기억상실형 경도인지장애 환자 담화의 전체통일성 분석 및 관련 인지기능 = Global Coherence Analysis of Discourse in Amnestic Mild Cognitive Impairment and Associated Cognitive Function

국문 초록 (Abstract)

배경 및 목적: 전체통일성 측정은 통일성의 유지 정도에 따라 각 발화에 점수를 주어 평균을 산정하는 방법, 전체통일성을 저해하는 발화를 오류로 보아 그 비율을 산정하는 방법, 담화의 전체통일성 유지 정도에 따라 전체점수를 주는 방법이 있으며, 이 중 효율적인 측정 법에 대한 결론을 도출하기 어렵다. 따라서 본 연구 목적은 세 가지 전체통일성 측정법을 여러 담화과제에 일관적으로 적용하여 기억상 실형 경도인지장애(amnestic mild cognitive impairment, aMCI) 환자와 정상노년층의 발화를 비교하고, 세 가지 측정법 중 aMCI와 정상군 간 차이가 있는 측정법이 무엇인지를 모색하고, 전체통일성과 관련된 인지기능을 조사한다. 방법: 정상노년층 20명과 aMCI 환자 20명을 대상으로 공분산분석을 통해 전체통일성 수행 정도를 비교하였다. 또한, 로지스틱 회귀분석으로 민감도와 특이도를 이용한 절단값을 구하였다. 편상관분석을 통해 전체통일성에 관여하는 인지기능도 조사하였다. 결과: 세 가지 측정법 중 전체통일성 지수와 오류 비율이 환자군과 정상군 간 차이가 있었으며, 로지스틱 회귀분석으로 위 두 측정법의 변별정확도를 확인하였다. 환자군의 전체통일성은 즉각기억 및 의미유창성 점수와 관련이 있었다. 논의 및 결론: 담화상에서 부적절한 자기중심적 발화, 앞 내용의 반복이 많이 포함되 며, 30% 이상의 오류비율을 보일 경우 aMCI일 가능성이 높다. 또한, 절단값 이하의 수행은 의미-화용론적인 손상, 단기기억 및 집행기 능의 감퇴를 반영한다.

다국어 초록 (Multilingual Abstract)

Objectives: Global coherence measures include a mean score of utterances according to the degree of theme maintenance, a method of estimating the ratio of utterances that inhibit coherence, and a subjective rating score given whole discourse (i.e., a global coherence index, an error rate, a subjective rating score). The purposes of this study are as follows: to compare scores of three measures between patients with amnestic mild cognitive impairment (aMCI) and the normal elderly; to find out adequate global coherence measure among them; and to investigate cognitive functions which are associated with global coherence. Methods: Analysis of covariance was used for the group comparison between 20 patients with aMCI and 20 normal elderly. Measures were investigated through logistic regression analysis and receiver operating characteristic curve, and then cut-points were computed with sensitivity and specificity. Partial correlation analysis was used for finding out cognitive functions related with global coherence. Results: Significant group differences were found in a global coherence index and an error rate. The logistic regression analysis resulted in significantly lower global coherence index and significantly higher error rate of aMCI compared to the normal elderly. Cognitive functions which were associated with three measures were immediate recall and semantic verbal fluency. Conclusion: Discourses of aMCI are liable to be irrelevant, egocentric, and repetitive, or have more than 30% error utterances. Scores under the cut-points imply communicative and semanticpragmatic declines of language use, and reduced memory and executive functions. These linguistic and cognitive impairments are reflected in global coherence of aMCI.

목차 (Table of Contents)

• 연구방법 연구결과 논의 및 결론

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