nineteen patient with Alzheimer's disease, 22 patients with vascular dementia, and 19 controls were participated in this study. Peripheral blood mononuclear cells were obtained from each donors, and subjected to the proliferation assays in response to the stimulation of phytohemagglutinin-P(PHA-P) and Aβ. The levels of IL-1β and TNF-α from the culture supernatant of the cells before and after the stimulation of Aβ were also determined by enzyme linked immunosorbent assay. Results : The results were as follows : 1) The proliferation of mononuclear cells in response to PHA-P were not different among three groups. 2) When compared to PHA-P, the proliferation responses of mononuclear cells to Aβ were insignificant in all experimental groups. However Alzheimer's disease group showed greater stimulation index than vascular dementia and controls. 3) IL-1β production was higher in the vascular dementia group than Alzheimer's disease and control groups both before and after the stimulation of Aβ. However the stimulation ratio of before and after Aβ stimulation was highest in Alzheimer's disease group. 4) TNF-α production was higher in Alzheimer's disease group than controls both before and after the stimulation of Aβ. Conclusion : These finding suggest that the immune responses to the stimulation of Aβ may be enhanced in patients with Alzheimer's disease compared to vascular dementia and control groups, supporting the immune hypothesis for th epathophysiology of Alzheimer's disease.

한방신경정신과 영역의 Alzheimer형 치매 관련 연구현황

김태윤 ( Tae Yoon Kim ),금창준 ( Chang Jun Kum ),오재우 ( Jae Woo Oh ) 대한한방신경정신과학회 2014 동의신경정신과학회지 Vol.25 No.3

Objectives: Alzheimer`s Dementia is somewhat common in clinical stages, and there are many reports and papers regarding this subject. We explain the present state of Alzheimer`s Dementia in JON (The Journal of Oriental Neuropsychiatry) for the benefits of clinical practice. Methods: We searched for articles in JON from 1990 to 2014 and selected ones that were related to Alzheimer`s Dementia; then, we analyzed the data and placed it in four categories, like experimental study, case study, Clinical Data-Analysis study, and clinical trial. Results: 1) We found 47 articles relating to Alzheimer`s Dementia in JON from 1997 to 2014: 41 experimental studies, 1 case study, 1 Clinical Data-Analysis study, and 4 Clinical trials. 2) There were Chung-kyung Acupuncture Method, Auricular acupuncture, and Cha-rak Acupuncture Method to treat Alzheimer`s Dementia. 3) There were many additional treatments, like aroma therapy. 4) In the experimental study, they reported on several herbs, including herbal prescriptions that affected the suppression of related mRNAs and genes. 5) There were 4 clinical trials regarding herbal prescription that was effective for treating Alzheimer`s Dementia. Conclusions: In JON, regarding Alzheimer`s Dementia, the majority dealt with experimental studies. Therefore, we also have to expand our sight into other fields of study. We need more clinical trials and case studies for the treatment of Alzheimer`s Dementia in Oriental Neuropsychiatry.

알츠하이머 치매 환자의 혈청 항산화제 농도 감소

장우영,김민경,김태석,이창욱 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.4

Objectives : Previous studies have suggested that oxidative injuries to the neuron may have important role in the pathophysiologic mechanisms ot dementia of Alzheimer's type. In the present study, we evaluate the plasma levels of albumin, total bilirubin, and uric acid in the patients with dementia of Alzheimer's type, and compare to those of the healthy controls. Methods : The plasma albumin, bilirubin, and uric acid levels were measured by standard methods in 102 patients with dementia of Alzheimer's type (male 42, female 60) and 99 healthy controls (male 47, female 52). The Korean version of Mini Mental Status Examination (MMSE-K) was used to evaluate the cognitive functions of patients with dementia of Alzheimer's type. Results : The plasma albumin (F=36.179, p<0.001), bilirubin (F= 101.508, p<0.001), uric acid (F= 12.688, p<0.001) levels in the patients with dementia of Alzheimer's type wcre significantly lower than those of the healthy controls. The scores of MMSE-K were positively correlated with the plasma albumin level in the patients with dementia of Alzheimer's type after adjusted for covariates such as age, gender, and body mass index (p=0.017). Conclusion : This study supported that oxidative injuries might be involved in the pathogenesis of dementia of Alzheimer's type, as well as suggested that some antioxidant might be associated with the cognitive functions in dementia of Alzheimer's type.

알쯔하이머형 치매와 혈관성 치매환자에서의 ALDH2와 APOE 유전자의 다형성에 관한 연구

김동홍,김영돈,이창화,엄기춘,김은식,윤경식,김동희 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.2

연구목적: 본 연구는 국내 치매환자들을 대상으로 치매발병의 위험요소가 될 수있는 ALDH2와 APOE 유전자형이 어떤 양상으로 나타나는지 알아보기 위하여 시행되었다. 방 법: 충남 부여군에 위치한 부여노인병원에 입원중인 65세 이상의 알쯔하이머형 치매와 혈관성 또는 혼재성 치매환자 59명(남:19, 녀:40)을 대상으로 ALDH2와 APOE 유전자형을 제한효소법에 의하여 조사하였고 치매유형에 따른 유전자형과 대립유전자의 빈도를 비교하였다. 결 과: 1) 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성 치매환자군보다 ALDH2*(-/2)유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 2) 알쯔하이머형 치매화자군에서 혈관성 또는 혼재성 치매환자군보다 APOE*(-/ε4) 유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 3) APOE*ε4와 ALDH2*2를 알쯔하이머병의 균등한 위험대립유전자로 가정하고 각 유전자형의 대립유전자의 수를 점수화하여 각 치매환자군의 위험유전자 전체점수를 비교한 결과 알쯔하이머형 치매환자군에서 점수가 더 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. 결 론: 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성치매치매환자군보다 ALDH2*2와 APOE*ε4 대립유전자의 빈도가 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. A study on gene polymorphism of ALDH2 and APOE in patients with alzheimer's disease and vascular or mixed dementia. Objective : This study was designed to investigate gene polymorphism of ALDH2 and APOE, reported the risk factor of Alzheimer's disease, in korean dementia patients. Method : 59 Patients(male:19, female:40) with dementia, aged 65 and older in Buyeo geriatric hospital located in Buyeo-gun, chungnam, were finally included in this study. gene polymorphism of ALDH2 and APOE was typed with polymerase chain reaction in patients with Alzheimer's desease and vascular or mixed dementia. Results : 1) There was no difference in allelic frequency of ALDH2 gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 2) There was no difference in allelic frequency of APOE gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 3) Supposing APOE*ε4 and ALDH2*2 were equal risk allele of Alzheimer's disease, the sum of score by counting each risk allele was higher in patients with Alzheimer's disease than vascular mixed dementia, however there was no significant difference. Conclusion : The genotype frequency of ALDH2*(-/2) and APOE*(-/ε4) was higher in patients with Alsheimer's disease than vascular or mixed dementia, however there was no significant difference in allelic frequency of gene polymorphism of ALDH2 and APOE between patients with Alzheimer's disease and vascular or mixed dementia.

여러 치매성 질환에서의 아포지단백 E의 유전형 분석

박윤미,전영미,권계철,구선희,박종우 대한임상병리학회 1999 대한임상병리학회지 Vol.19 No.6

플로리앙 젤레르 작 아버지(Le Père) 앙드레 역할창조 연구 - 비인지 기능 장애와 앤 보가트의 뷰포인트를 중심으로

장건우,조준희 한국연극교육학회 2023 연극교육연구 Vol.45 No.-

This study aims to analyze the "Andre" of <Le Pere> in Florian Zeller's family drama trilogy from the perspective of non-cognitive dysfunction and examine the process of creating a role through Anne Bogart's physical acting methodology In the process of analyzing and building Andre's behavioral patterns, it was difficult to accept and express his Alzheimer's dementia behavior and symptoms with existing universal perceptions and representational acting training methods. Therefore, it was judged that grasping the character's disposition based on objective criteria and building a corresponding inner world could provide confidence in the role and help to play the character clearly. For this, BPSD (Behavioral and Psychological Symptoms of Dementia) criteria were used to define Andre as an Alzheimer's dementia patient, and three characteristics were derived: "Quickly declining memory," "warning for others," and "anxiety caused by a departing family." After that Ann Bogart's Viewpoint Acting Training Method applied to make the psychological and behavioral symptoms of Alzheimer's dementia into physical behavior. The cognitive training method of time and space a training method of Ann Bogart’s Viewpoint Acting Training Method-was applied to 'Andre' to shape the psychological symptoms of cognitive impairment as physical behavior. This study attempted to clearly establish the behavioral patterns of Alzheimer's dementia patient 'Andre' by creating the role based on objective criteria. The significance of this study is that it provides a practical way to create the role Andre by embodying the mental symptoms and physical behaviors of Alzheimer's disease through Anne Bogart's Viewpoint Acting Training Method.

구간거리 측정에 의한 알쯔하이머 치매 진단

이종훈,손일권,류지안,박종한,손인기 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.1

연구목적: 본 연구는 알쯔하이머 치매 환자에서 구간거리 측정의 유용성을 알아보기 위해서 시행되었다. 방법: 대상은 어느 대학병원 정신과에 입원한 환자들 중에서 알쯔하이머 치매환자 30명, 치매이외의 다른 정신장애 대조군 20명, 그리고 비정신고 대조군 22명이었다. 후향적으로 모아진 자기공명여상 자료를 이용하여를 알아보았다. 결과: 1)구간거리는 알쯔하이머 치매군 26.78mm(SD=2.26), 비정신과 대조군 23.29mm(SD=1.98)로 알쯔하이머 치매군이 다른 두 군에 비해 우의하게 더 증가되었다.(F=7.496,df=2,p<.001). 2)보정후 구간거리 (interuncal distance/intracranial width)는 알쯔하이머 치매군 0.024(SD=0.024), 정신과 대조군 0.177(SD=0.015)로 알쯔하이머 치매군이 다른 두군에 비해 유의하게 더 증가되었다(F=12.160, df=2, p<.000). 3)구간거리에서 Area under curve는 0.736이었고, Area under curve의 표준오차는 0.062(95%CI, 0.613~0.858)이었다. 민감도와 특이도는 구분점 24.41mm에서 각각 56.7%와 81%이었다. 4)보정후 구간거리에서 Area under curve는 0.801이었고, Area under curve의 표준오차는 0.059(95%CI, 0.685~0.917)이었다. 민감도와 특이도는 구분점 0.188에서 각각 83.3%와 76.2%이었다. 결론: 구간거리의 측정은 알쯔하이머 치매환자를 진단할 때 간단하면서도, 사용할만한 진단적 도구이다. Objectives : This study was performed to investigate that the interuncal distance measurement is useful to diagnose Alzheimer's dementia. Method : 30 patients with Alzheimer's dementia, 20 patients with other mental disorders, and 22 patients with nonpsychiatric disorders entered in this study. We measured the interuncal distance and the intracranial width using MR images that were collected retrospectively to examine the differences among each groups. Results : 1) The interuncal distance was 26.08mm(SD=3.51) in Alzheimer's dementia, 23.78mm(SD=2.26) in psychiatric control subjects and 23.29mm (SD=1.98) in nonpsychiatric control subjects. According to these results, the inter-uncal distance of Alzheimer's dementia was significantly longer than the other two groups(F=7.496, df=2, p<.001). 2) The corrected interuncal distance(interuncal distance/intracranial width) was 0.202(SD=0.024) in Alzheimer's dementia, 0.184(SD=0.015) in psychiatric control subjects and 0.177(SD=0.015) in nonpsychiatric control subjects. According to these results, the corrected interuncal distance of Alzheimer's dementia was significantly longer than the other two groups(F=12.160, df=2,p<.000). 3) Area under cutie in the interuncal distance measurements was 0.736 and the standard error was 0.062(95%Cl, 0.613-0.858). The scale of sensitivity and specificity at the cutoff point of 24.41mm were 56.7% and 81%. The corresponding values of corrected interuncal distance measurements were 0.801, 0.059(95%Cl, 0.685-0.917), 0.188, 83.3%, and 76.2%. Conclusions : The interuncal distance measurement is useful to diagnose Alzheimer's dementia.

건강보험 청구자료를 이용한 알츠하이머 치매 치료제와 콜린알포세레이트의 처방 양상 분석

황상구,박혜경 한국임상약학회 2019 한국임상약학회지 Vol.29 No.1

Background: Alzheimer's dementia is the most common dementia. However, recently, choline alfoscerate is prescribed for treating Alzheimer's dementia, although it is not a treatment for this disease. Purpose: To analyze the prescription patterns of choline alfoscerate as a dementia treatment for patients with Alzheimer's disease and to analyze, as well as the factors affecting choline alfoscerate prescription. Method: The 2016 HIRA-NPS data was used in this study. The code of Alzheimer's dementia is F00 in the ICD-10 disease classification code. We analyzed the demographic, clinical, and regional characteristics associated with donepezil, rivastigmine, galantamine, memantine, and choline alfoscerate prescriptions. All statistical and data analyse were conducted by SAS 9.4 and Excel. Results: For patients with Alzheimer's disease, choline alfoscerate was the second most prescribed after donepezil. Analysis results showed that choline alfoscerate was more likely to be prescribed to men than to women, and more likely to be prescribed by local health centers than by medical institutions. Moreover, choline alfoscerate was highly likely to be prescribed at neurosurgical departments, among medical departments. Conclusions: This study confirmed that choline alfoscerate was prescribed considerably for patients with Alzheimer's dementia. Further studies valuating its clinical validity should be performed to clarify whether choline alfoscerate prescription is appropriate for treating Alzheimer's dementia.

한국의 일 요양 시설에 거주하는 한센병 환자들에서의 치매 유병률

이철순(Cheol Soon Lee),강효승(Hyo Seung Kang),구준(Joon Gu),박철수(Chul Soo Park),손진욱(Jin Wook Shon),김봉조(Bong Jo Kim) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.2

Objectives : To identify prevalence of dementia and it's subtypes in patients with Hansen's disease in a sanatorium of Korea. Methods : The study employs a two-stage design for case identification. One hundred-six patients with Hansen's disease aged 65 and over participated in the study. The Korean Version of the Consortium to Establish a Registry for Alzheimer's disease (CERADK) assessment packet was administered to One hundred-two patients with Hansen's disease. Dementia was defined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic features of dementia. Results : The prevalence was 15.1% in Hansen's sanatorium. The prevalence of Alzheimer's and vascular dementia were 10.4% and 4.7%. The age-adjusted prevalence rate for dementia was 11.9%. The rate of patients with dementia was 12.73% in males and 17.65% in females. Conclusion : The prevalence of dementia in Hansen's disease sanatorium of Korea appears to be similar with those reported in previous study. Our result suggests that Hansen's disease was unrelated to prevalence of dementia, and also that the dementia is major neuropsychiatric disease in patient with Hansen's disease.

치매 개념의 역사적 변천

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.1

Most histories of senile dementia begin with Alois Alzheimer's description in 1906 of the first case of Alzheimer's disease. However, the history of senile dementia is quite rich, dating back to the ancient Greek and Roman philosophers and physicians, so the history of dementia is probably as old as mankind itself. Although senile dementia has been recognized as a condition of aged individuals since at least the time of Pythagoras in the 7th century B.C., because it was dismissed as an inevitable feature of aging, it remained largely an uninvestigated disorder until the 19th century. An introduction of a scientific approach to clinical observation and the systematized classification of mental disorders in the mid-19th century that senile dementia began to be differentiated from other dementias, and was established as its own defined class of mental disorder. The identification of Alzheimer's disease at the onset of the 20th century was a turning point for the understanding of senile dementia, and the concepts and histological findings presented by the early researchers of Alzheimer's disease remain relevant still today. Here the author traces the history of the evolution of our current conceptualization of Alzheimer's disease from the Greek-Roman concept of age-associated dementia.