농촌지역 노인들의 인지기능 장애와 사망과의 관련성

선병환,박경수,나백주,박요섭,남해성,신준호,손석준,이정애,Sun, Byeong-Hwan,Park, Kyeong-Soo,Na, Baeg-Ju,Park, Yo-Seop,Nam, Hae-Sung,Shin, Jun-Ho,Sohn, Seok-Joon,Rhee, Jung-Ae 대한예방의학회 1997 예방의학회지 Vol.30 No.3

60세이상 노인인구를 대상으로 '농촌지역 노인들의 우울 및 인지기능 장애에 관한 연구'를 한 이정애와 정향균의 연구대상 558명에 대해 농촌지역 노인들의 인지기능 장애와 사망과의 관련성을 살펴본 결과는 다음과 같다. 1) 3년동안 동안 전체 대상자의 사망률은 558명중 57명인 10.2%이었으며 353명의 정상 인지기능군 중 사망자는 30명으로 사망률 8.5%, 126명 의 경도 인지장애군중 사망자는 14명으로 사망률 11.1%, 79명의 중증 인지장애군중 사망자는 13명으로 사망률 16.5% 이었다(표 3). 2) 3년동안 전체 연구 대상자의 생존율은 0.91이었으며 정상, 경도, 중증 인지기능 장애군의 3년 생존율은 각각 0.92, 0.90, 0.86이었다. 로그 순위 검정법으로 인지기능 정상군과 경도 및 중증의 각 인지기능 장애군의 생존곡선을 비교한 결과 통계적으로 유의하지 않았다. 또한 인지기능 정상군과 경도 이상의 인지기능 장애군간 생존곡선을 비교한 결과도 유의한 차이는 없었다. 3) 혼란변인을 보정하지 않는 Cox의 비례위험 회귀 모형의 단변량분석의 결과 95% 신뢰구간(C.I. : Confidence Interval)에서 사망위험도가 유의한 변인은 연령, 월수입, 흡연습관, 신체장애 등이었으며, 인지기능 장애정도를 정상 그리고 경도 및 중증으로 분류한 분석에서는 정상군에 비해 경도 및 중증의 사망위험도가 유의하게 높지 않았으나, 인지기능 점수(MMSEK score)의 증가에 따른 분석 결과 사망위험도가 0.94로 유의하게 낮게 나타났다(표 4). 4) 잠재적 혼란변인들의 영향을 보정한 Cox의 비례위험 회귀모형의 다변량 분석의 결과 인지기능 장애정도 및 MMSEK 점수증가에 따른 사망위험도는 어느 모형에서도 인지기능 장애정도가 사망에 미치는 위험도는 통계적으로 유의하지 않았다(표 5). 5) 남녀별로 각각 인지기능 장애와 사망위험도와의 관계를 알아보기 위해 다변량 분석을 시행한 결과 인지기능 장애정도 및 MMSEK 점수 증가에 따른 사망위험도는 어느 모형에서도 인지기능 장애정도가 사망에 미치는 위험도는 통계적으로 유의하지 않았다(표 6, 표 7). 이상 본 연구는 농촌지역 노인들에서 인지기능 장애정도가 사망에 미치는 영향을 알아보고자 하였지만, 인지기능 장애정도가 사망에 미치는 영향을 통계적으로 유의하게 고찰하지 못하였다. The purpose of this study was to examine the mortality risk associated with cognitive impairment among the rural elderly. The subjective of study was 558 of 'A Study on the Depression and Cognitive Impairment in the Rural Elderly' of Jung Ae Rhee and Hyang Gyun Jung's study(1993). Cognitive impairment and other social and health factors were assessed in 558 elderly rural community residents. For this study, a Korean version of the Mini-Mental State Examination(MMSEK) was used as a global indicator of cognitive functioning. And mortality risk factors for each cognitive impairment subgroup were identified by univariate and multivariate Cox regression analysis. At baseline 22.6% of the sample were mildly impaired and 14.2% were severely impaired. As the age increased, the cognitive function was more impaired. Sexual difference was existed in the cognitive function level. Also the variables such as smoking habits, physical disorders had the significant relationship with cognitive function impairment. Across a 3-year observation period the mortality rate was 8.5% for the cognitively unimpaired, 11.1% for the mildly impaired, and 16.5% for the severly impaired respendents. And the survival probability was .92 for the cognitively unimpaired, .90 for the mildly impaired, and .86 for the severly impaired respondents. Compared to survival curve for the cognitively unimpaired group, each survival curve for the mildly and the severely impaired group was not significantly different. When adjustments models were not made for the effects of other health and social covariates, each hazard ratio of death of mildly and severely impaired persons was not significantly different as compared with the cognitively unimpaired. But, as MMSEK score increased, significantly hazard ratio of death decreased. Employing Cox univariate proportional hazards model, statistically other significant variables were age, monthly income, smoking habits, physical disorders. Also when adjustments were made for the effects of other health and social covariates, there was no difference in hazard ratio of death between those with severe or mild impairment and unimpaired persons. And as MMSEK score increased, significantly hazard ratio of death did not decrease. Employing Cox multivariate proportional hazards model, statistically other significant variables were age, monthly income, physical disorders. Employing Cox multivariate proportional hazards model by sex, at men and women statistically significant variable was only age. For both men and women, also cognitive impairment was not a significant risk factor. Other investigators have found that cognitive impairment is a significant predictor of mortality. But we didn't find that it is a significant predictor of mortality. Even though the conclusions of our study were not related to cognitive impairment and mortality, early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival.

Effect of chemotherapy and radiotherapy on cognitive impairment in colorectal cancer: evidence from Korean National Health Insurance Database Cohort

Kwanghyun Kim,Chang Woo Kim,Aesun Shin,Hyunseok Kang,Sun Jae Jung 한국역학회 2021 Epidemiology and Health Vol.43 No.-

OBJECTIVES: We investigated the risk of chemotherapy-related and radiotherapy-related cognitive impairment in colorectal cancer patients. METHODS: Medical use data of colorectal cancer patients were obtained from the Korean National Health Insurance Database from 2004 to 2018. We randomly selected 40% of all colorectal cancer patients (n=148,848). Cognitive impairment was defined as having 1 or more International Classification of Diseases, 10th revision diagnostic codes for dementia or mild cognitive impairment. Patients aged 18 years or younger, patients diagnosed with cognitive impairment before colorectal cancer diagnosis (n=8,225), and patients who did not receive primary resection (n=45,320) were excluded. The effects of individual chemotherapy regimens on cognitive impairment were estimated. We additionally estimated the effect of radiotherapy in rectal cancer patients. Time-dependent competing risk Cox regression was conducted to estimate the overall and age-specific hazard ratios (HR) separately for colon and rectal cancer. Landmark analyses with different lag times were conducted as sensitivity analyses. RESULTS: Chemotherapy did not increase the risk of cognitive impairment in colorectal cancer patients (colon cancer: HR, 0.92; 95% confidence interval [CI], 0.83 to 1.03; rectal cancer: HR, 0.88; 95% CI, 0.75 to 1.04), while radiotherapy was negatively associated with cognitive impairment in rectal cancer patients (HR, 0.01; 95% CI, 0.84 to 0.99). Varying directions of the associations between regimens and cognitive impairment were detected. The adverse effect of certain chemotherapy regimens on cognition was more prominent in older adults. CONCLUSIONS: Chemotherapy and radiotherapy did not increase the risk of cognitive impairment. Older patients with low cognitive reserve could be affected by the adverse cognitive effects of chemotherapy.

Diagnosis and evaluation criteria for mild cognitive impairment in the field of animal assisted intervention

Yunseok Jang,Won-Guk Kang,Hyun-A Lee,Okjin Kim 한국실험동물학회 2021 한국실험동물학회 학술발표대회 논문집 Vol.2021 No.7

This study was conducted to investigate the diagnosis and evaluation criteria of the elderly with mild cognitive impairment. A condition that belongs to the transitional period between cognitive changes and dementia during the process of mild cognitive impairment and normal aging. The main feature that distinguishes it from mild cognitive impairment and dementia is that memory does not have a significant impact on impaired conditions or in living an independent daily life with such cognitive impairment. The American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-V, 2013) predicts mild cognitive impairment that is less than previous levels of practice in one or more cognitive areas. If you diagnose mild cognitive impairment. Measurement tools include the simple mental status test-Korean version (MMSE-K), the evaluation tool for elderly people (LOTCA-G), and the qi-psychiatric behavior test-simple type (NPI-Q). In addition, using the enzyme-linked immunosorbent assay (ELISA) method, the measurement of stress, which is a factor causing mild cognitive impairment, is analyzed through changes in hormones such as Cortisol and Oxytocin. As a method to solve such mild cognitive impairment, there is a method to select clients who meet the above diagnostic criteria for mild cognitive impairment and to apply an intervention Animal-Assisted Intervention to alleviate symptoms. Acknowledgement: This paper was supported by Rural Development Administration in 2020, Agenda Research Project(PJ01475901) - Study on the mechanism of animal assisted therapy in human animal bond.

Risk and Protective Factors for the Onset of Cognitive Impairment in Korea: A 10-Year Longitudinal Panel Study

Yujin Kim 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.8

Objective This study aimed to examine the associations between multiple modifiable risk/protective factors and the onset of cognitive impairment, using nationally representative panel data spanning 10 years. Methods A total of 7,568 respondents who were cognitively normal at baseline were included and followed up for 10 years using data from the 2006-2016 Korean Longitudinal Study of Ageing. The data were converted into 28,113 person-year observations, and a life table approach and a series of event history models were used to estimate the transition rates to cognitive impairment over time and to examine the influence of time-varying factors on the onset of cognitive impairment. Cognitive impairment was measured using the Korean version of the Mini-Mental State Exam. Results About half of the respondents without cognitive impairment at baseline had experienced cognitive impairment by the end of the last interview, and women were more likely than men to experience cognitive impairment during the observation period. Vascular risk factors, hearing loss, socioeconomic status, regular exercise, participation in social activities, and frequent contact with close friends were significantly associated with the onset of cognitive impairment. Conclusion This investigation of modifiable factors for cognitive impairment using population-based data may lead to the identification of preventive strategies that people could integrate into their lifestyles.

스텝을 활용한 인지-운동프로그램이 경도인지장애 노인의 인지기능, 보행, 우울에 미치는 효과

주은솔 ( Ju Eunsol ),방요순 ( Bang Yosoon ),오은주 ( Oh Eunju ) 대한통합의학회 2020 대한통합의학회지 Vol.8 No.3

Purpose : The purpose of this study was to determine the effects of a cognitive-exercise program using step on the cognitive function, gait, and depression of elderly with mild cognitive impairment. Methods : The subjects comprised 30 elderly people with mild cognitive impairment who used elderly welfare centers in the provinces A, B, and C between March 21 and June 7, 2019. They were divided into an experimental group (n=15) and a control group (n=15) before undergoing an experiment based on a pretest-posttest control group design. The lowenstein occupational therapy cognitive assessment-geriatric population was used to assess the subjects’ cognitive function, while the 4-stage balance test, 30-second chair-stand test, timed up & go test, and functional reach test were employed to evaluate their gait. In addition, the beck depression inventory was used to measure their levels of depression. Results : The cognitive-exercise program using step enhanced the subjects’ cognitive function and gait and reduced their levels of depression. Furthermore, statistically significant differences were found between the experimental group and the control group. Conclusion : The cognitive-exercise program using step promoted the process of sensorimotor and cognition through the learning process of various steps taking left and right steps and cognitive activities. It improves gait by activating the coordination of the musculoskeletal and nervous systems of the body and positively affecting posture control, balance, flexibility, and lower extremity muscles. It also relieved depression by performing successful step learning and cognitive activities with forward-looking (doing) that leads to pleasure and achievement. The present study confirmed the value of a cognitive-exercise program using step to treat multiple domains of functional decline in elderly patients with mild cognitive impairment. This is therefore proposed as an intervention program for this patient group.

인지기능과 구강건강관련 삶의 질의 연관성에 대한 연구: 성향점수 분석과 회귀모델을 중심으로

차선아,배수영,남상훈,홍익표 대한신경계작업치료학회 2023 재활치료과학 Vol.12 No.3

Objective : This study analyzed the correlation between cognitive function and oral health-related quality of life (OHQoL). Methods : Demographic and clinical characteristics were extracted and utilized for subjects aged 45 years or older who participated in the 8th Korean Longitudinal Study on Aging in 2020. The dependent variable was the Geriatric Oral Health Assessment Index, and the independent variable was the level of cognitive function classified by the Mini-Mental State Examination scores. The analysis method used inverse probability of treatment weighting (IPTW). Then, the association between cognitive function and OHQoL was analyzed by multiple regression analysis. Results : Among the participants, 4,367 (71.40%) had normal cognition, 1,155 (18.89%) had moderate cognitive impairment, and 594 (9.71%) had severe cognitive impairment. As a result of analysis by applying IPTW, there was a negative correlation between the cognitive function group and OHQoL (normal vs. moderate: β = -2.534, p < .0001; normal vs. severe: β = -2.452, p < .0001). Conclusion : After propensity score matching, mild cognitive impairment showed a more negative association than severe cognitive impairment. Therefore, patients with cognitive impairment require oral health management education to improve OHQoL regardless of the level of cognitive impairment. 목적 : 본 연구는 노인들의 인지기능과 구강건강관련 삶의 질 사이의 연관성을 분석하기 위해 수행되었다. 연구방법 : 2020년에 수집된 제8차 고령화연구패널조사에 참여한 지역에 거주하는 45세 이상의 중고령자를 대상으로 인구통계학적 및 임상적 특성을 추출하여 활용하였다. 독립변수는 한국형 간이정신상태검사 점수를 기준으로 분류한 인지기능, 종속변수는 구강건강관련 삶의 질을 측정하기 위한 노인구강건강 평가지수이다. 인지기능 그룹 간 공변량의 차이를 보정하기 위해 성향점수 활용법 중 역확률가중치를적용 후 인지기능과 구강건강관련 삶의 질의 연관성을 분석하기 위해 역확률가중치 적용 전의 다중회귀분석과 적용 후의 다중회귀분석 결과에 차이가 있는지 결과를 비교하였다. 결과 : 연구 대상자는 총 6,116명으로 인지정상군 4,367명, 경도 인지손상군 1,155명, 중증 인지손상군 594명으로 구성되었다. 성향점수 역확률가중치 적용 결과로 표준화된 평균 차이(standardized mean difference)를 확인하여 0.2 이상인 변수를 다시 통제하고 분석한 다중회귀모델에서 인지기능 그룹과 구강건강관련 삶의 질 간의 부정적인 연관성이 있었다(정상 vs. 경도: β = -2.534, p < .0001; 정상 vs. 중증: β = -2.452, p < .0001). 결론 : 본 연구 결과에서 인지손상과 구강건강관련 삶의 질은 음의 연관성을 나타내었다. 성향점수 활용 후 중증 인지손상보다 경도 인지손상에서 더 부정적인 연관성을 나타낸 결과는 인지손상은 저하된 정도와 관계없이 구강건강관련 삶의 질에 부정적인 영향을 미치는 것을 의미한다. 따라서 인지기능의 감퇴가 나타난 모든 환자들은 구강관리의 중요성과 교육이 필요하다는 것을 시사한다.

지역사회 거주 경도인지장애 노인 운전자의 자가-보고식 평가 수행에 영향을 미치는 인지기능

최성열(Seong-Youl Choi) 한국산학기술학회 2018 한국산학기술학회논문지 Vol.19 No.12

노인 운전자가 스스로 운전능력을 점검하는 자가-보고식 평가는 운전 중 사고 또는 사고위험성을 사전에 대비할 목적으로 사용된다. 지역사회에 거주하는 정상노인의 다수가 경도인지장애로 인해 인지기능 저하를 경험할 수 있으며, 이들의 저하된 인지기능은 노인 운전자용 자가-보고식 평가 수행에 영향을 미치는 변수가 될 수 있다. 따라서 본 연구를 통해 지역사회에 거주하는 경도인지장애 노인 운전자가 자가-보고식 평가를 수행하는 데 있어 영향을 미치는 인지기능을 확인하였다. 지역사회에 거주하는 노인 운전자 103명의 Korean Version of the Montreal Cognitive Assessment 평가결과를 바탕으로 경도인지장애와 정상 노인을 분류하였다. 그리고 두 집단의 자가-보고식 평가인 Korean-Drivers 65 plus 점수를 비교하였고, 이 평가 결과에 영향을 미치는 인지기능을 분석하였다. 그 결과 경도인지장애 그룹이 정상 그룹과 비교하여 유의하게 낮은 평가수행 결과를 보였으며, 경도인지장애 노인 운전자의 자가-보고식 평가 결과는 시공간 실행력 및 지연 회상력과 유의한 상관성이 확인되었다. 회귀분석을 통해 자가-보고식 평가 수행에 영향을 미치는 인지기능을 확인한 결과 시공간 실행력이 가장 영향력인 높은 변수로 확인되었다. 지연 회상력 또한 부분적 영향이 확인되었지만 경도인지장애 노인 운전자의 자가-보고식 평가 결과를 변질 시키는 수준은 아닌 것으로 확인되었다. A self-report evaluation is used to prevent driving accidents by elderly drivers. The majority of normal older adults may have mild cognitive impairment with reduced cognitive function. These depressed cognitive functions may be variables that affect the performance of elderly drivers. This study confirmed the cognitive functions that affect the self-reported evaluation for elderly drivers with mild cognitive impairment. Based on the results of the Korean Version of the Montreal Cognitive Assessment, 103 elderly drivers were classified into mild cognitive impairment and normal groups of elderly drivers. The Korean-Drivers 65 plus scores used in the self-reported evaluation of the two groups were compared, and the cognitive functions affecting the evaluation were analyzed. Results found the mild cognitive impairment group showed a significantly lower evaluation performance compared to the normal group, and the self-reported evaluation results of the elderly driver with mild cognitive impairment showed a significant correlation between visuoconstructional skills and delayed recall. As a result of regression analysis, the visuoconstructional skill was identified as the cognitive function with the strongest influence on the self-reported evaluation performance. Delayed recall was also found to have a partial effect but not at the level of altering the self-reported evaluation results of the elderly driver with mild cognitive impairment.

경도인지장애 침치료 인지기능효과 : 체계적 문헌고찰 메타분석

김원순 대한예방한의학회 2024 대한예방한의학회지 Vol.28 No.2

Objectives : Using MMSE and MoCA cognitive tools, this study tried to measure the effect of acupuncture differing by cognitive types. Through the method of PRISMA literature review, this study aimed to understand and improve the acupuncture’s effectiveness in its application. Methods : The research method was a literature review and Cochrane meta-analysis of papers on the effectiveness of acupuncture treatments for mild cognitive impairment conducted from 2012 to 2023. The Cochrane risk of bias (RoB) tool was used as a quality analysis tool, and the meta-analysis tool was Cochrane RevMan V5.4.1 software. Results : As a result of the study, a total of 967 subjects were used for analysis, and 16 papers on randomized acupuncture trials were analyzed. The results are as follows: As a result of meta-analysis of acupuncture intervention for mild cognitive impairment, the MMSE score had an average of 1.61 with a 95% confidence interval ranging from 0.14 to 3.07, and a statistically significant result with p<0.001. The Z-score was 2.15, which corresponded to a p-value of 0.03. The MoCA score had an average range between 0.39 and 2.49, also showing statistical significance with p<0.001, and a Z-score of 2.70 (p=0.007). The effect of acupuncture in subjects with mild cognitive impairment was significant. Conclusion : The suggestions and conclusion indicate that acupuncture intervention has a significant effect on mild cognitive impairment. This study propose future experimental research on various types of acupuncture interventions for mild cognitive impairment. The significance of this study is that it presented basic data for the development of a preventive convergence cognitive intervention program for patients with mild cognitive impairment in the community.

경두개 직류자극과 가상현실프로그램 적용이 경도인지장애 환자의 인지 및 우울에 미치는 영향

김고운 ( Ko-un Kim ),김보라 ( Bo-ra Kim ),안태규 ( Tae-Gyu An ) 대한통합의학회 2021 대한통합의학회지 Vol.9 No.3

Purpose : The purpose of this study is to investigate the effects of transcranial direct current stimulation and virtual reality program application on cognition and depression of patients with mild cognitive impairment, and to find an intervention method that can enhance active participation of patients with mild cognitive impairment. Methods : In this study, 50 mild cognitive impairment patients were divided into a treatment group (25 patients) and a control group (25 patients). The treatment group was applied with a transcranial direct current stimulation and a virtual reality program, while the control group received a placebo transcranial direct current stimulation and a virtual reality program. Both groups received five 50-minute sessions per week (one session per day) for six weeks (total of 30 sessions). NCSE was used to evaluate the cognitive functions of the patients before and after treatment intervention. Moreover, K-BDI was conducted to examine the depression of the patients. Results : As a result of the transcranial direct current stimulation and a virtual reality program intervention, the cognitive function of both treatment and control group significantly (p<.05) improved, and the depression of both treatment and control group significantly (p<.05) decreased. Moreover, the changes in cognitive functions and depression were significant between the two groups¸ treatment and control group (p<.05). Conclusion : The results of the study showed that the application of the transcranial direct current stimulation and virtual reality program significantly improved the cognitive function of mild cognitive impairment patients and decreased the depression of them. Therefore, it could be concluded that the transcranial direct current stimulation and virtual reality program was an intervention method which positively affects the cognitive function and depression of mild cognitive impairment patients.

그룹 전산화 인지 재활 프로그램이 인지 손상 환자의 인지 기능에 미치는 효과

신재욱,한혜경,신상화,박재성,박찬효,김혜진,김동인 대한고유수용성신경근촉진법학회 2019 PNF and Movement Vol.17 No.1

Purpose: This study aims to investigate the effects of a group computerization cognitive rehabilitation program on cognitive function in patients with cognitive impairment. Methods: The subjects of this study comprised 34 patients with cognitive impairment (15 males and 19 females) who were randomized into two groups. The experimental group (n = 17) were trained with the group computerization cognitive rehabilitation program, while the control group (n=17) received traditional cognitive therapy. The interventions for both groups were performed for 1 hour per day, once a week for 12 weeks. The cognitive functions of the subjects before and after the experiment were measured using the Korean mini-mental state examination (K-MMSE), global deterioration scale (GDS), clinical dementia rating (CDR), and Lowenstein occupational therapy cognitive assessment (LOTCA). A paired t-test was conducted to examine the intragroup differences before and after the experiment, and ANCOVA was performed to check intergroup differences. Results: The intragroup comparison results showed that the cognitive function of the group that were trained with the group computerization cognitive rehabilitation program improved after the experiment more than for the group that received traditional cognitive therapy. The intergroup comparison results showed significant differences in orientation, visual perception, and visuomotor organization between the two groups. Conclusion: The results of this study confirmed that the group computerization cognitive rehabilitation program was more effective in improving cognitive function than the traditional cognitive therapy in patients with cognitive impairment. Based on the results of this study, the group computerization cognitive rehabilitation program can be used as an effective intervention method for patients with cognitive impairment.