파킨슨병 환자의 정량적 뇌파분석 -비선형분석을 이용한 정상인 및 본태성 진전 환자와의 비교

조은경,최병옥,김용재,박기덕,김응수,최경규,Cho, Eun-Kyoung,Choi, Byung-Ok,Kim, Yong-Jae,Park, Ki-Duck,Kim, Eung-Su,Choi, Kyoung-Gyu 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.2

Background: Parkinson's disease is movement disorder due to dopaminergic deficiency. It has been noted that cognitive dysfunction also presented on Parkinson's disease patients. But, it is not clear whether such a cognitive dysfunction was a dopaminergic dysfunction or cholinergic dysfunction. Using linear and non-linear analyses, we analysed the effect of cognitive and motor symptom on EEG change. Methods: EEGs were recorded from patients with Parkinson's disease and essential tremor, and normal controls during rest. We calculated the power spectrum, correlation dimension and Lyapunov exponent by using 'Complexity'program. The power spectrum, correlation dimension, and Lyapunov exponent were compared between Parkinson's disease patients and essential tremor patients. Results: Theta power was increased in Parkinson's disease patient group. Correlation dimension was increased in Parkinson's disease patients. Positive correlation was noted between MMSE and correlation dimension, and negative correlation was noted between MMSE and Lyapunov exponent. Lyapunov exponent was decreased in Parkinson's disease patient. Conclusions: We conclude that the state of Parkinson's disease patient is characterized by increased correlation dimension and decreased Lyapunov exponent.

Factors Associated with Functional Dependence in Alzheimer's Disease

조주연(Choo-Yon Cho),조항석(Hang-Suk Cho),조경희(Kyung-Hee Cho),최경규(Kyoung-Gyu Choi),오희종(Hee-Jong Oh),김대현(Dae-Hyun Kim),정승필(Seung-Pil Jung),최규동(Kyu-Dong Choi),이홍수(Hong-Soo Lee),배철영(Chul-Young Bae) 대한임상노인의학회 2000 대한임상노인의학회지 Vol.1 No.1

연구배경 : 노인의 인지장애는 노인성 치매로 잘 알려진 알쯔하이머병의 기능적 상태가 감소한 경우와 연관이 많다. 그러나 이러한 인지장애가 기타 신체적, 정신적, 사회적 및 가족적 문제와 어느 정도까지 병존하고 있는지는 아직도 많이 알려져 있지 않은 편이다. 이 연구의 목적은 흔한 노인성 조건들, 가족기능, 그리고 영양학적 문제들이 기능적 의존성과 독립적으로 연관되어 있는지를 알아보기 위하여 시행되었다. 방법 : 1997년도 12월부터 1998년도 6월까지 우리나라의 9개 종합병원 및 대학병원 가정의학과, 신경과 및 노인병클리닉에 내원하거나 입원한 53명의 알쯔하이머병 환자들이 대상이 되었다. 모든 환자들은 치매에 관한 DSM-IV 진단기준 및 NINCDS-ADRDA 기준상 probable Alzheimer's disease에 부합하였으며, 모두 경도 내지 중등도의 인지장애를 보였고, 언어소통이 가능하였다. 종속변수는 기본적 일상생활활동 (Basic Activities of Daily Living, BADLs) 및 도구적 일상생활활동 (Instrumental Activities of Daily Living, IADLs) 이었고, 주요 독립변수에는 정신상태, 우울, 흔한 노인성 조건들 19가지, 가족기능, 영양상태 등이 포함되었다. 기술통계학과 사회인구학적 및 건강변수들과 같은 혼란변수를 통제하기 위하여 다변량분석을 사용하였다. 결과 : 알쯔하이머병 환자들의 56%가 하나 이상의 ADLs 의존성을 보였으며, 그중 목욕하기 (55%), 옷입기 (47%) 등에서 어려움을 보였으며, IADLs 의존성중에서는 여행 (79%), 집안일 (79%), 재정관리 (79%) 등에서 의존성이 높았다. 알쯔하이머병 환자들에 영향을 미치는 일부노인성 조건들, 그중 특히 피로, 요실금, 구갈, 수면장애, 낙상력, 눈의 통증, 어지러움, 슬관절통, 체중감소, 요통 등의 경우 IADLs 의존성과 다발성 연관관계를 보였고, 낮은 교육수준, 요실금 등은 ADLs 의존성과 관련이 깊은 것으로 나타났다. 이러한 결과들은 ADLs, IADLs 개개항의 의존성, 조건들이 독립적인 예측인자가 될 수 있으므로 그에 대한 의학적 가료를 요할 것을 의미하며, 하나의 조건을 예방하는 것으로는 그 이상의 IADLs 의존성을 방지하는데 충분하지 못하다는 것이다. 즉, 여러 가지 활동의 의존성 및 조건들이 개개인의 결과변수에 독립적으로 관련하기 때문에 그들의 기능적 의존성 이 예견된다면 이러한 다발성 조건들은 동시에 치료하여야 할 필요가 있다고 할 수 있겠다. 결론 : 알쯔하이머병의 기능적 의존성과 흔한 노인성 조건들에 대하여 조사한 결과, 일부 조건들이 알쯔하이머병의 기능적 상태에 미치는 효과를 최소화하기 위한 노력이 개개인에 맞게 이루어져야 하고, 다발성 질환들을 다스려야 할 필요가 있다는 것이다. 알쯔하이머병에 대한 성공적인 평가 및 치료는 환자의 개개 의학적 조건들의 기능적 상태에 독립적으로 기여하는가에 대해 사려깊게 짚어보아야 할 것이다. 그 개연성의 문제에 대하여서는 알쯔하이머병에 대한 종적 및 기타 실험적 자료들이 계속 나와야 할 것이다. Background : The purpose of this study was to determine whether common geriatric conditions, family function, and nutritional problems had an independent association with functional dependence beyond the effect of cognitive impairment in 53 patients with Alzheimer's diseases. Methods : The ample for this study consisted of 53 in-patients and out-patients of nine hospitals in Korea. All subjects met DSM-IV criteria for dementia and NINCDS-ADRDA criteria for probable Alzheimer's disease. Among fifty-three patients with probable Alzheimer's disease, all were mildly to moderately impaired and communicable. Chi-square tests were performed to assess bivariate relationships between the selected social and demographic factors, common geriatric conditions, nutritional status, and functional status. Multivariate analyses were done using logistic regression models to adjust for the potentially co nfounding effects of sociodemographic and health variables. Results : 56.6% of the study population was dependent on one or more items in ADLs. The most prevalent items of ADL dependence were bathing (54.7%) and dressing (47.2%). Subjects with lower education level, poor cognition, and poor nutrition were more likely to be dependent. Low educational level, poor cognition, and urinary incontinence were associated with the increased risk of ADL dependence. Several conditions are independently associated with the specific items of IADLs. Each item of IADL dependence of the patient has its own set of independent predictors. Some conditions are more universal in independently predicting IADL dependence. Conclusion : It was found that some common geriatric conditions affecting patients with Alzheimer's diseases appear to have multiple and differential relationships with the specific instrumental activities of daily living (IADLs) dependences. These results have implications for medical care. Preventing one condition may not be sufficient to prevent future IADL dependences since in most cases more than one condition is independently related to each outcome variable. Thus, multiple conditions may need to be managed concurrently if further functional dependence is to be expected.

파킨슨병에서 선조체의 신경망적 모델 : 예비적 연구 Preliminary Study

최경규,박기덕 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.2

Objective : To construct the neural network model in the striatum that can explain the clin-ical effect of Parkinson disease. Methods : We use an approach to studying the function of neural systems that is based on the use of a class of computer models known as parallel distributed processors(PDPs).And the focus of this study is the nigrostriatal dopaminergic effects on the corticostriatal fibers and the striatal medium spiny neurons. Results : A model that explains hypokinesia in Parkinson disease is presented for the opation of the striatum. Conclusions : In order to study the brain funcion and mechanism of physiopathology, te-stable theories that consider brain as a whole system are needed. We think neural network model with PDPs would be an important field in neuroscience in near future.

실어증에 대한 임상적 연구 : 형태와 예후를 중심으로 Types and Prognosis

최경규 梨花女子大學校 醫科大學 醫科學硏究所 1988 EMJ (Ewha medical journal) Vol.11 No.4

Aphasia is a language disorder due to damage of the language center in the dominant hemisphere. I studied 42 patients whose main neurologic symptom was aphasia. In 42 aphasia patients, motor aphasia appeared in 13 pts(30.9%), sensory aphasia in 11 pts(26.1%), conduction aphasia in 5 pts(11.9%), anomic aphasia in 4 pts(9.5%), global aphasia in 4 pts(9.5%), transcortical motor aphasia in 3 pts(7.4%), transcortical sensory aphasia in 2 pts(4.7%). The most common associated pathologic condition was hypertension(85.7%) and the others were hypertriglyceridemia(42.9%), cardiac arrythmia(38.1%), transient ischemic attack(14.5%), seizure(9.5%) and hypotension(7.4%). The most common combined neurologic symptom was motor hemiparesis(26.22%), and the others were dysphagia, sensory hemianesthesia, ocular motor diturbance, agraphia, alexia, acaculia, finger agnosia and apraxia. The anomic aphasia and transcortical aphasia had best prognosis and the global aphasia had worst prognosis.

경도 인지기능장애의 신경병리 : 노화, 알쯔하이머병과의 관계를 중심으로 View from Relationships with Aging and Alzheimer's Disease

최경규 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.2

The progression of cognitive impairment toward dementia of the Alzheimer's disease is gradual, and there is probably an intermediate or transitional stage between healthy aging and dementia of the Alzheimer type. This transitional stage has received mild cognitive imapairment (MCI). Whether MCI truly represents the prodromal or earliest clinical phase of Alzheimer's dementia is the subject of many research. Current studies suggest that in many instances early memory are associated with specific Alzheimer related neuropathological changes in limbic areas. Many studies show evidences that there is significant neuronal loss in selected memory related structures of brains with MCI.

신경계의 실험적 신경망 모델에 관한 예비연구

최경규,박기덕 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.4

Present knowledge of brain mechanism is mainly based on anatomical and physiological studies. Such studies are however insufficient to understand the information processing of thebrain. The present new focus on neural network studies is the most likely candidate to fill thisgap. We made a simulation of striaum by neural network model, which is capable of limitedgeneralization and completion and possesses characteristic property of brain such as termedgrceful degradation.

一酸化炭素가 中樞神經系의 dopaminergic system에 미치는 影響

崔暻奎,李愚馨 梨花女子大學校 韓國生活科學硏究院 1989 韓國生活科學硏究院 論叢 Vol.44 No.-

일산화탄소는 인체의 여러 기관에 손상을 주나 그 중에서도 특히 중추신경계 손상에 의한 다양한 임상증상이 특징적이다. 이때에 나타나는 증상이 중추신경계에서의 신경전달물질의 변동시에 나타나는 증상과 유사하고 또 이에 대한 약물치료에 호전을 보이는 경우가 있어 일산화탄소 중독시에 중추신경계에서의 신경전달물질의 함량의 변동이 예상된다. 저자들은 이러한 가설하에 2,000ppm의 일산화탄소 농도에서 흰쥐를 중독시킨 다음 선조체, 흑질 및 뇌척수액에서 dopamine과 그 대사물질인 DOPAC, HVA의 함량을 측정한 결과 일산화탄소가 선조체에서 dopamine의 분비를 억제하고 또 대상과정에서 COMT를 억제하는 효과가 있음을 알 수 있었다. The acute and delayed effects of Carbon Monoxide intoxication on dopamine and its metabolites in striatum, substantia nigra and cerebrospinal fluid were examined in the rat. The acute effects of Carbon Monoxide intoxication were examined right after the intoxication and delayed effects were examined 2 weeks after the Carbon Monxide intoxication. At the acute stage of Carbon Monoxide intoxication, dopamine and DOPAC levels of striatum and DOPAC level of CSF were significantly greater than those of the control group. At the delayed stage of Carbon Monoxide intoxication, dopamine and DOPAc levels in the striatum were significantly greater than those of the control rats. The changes of dopamine and its metabolite levels in the striatum suggested that Carbon Monoxide inhibited not only dopamine release in dopaminergic neurons but also COMT in the extraneuronal metabolic pathway.

파킨슨증상 발현 기전의 신경망적 모델

최경규,김용재,박기덕 대한신경과학회 1998 대한신경과학회지 Vol.16 No.3

임상적으로 진단된 알츠하이머병의 부검 결과

최경규 梨花女子大學校 醫科大學 醫科學硏究所 1993 EMJ (Ewha medical journal) Vol.16 No.1

Eight hundred and eighty four autopsy brains from patients with clinically diagnosed Alzheimer's disease were examined pathologically. Six hundred ninety eitht(79.96%) of the 884 casesfullfilled histological criteria for Alzheimer's disease, with or withour additional fndings, suchas substantia nigral degeneration. cerebellar degeneration. Parkinson's disease or cerebral infarcts. One hundred and eighty six cases(20.04% ) were diagnosed as other neurodegenerativedisease such as Parkinson's disease, non-specific cortical degeneration or Pick's disease. Degenerative changes in the substantia nigra were common in patients with Alzheimer's diseasethan has been reported for the general aged population. Brain atrophy was severer in preseniletype of Alzheimer's disease than in senile type of Alzheimer's disease.

신경계 질환 환자에 대한 영양보충제 '뉴케어'의 임상적 효과

김용재,박기덕,최경규 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.2

연구목적: 질병의 경과에 미치는 영양상태의 중요성은 이미 알려져 있지만, 임상의사가 직접 환자를 대할 때는 영향 결핍 상태를 흔히 간과하게 된다. 본 연구는 연하곤란으로 영양불량 상태에 있는 신경계 질환 환자군에서 영양보충제인 뉴케어를 경구 투여하였을 때, 환자의 질병 회복과 영양상태의 개선에 미치는 임상적 효과를 평가 하고자 하였다. 연구방법: 뇌졸중, 뇌출혈, 노인성 치매 등의 신경계 질환으로 연하장애 상태에 있는 환자들을 대상으로 하여 영양보충제인 뉴케어를 투여한 후 혈액학적, 혈액화학적 변화와 주관적 부작용 등을 평가하였다. 결 과: 연구에 사용한 여러 척도 가운데 혈장 알부민치와 영양지수의 변화가 유의하게 나타났다. 뉴케어를 투여한 군에서 혈장 알부민이 전ㆍ후 각각 44.6 48.2로 전ㆍ후 각각 44.6, 44.1를 보인 대조군에 비해 유의한 증가를 보였다.(p<0.05). 몇 몇에서 설사가 나타나기도 하였으나 투여를 중단할 만한 뚜렷한 부작용은 관찰되지 않았다. 결 론: 이상으로 신경계 질환 환자에서 뉴케어는 혈청 알부민과 영양지수의 증가를 일으켰으며, 안전하고 효율적인 영양보충제로 생각된다. Patients suffering from neurological disorder, such as cerebral infarctoin, often face serious swallowing difficulty and malnutrion. Although the importance of nutritional support has been well demonstrated, malnutrition remains a frequently neglected condition in the clinical setting. In this study, we investigate the effectiveness of enteral nutritional support to neurological patients using nutritional beverage Nucare. 50 patients with acute and chronic neurological disease with eating problem were participated. 27 patients(experimental group : 17, control group :7), fed more than 7 days, were selected and statically analyzed by the changes of hematologic, biochemical parameters and nutritional index compared with control roup(p<0.05), which are good predictors of nutritional and hospital outcome. This suggests that enteral nutritional support with Nucare can improve the nutritional status and clinical outcome of patient with acute and chronic neurological disease.