도시지역 노인들의 치매유병률에 관한 단면조사연구

나덕렬,연병길,강연욱,민경복,이수현,이상숙,이미라,표옥정,박찬병,김선민,배상수,김동현,Na, Duk-L.,Yeon, Byeon-Gil,Kang, Yeon-Wook,Min, Kyung-Bok,Lee, Soo-Hyun,Lee, Sang-Suk,Lee, Mi-Ra,Pyo, Ok-Jung,Park, Chan-Byung,Kim, Sun-Mean,Bae, Sang-S 대한예방의학회 1999 예방의학회지 Vol.32 No.3

Objectives: In Korea, as in most countries, there will be a sharp increase in the number of dementia patients in the near future. However basic data on dementia prevalence, which is important in defining epidemiologic characteristics and in implementing preventive strategy, are limited. This study was conducted to estimate the prevalence rate of dementia in the urban elderly aged 65 or older in Kwangmyung, Korea. Methods: A two phase design was used for case finding and case identification. In phase I, a representative sample aged 65 or older was selected and interviewed by door-to-door survey with a Korean version of the Mini-Mental State Examination (K-MMSE). In phase II, Of the 946 subjects interviewed in phase 1,356 elderly were randomly selected disproportionately according to K-MMSE score. Of these elderly, 223 (61.5%) underwent standardized clinical evaluations, including psychiatric interview, neurological examination, and neuropsychological assessment. Dementia was diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The diagnosis of Alzheimer's disease (AD) was made by National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and feinted Disorders Association(NINCDS-ADRDA) criteria and vascular dementia (VD) by DSM-IV. Results: The overall weighted prevalence rate of all dementia among Kwangmyung residents aged 65 or older was 12,8%(age-adjusted rate: 13,0%, 95% Confidence Interval[CI]: 10.6-15.3%). Women had much higher prevalence rate than men even when age was controlled(15.9%[95% CI 12.6-19.2%] vs 7.5%[95% CI 4.0-10.4%]), The rates of dementia were 5.2%, 12.2%, 17.0%, and 34.3% for the age groups of 65-69, 70-74, 75-79 and 80 and over, respectively. The rate of AD appeared to be slightly higher than that of VD(5.2% vs 4.8%), though not statistically significant. Most of the cases(69%) were mild dementia according to CDR(<1) in these subjects. Conclusions : These results showed that the prevalence rate of dementia among urban elderly in Korea appears to be higher than those of other Asian countries.

Characteristics of Conversation in Frontotemporal Dementia: Comparison with Dementia of the Alzheimer’s Type

민준상(Jun Sang Min),윤지혜(Ji Hye Yoon),나덕렬(Duk L. Na),이윤경(Yoon kyoung Lee) 한국언어청각임상학회 2018 Communication Sciences and Disorders Vol.23 No.1

배경 및 목적: 전두측두치매(FTD) 환자는 전두엽의 전반적인 손상으로 인해 병의 초기부터 대화 시 화용적인 어려움을 보인다. 본 연구는 알츠하이머성 치매(DAT) 집단과의 비교를 통해 FTD 환자에서 두드러지는 대화 특성을 확인하였다. 방법: 총 50명(FTD 10명, DAT 20명, 정상[NA] 20명)을 대상으로 다양한 주제에 대하여 자유롭게 대화하도록 하였다. 자료 분석은 대화참여 지표와 대화화제 지표 및 대화방해 지표로 나누어 분석하였다. 결과: 첫째, 대화참여 측면에서 FTD 집단은 DAT, NA 집단보다 대화차례 주고받기 빈도와 대화차례당 발화 수 모두에서 유의하게 낮은 수행력을 보였다. 둘째, 대화화제 측면에서 FTD 집단은 DAT, NA 집단보다 화제 수, 화제당 대화차례 빈도, 화제유지비율, 화제전환비율은 유의하게 낮았고 화제이탈비율은 유의하게 높았다. 셋째, 대화방해 측면에서 FTD 집단은 DAT, NA 집단과 유의한 차이를 보이지 않았다. 논의 및 결론: 이러한 결과는 전두엽의 내측부위 손상으로 인한 동기부족으로 발화 수가 적고, 배외측 부위 손상으로 인한 전반적인 언어처리 및 작업기억능력의 결함으로 다양한 화제를 개시하거나 화제를 유지하는 것에 어려움을 보인 것으로 해석해볼 수 있다. Objectives: Due to the general damage to the frontal lobe, patients with frontotemporal dementia (FTD) could have pragmatic difficulties in conversation from early stages. The purpose of this study is to investigate the characteristics of conversation in patients with FTD through a comparison with dementia of the Alzheimer’s type (DAT), and then examine the relationship with general cognitive functions. Methods: Fifty subjects (FTD group = 10, DAT group = 20, normal adults [NA] group = 20) were engaged in free conversation on various topics. Results: First, regarding conversation participation, the FTD group showed significantly lower performance than the DAT group and the NA group in the frequency of conversation turn exchanges and the number of utterances during conversation turns. Second, regarding conversation topic, the FTD group showed a significantly lower number of topics, a lower frequency of conversation turns per topic, a lower rate of topic maintenance, and a lower rate of topic switching, but a significantly higher rate of topic breakaway than the DAT group and the NA group. Third, with regard to conversation disturbance, the FTD group did not show a significant difference in performance from the DAT group or the NA group. Conclusion: It is possible that FTD patients displayed a smaller number of utterances due to lack of motivation caused by the damage to the medial frontal lobe and have difficulties in topic maintenance and various topic initiation due to dysfunction of general language processing abilities and working-memory capacity caused by the damage to the dorsolateral area.

Characteristics of Writing in Parkinson’s Disease: Focused on Pen Pressure, Letter Size, and Writing Speed

이한솔(Han Sol Lee),윤진영(Jinyoung Youn),조진환(Jin Whan Cho),안종현(Jong Hyeon Ahn),윤지혜(Ji Hye Yoon),나덕렬(Duk L. Na) 한국언어청각임상학회 2020 Communication Sciences and Disorders Vol.25 No.1

배경 및 목적: 파킨슨병(PD)의 운동 장애는 쓰기 수행에서 글자 크기뿐만 아니라 필압과 속도 측면에도 영향을 미칠 수 있다. 본 연구의 목적은 PD의 쓰기 특성을 필압, 크기, 속도를 중심으로 살펴보고자 하였다. 방법: PD 38명과 정상 성인(NA) 25명, 총 63명을 대상으로, 태블릿 PC와 디지털펜을 가지고 필압, 획의 길이, 쓰기 시간을 측정할 수 있는 소프트웨어를 사용하여 점선 따라 그리기와 문장 쓰기 과제를 실시하고, 필압, 글자 크기, 쓰기 속도를 분석하였다. 결과: 점선 따라 그리기 과제에서 필압은 두 집단 간 차이가 없었고, 쓰기 속도는 PD 집단이 NA 집단 보다 느렸다. 문장 쓰기 과제에서 PD 집단이 NA 집단 보다 필압이 저하되고, 글자 크기가 작으며, 쓰기 속도가 느렸다. 두 집단은 공통적으로 글자 크기와 쓰기 속도 간의 정적 상관이 나타났으며, PD 집단은 필압과 쓰기 속도 간의 정적 상관도 나타났다. 논의 및 결론: 본 연구 결과는 PD로 인하여 강도, 크기, 속도 등의 운동 능력을 조절하는 것의 어려움이 쓰기 수행 시 필압, 글자 크기, 쓰기 속도로 반영될 수 있음을 보여준다. 본 연구는 그간 글자 크기에만 초점이 맞추어졌던 PD의 쓰기 특성에서 필압이나 쓰기 속도와 같이 다양한 요소를 측정하는 것이 중요함을 확인하였다는 점에서 의의가 있다. Objectives: Movement disorders in Parkinson’s disease (PD) can affect not only letter size but also pen pressure and writing speed. The purpose of this study was to investigate the characteristics of writing with focus on pressure, size, and speed in PD. Methods: Sixty-three subjects (38 in a PD group and 25 in a normal adult [NA] group) performed tasks involving drawing along dotted lines and sentence writing using a tablet PC, digital pen, and software that could measure pen pressure, stroke length, and duration. Results: In the task involving drawing along a dotted line, the PD group showed significantly slower writing speed compared with the findings in the NA group. Additionally, in the task involving sentence writing, the PD group showed significantly weaker pen pressure, smaller letter size, and slower writing speed compared with the NA group. Moreover, both groups showed a positive correlation between letter size and writing speed, but only the PD group showed a positive correlation between pen pressure and writing speed. Conclusion: Difficulty in motor control of strength, size, speed, etc. owing to PD is reflected in pen pressure, letter size, and writing speed when performing a writing task. Our results show an importance in measuring multiple factors such as pen pressure and writing speed in the characteristics of writing in PD, which has until now, has been focused only on letter size.

발성실행증 사례연구

권미선,나덕렬,김향희,정진상,Kwon, Mi-Seon,Na, Duk-L,Kim, Hyang-Hee,Jung, Jin-Sang 한국음성학회 2005 음성과학 Vol.12 No.2

Apraxia of phonation (AOP) has often been described as a feature of apraxia of speech or of severe non-fluent type of aphasia. Pure AOP is rare and, to our knowledge, only two cases have been reported. Brain lesion sites of the reported cases were not those sites known to be responsible for apraxia of speech. This study presents a case of AOP which resulted from the secondary stroke in the left corona radiata immediately following the first stroke in the left temporoparietal lobe. A 61-year old right-handed man shwoed a global type of aphasia after the first cerebral infarction, but was able to generate spontaneously some short fragments of speech. On the day after the first infarction, he suffered from the secondary infarction, leaving him a complete loss of voluntary phonation. He did not showed any significant change in language functions. Several occurrences of involuntary phonation were observed upon laughing or crying. He was also able to cough unintentionally. A vidoe-stroboscopic examination failed to reveal any evidence of structural and functional impairment in larynx. Although this case is not of pure form of AOP, AOP appeared after the secondary stroke without significant changes of language impairment since the first stroke. Therefore, AOP may be a consequence of the brain lesion from the secondary stroke even though we cannot rule out the possibility of an additive effect of the secondary to the first stroke.

사설 및 신문기사 빈칸채우기 훈련에 따른 주관적 인지저하 환자성인의 단어인출 능력 변화

진소라(So Ra Jin),나덕렬(Duk L. Na),윤지혜(Ji Hye Yoon) 한국언어치료학회 2020 한국언어치료학회 학술발표대회 논문집 Vol.2020 No.11

실어증환자 자발화의 유창성 연구

김향희(Hyanghee Kim),권미선(Miseon Kwon),나덕렬(Duk L. Na),최상숙(Sang-sook Choi),이광호(Kwang ho Lee),정진상(Chin Sang Chung) 한국언어청각임상학회 1998 Communication Sciences and Disorders Vol.3 No.-

실어증환자들이 산출하는 자발화의 유창성 정도에 대한 평가는 상당히 주관적이며, 과연 어떤 요소들을 기준으로 유창성 판단이 이루어지는지 명확하지 않다. 본 연구에서는 청지각적인 판단에 의하여 31명의 실어증환자들을 비유창군, 정상유창군 및 과유창군 등 세 환자군으로 나눈 후, 그들의 그림설명 자발화들을 여덞가지 유창성 요소들(총 발화수, 총 발화수 내 총 문장수 비율, 총 문장수 내 복문수 비율, 발화당 음절수, 발화당 단어수, 초당 음절수, 한국어 9품사 출현비율, 발화오류비율)에 준하여 분석해 보았다. 그 결과, 적어도 두 환자군간에 유의미한 차이를 보였던 요소들은 발화당 음절수, 발화당 단어수, 총 발화수 내 총 문장수 비율 등이었다. 그 밖에, 단계식 판별분석 결과, 환자군간의 유창성 정도를 결정짓는 가장 중요한 첫째 요인은 ‘발화당 음절수’로 밝혀졌으며 두 번째 요인은 ‘총 발화수’로서 이 두 요인들을 이용할 때 전체환자의 79.37%가 청지각적인 판단으로 할당된 환자군에 정확하게 분류되었다. 본 연구의 결과는 임상에서 실어증환자들의 유창성 정도에 대한 판단력을 향상시킬 수 있는 계기를 마련해 준다고 할 수 있겠다. Fluency judgements of an aphasic patient's spontaneous speech can be extremely subjective. A number of variables that might be related to the fluency produced by aphasic patients were investigated. Tape-recorded language samples of the picture description task of K-WAB were used for the analysis. A consensus judgement on the degree of fluency (i.e., hypo- fluent, normal-fluent, and hyper-fluent) was made by three speech-language pathologists. The picture description measures of the three groups (hypo-fluent = 16 patients; normal- fluent = 11; hyper-fluent=4) were analyzed using eight variables (i.e., the number of syllables per second or SPS the mean number of syllables per utterance or SPU; the mean number of words per utterance or WPU; the total number of utterances or TU; the total number of complex sentences/TU ratio; the total number of sentences /TU radio or TS/TU; the analysis of nine content-function words; and the per-centages of errors). We used the aforementioned eight variables as dependent variables and the three fluency groups as independent variables. The variables that categorize at least two patient groups were SPU, WPU, TU, and TS/TU. Based on a discriminant function analysis, the percentage of group cases correctly classified was 79.37%. This study reveals important variables that might contribute to improving the fluency judgement of language of patients with aphasia.

Orthographic Knowledge of Hangul Syllable in Alzheimer’s Disease

윤지혜(Ji Hye Yoon),김향희(HyangHee Kim),나덕렬(Duk L. Na),서미경(Mee Kyung Suh) 한국언어청각임상학회 2013 Communication Sciences and Disorders Vol.18 No.1

배경 및 목적: 올바른 쓰기 수행에는 발달의 비교적 초기단계에 습득되는 기본적 철자 지식을 바탕으로 언어적 능력과 시공간 구성능력이 필요하다. 알츠하이머성 치매는 좌, 우반구에 아밀로이드 단백질이 침착되고, 언어능력과 관련있는 측두엽과 시공간 구성능력과 관련있는 두정엽에 위축을 보인다. 알츠하이머성 치매환자의 쓰기수행에 대한 선행 연구를 통하여 언어적 오류와 더불어 시공간적 오류가 확인되었다. 그러나 쓰기수행 연구에 비하여 한국 알츠하이머성 환자의 철자 지식 및 표상에 대한 능력에 대한 연구는 제한적이다. 따라서 본 연구에서는 한글 쓰기능력과 관련하여 한글 음절이나 글자에 대한 지식이 어떠한 관계가 있는지 알아보고자 하였다. 방법: 75명의 알츠하이머성 치매환자를 대상으로 한글 쓰기 및 한글표상능력 확인을 위한 판단과제를 시행하였다. 결과: 치매중증도가 심한 환자군에서 한글 받아쓰기 수행은 상당히 저하됨에도 불구하고 한글표상능력에서는 약 41.5% 정도의 정반응률이 관찰되었다. 논의 및 결론: 발달초기에 습득되는 기본적인 한글 음절 및 글자에 대한 지식은 알츠하이머성 치매질환이 진행되면서 환자가 글을 읽고 쓸수 없는 경우에도 여전히 부분적으로 보존됨을 확인하였다. Objectives: Alzheimer’s disease (AD) can cause visuoconstructional and linguistic dysfunction due to bilateral involvement of the tempoparietal-frontal hemispheric areas. At the later stages of disease, the patients often manifest written language impairment. Generalized orthographic knowledge/representation, that is, knowledge of symbol and letter patterns within and across words, is important for written language. The aim of this study was to delineate the basic knowledge of the graphemic or syllabic shapes in Hangul as well as Hangul writing ability of those with AD. We hypothesized that the orthographic representation of Hangul syllable might withstand the impact of AD, because the basic knowledge of a letter shape of Hangul might be preserved in this clinical population. Methods: Seventy-five AD patients were included in this study. The patient group was divided into four subgroups according to the clinical dementia rating (CDR): 16 were very mild cases (CDR0.5); 37, mild (CDR1); 19, moderate (CDR2); and 3, severe (CDR3). We administered dictation and representation tasks of Hangul syllables and compared the performances among groups. Results: In the writing-to-dictation and representation tasks, the number of correct responses significantly differed according to CDR (p<.001). Interestingly, the patients at a later stage of the disease received scores of below 10% on the Hangul writing to dictation task, and 41.5% on the Hangul representation tasks. Conclusion: This finding supports the hypothesis that orthographic knowledge/representation of Hangul grapheme/syllable may partly withstand the impact of AD.

전두측두치매 환자의 대화 특성

민준상(Jun Sang Min),윤지혜(Ji Hye Yoon),나덕렬(Duk L. Na) 한국언어치료학회 2016 한국언어치료학회 학술발표대회 논문집 Vol.2016 No.12

Purpose: Due to the general damage to the frontal lobe, patients with FTD (frontotemporal dementia) could have pragmatic difficulties in conversation from the early stage. The purpose of this study is to investigate the characteristics of conversation in patients with FTD through a comparison with NE (normal elderly), and then examine the relationship with general cognitive functions through a comparison with those with AD (Alzheimer"s dementia). Methods: A total of 43 subjects (FTD group: 3, AD group: 20, NE group: 20) were made to make a speech freely on two topics using the conversation induction procedure. Results: First, in the aspect of conversation participation, the FTD group showed significantly lower performance than the AD group and the NE group in the conversation participation indexes. Second, in the aspect of conversation topic, the FTD group showed a significantly lower performance than the AD group and the NE group in the conversation topic indexes. Conclusion: Compared to the AD group and the NE group, the FTD group participated less in conversation, made a significantly less speech, used a smaller number of topics, and showed difficulties in topic maintenance. It is possible that patients with FTD could show a small number of utterances due to lack of motivation caused by the damage to the medial region of the frontal lobe, have difficulties in topic maintenance due to dysfunction of general language processing abilities and working-memory capacities caused by the damage to the dorsolateral area, have deteriorated conversation exchange ability caused by the damage to the orbitofrontal area, and thereby stop conversation in the middle.

전두측두치매 환자의 존댓말 사용 특성

홍원경(Weon Kyeong Hong),윤지혜(Ji Hye Yoon),나덕렬(Duk L. Na) 한국언어치료학회 2016 한국언어치료학회 학술발표대회 논문집 Vol.2016 No.12

Purpose: In order to use honorific speech properly, it is needed to understand and apply social convention and make a proper judgment on the object of conversation. FTD (frontotemporal dementia) causes personality change, disinhibition, and deterioration of judgment that gradually develop due to the damage to the frontal lobe. The purpose of this study is to understand honorific speech in patients with FTD and grasp their expressional characteristics through a comparison with NE (normal elderly), and then examine the relationship with general cognitive functions through a comparison with those with AD (Alzheimer"s dementia). Methods: A total of 45 subjects (FTD group: 5, AD group: 20, NE group: 20) were made to respond to 20 items of expression task and 30 items of receptive task related to honorific speech produced by the researcher. In order to investigate the characteristics of correct responses and reaction time, their performance was measured with a software program. Results: The FTD group showed significantly lower performance than the AD group and the NE group in both tasks. Conclusion: Due to the damage to the orbitofrontal area of the frontal lobe, patients with FTD show simplification of thoughts and the symptom of disinhibition, which lead to difficulties in observing social manners, improper words and actions, and deterioration of social interaction. This result indicates that it should be hard for them to use honorific speech properly. In addition, it is thought that, due to the damage to the dorsolateral area of the frontal lobe, they would lack language processing abilities, which could make them have difficulties in using final/prefinal endings, postpositions, and words needed for honorific speech.

요추천자 후 근거중심 간호실무 알고리즘 개발

이지향(Jee Hyang Lee),박선영(Sun Young Park),김미경(Mi Kyung Kim),나덕렬(Duk L. Na),김병준(Byoung Joon Kim) 한국근거기반간호학회 2013 근거와 간호 Vol.1 No.1

Purpose: The purpose of the study was to develop Evidence-based nursing practice guideline for post-lumbar puncture patients in neurology ward and to evaluate the guidelines by applying them to practice. Methods: Eighty patients without preceding headache who underwent Lumbar puncture were selected prospectively. We compared the incidence of post-lumbar puncture headache between bed-rest for 4 hours and 1hours. Results: The post-lumbar puncture headache was found in 13 cases among bed-rest for 4 hours and 1hours groups. The frequency of each group was 25%(10/40) in 4 hours-bed rest group and 7.5%(3/40) in 1 hours-bed rest group. Conclusion: There was no significant difference between two groups (p-value= .066). 4 hours-bed rest after lumbar puncture is unnecessary.