노화, 치매 그리고 건축

朱鎭亨(Jhoo Jin-Hyeong) 대한건축학회 2006 建築 Vol.50 No.11

급성 일산화탄소 중독 후 발생된 지연성 뇌병증의 치료 증례

이선희(Sun Hee Lee),주진형(Jin Hyeong Jhoo) 대한노인정신의학회 2017 노인정신의학 Vol.21 No.1

Delayed carbon monoxide (CO) encephalopathy patients can show cognitive impairment, aphasia, affective and personality changes and behavioral symptoms. The prognosis of them is sometimes poor or irreversible. We present a case of 61-year-old woman who visited us at 56 days after CO intoxication and showed moderate to severe cognitive impairment and behavioral problems. We prescribed the donepezil (5 mg/d), memantine (5 mg/d), choline alfoscerate (800 mg/d) and ziprasidone (20 mg/d), based on previous case reports and performed the cognitive rehabilitation. After 30 days treatment in hospital, she showed dramatic improvement in cognitive functions and behavioral problems. This case suggests that adequate pharmacological and cognitive treatment could improve the moderate to severe symptoms of delayed CO encephalopathy even about 2 months later after CO intoxication.

의료취약지역에서 치매 원격진료의 만족도 조사

김소명(So-Myung Kim),주진형(Jin Hyeong Jhoo),변기환(Gihwan Byeon),정승민(Seungmin Jeong),김연미(Yeon Mi Kim),이강욱(KangUk Lee) 대한신경정신의학회 2021 신경정신의학 Vol.60 No.4

Objectives To assess the satisfaction of dementia patients with telemedicine services. Underlying factors were extracted from a satisfaction dataset, and possible associations among factors were investigated to determine their statistical relevances. Methods A survey was conducted using a questionnaire to determine satisfaction with telemedicine services of patients with dementia in 9 public health centers and 5 designated hospitals in 8 provinces in Gangwon-do from 20 July 2020 to 31 October 2020. Four hundred and ninety-seven users responded to the survey. Factor analysis was performed on survey data and multiple linear regression was used to extract relevant factors. Results The percentage of subjects satisfied with telemedicine services was 78.8%. Thirty-five items of the satisfaction survey indicated that the five factors, that is, necessity (Cronbach’s α 0.952), satisfaction (Cronbach’s α 0.929), medical system reliability (Cronbach’s α 0.924), medical staff reliability (Cronbach’s α 0.924), and geographic vulnerability (Cronbach’s α 0.922), were related to satisfaction with telemedicine services, and that of these, geographic vulnerability was most associated with the need for telemedicine services. Conclusion This study shows that dementia patients with experience of telemedicine services were generally satisfied with treatment. Despite its limitations, the satisfaction survey was found to provide a reliable and valid scale for assessing user satisfaction.

Choline Acetyltransferase 유전자 다형성이 경도인지손상 발현에 미치는 영향

이정재,박준혁,이석범,허윤석,김태희,윤종철,주진형,이동영,박경운,김기웅,Lee, Jung-Jae,Park, Joon-Hyuk,Lee, Seok-Bum,Huh, Yoon-Seok,Kim, Tae-Hui,Youn, Jong-Chul,Jhoo, Jin-Hyeong,Lee, Dong-Young,Park, Koung-Un,Kim, Ki-Woong 대한생물정신의학회 2010 생물정신의학 Vol.17 No.4

Objectives : The potential association between choline acetyltransferase(CHAT) polymorphism and the risk of mild cognitive impairment(MCI) has not been investigated in Korea. We examined the main effect of CHAT polymorphism and its interaction with apolipoprotein E(APOE) polymorphism in the development of MCI in elderly Korean sample. Methods : We analyzed CHAT 2384G > A polymorphism and APOE polymorphism among 149 MCI subjects with MCI and 298 normal controls. We tested the association between MCI and CHAT A allele status using a logistic regression model. In addition, we employed generalized multifactor dimensionality reduction(GMDR) to investigate the interaction between CHAT and APOE with regard to the risk of MCI. Results : The CHAT A allele was associated with AD risk(OR = 1.59, 95% CI = 1.02-2.48, p = 0.042). No significant gene-gene interaction between CHAT and APOE was found in GMDR method(testing balanced accuracy = 0.540, p = 0.055). Conclusion : The CHAT A allele was associated with MCI risk in the Korean elderly. Its interaction with the APOE ${\varepsilon}4$ allele was not significant with regard to the development of MCI.

치매 선별용 간이정신상태검사(Mini-Mental State Examination for Dementia Screening;MMSE-DS)와 단축형 MMSE-DS (SMMSE-DS)의 한국 노인 정상규준 연구

한지원(Ji Won Han),김태희(Tae Hui Kim),주진형(Jin Hyeong Jhoo),박준혁(Joon Hyuk Park),김정란(Jeong Lan Kim),유승호(Seung Ho Ryu),문석우(Seok Woo Moon),추일한(Il Han Choo),이동우(Dong Woo Lee),윤종철(Jong Chul Yoon),도연자(Yeon Ja Do) 대한노인정신의학회 2010 노인정신의학 Vol.14 No.1

Objectives : This study aimed to present the normative information of the Mini-Mental State Examination-Dementia Screening (MMSE-DS) and its short form (SMMSE-DS) in the Korean elderly. Methods : The MMSE-DS was administered in a standardized manner to 1,008 healthy volunteers aged 60 years or over recruited from participants in the Korean Longitudinal Study on Health and Aging or from volunteers in the National Dementia Screening and Registry Program. The SMMSE-DS was consisted of 13 items from the MMSE-DS based on the diagnostic accuracy of individual items for dementia. Results : Age and educational level were found to have significant effect on the SMMSE-DS score, but sex was not. Based on this result, overlapping age normative table (60 to 74, 70 to 84, and 75 to 90 years of age) with 4 educational strata (0 to 3 years, 4 to 6 years, 7 to 12 years and 13 years and more) was developed for the SMMSE-DS. For resulting 12 normative units, 5 percentile, lower quartile, median, upper quartile, mean, standard deviation and -1.5standard deviation were calculated. Conclusion : The normative data from this study can be widely used as reference values to objectively interpret the MMSE-DS and SMMSE-DS scores of the Korean elderly.

한국 노인에서 광역시도별 자살률과 의료급여의 상관성

이종민(Jong Min Lee),이상아(Sang Ah Lee),이강욱(Kang Uk Lee),박종익(Jong Ik Park),이자영(Ja Young Lee),최민경(Min Gyeong Choe),주진형(Jin Hyeong Jhoo) 대한노인정신의학회 2011 노인정신의학 Vol.15 No.1

Objectives:We aimed to find out the relationship between the regional suicide rates and the percentages of medical aid in the elderly in Korea. Methods:Suicide rates of the elderly in 16 upper-level local governments from 2007 to 2009 were calculated using ‘Cause of Death Statistics’ and ‘Annual Report on Live Births and Deaths Statistics’ from Korea National Statistical Office. The percentages of medical aid persons among the elderly in 16 upper-level local governments were calculated using ‘National Health Insurance Statistical Yearbook’ from Health Insurance Review Agency and National Health Insurance Corporation. The correlation between the suicide rates and the percentages of medical aid in the elderly was measured. Results:There was no significant correlation between the suicide rates and the percentage of medical aid in the elderly in 16 upper-level local governments. But significant negative correlation was found when only the old-elderly or the old women were analyzed. And the significant negative correlation was also found when only 8 local governments except the major cities and the national capital area were included for analysis. Conclusion:Medical aid system could be helpful to reduce the suicide rate in the old-elderly or the old women in Korea. And this effect might be intensified in non-metropolitan and non-capital area.

알쯔하이머병의 말초 생물학적 지표로서 혈청 Alpha-1-antichymotrypsin

우종인,이정희,주진형 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.6

저자들은 대조군과 각 치매군의 혈청 alpha-1-antichymotrypsin(ACT) 수치를 측정하여 이것의 알쯔하이머병(AD)의 말초 지표로서의 가능성을 검토하고 혈청 ACT와 노화 과정사이의 상관성을 분석하고자 하였다. 치매의 진단을 위하여 NINCDS-ADRDA 기준을 이용하였고 혈청 ACT 수치에 영향을 미칠 수 있는 검사상의 이상자나 약물 복용자등은 연구에서 배제되었다. 최종 진단은 정신과 전문의 2명과 전공의 6명이 참여하여 합의 증례 토의를 통해서 내려졌다. 이러한 과정을 거쳐 10명의 probable AD 환자(나이 : 71.5±7.5, 범위 : 55∼82), 9명의 혈관 요인을 지닌 possible AD 환자(나이 : 72.3±8.2,범위 : 58∼89), 8명의 혈관성 치매(VD, 나이 : 72.5±9.4, 분포 : 56∼85)환자, 9명의 65세 이상의 정상 대조군(OC, 나이 : 70.9±4.6, 범위 : 66∼82저자들은 대조군과 각 치매군의 혈청 alpha-1-anti-chymotrypsin(ACT) 수치를 측정하여 ), 23명의 65세 미만의 정상 대조군(나이 : 31.2±13.0, 범위 : 21∼54)이 최종 대상군으로 설정되었다. 이들을 대상으로 72시간 단순 방사상 면역확산법을 시행하여 혈청 ACT 수치를 측정하였고 다음과 같은 결과를 얻었다. 1) Probable AD(420.0±75.6mg/L)군과 혈관 요인을 지니는 Possible AD군(443.7±54.6mg/L)의 평균 혈청 ACT 수치는 VD 환자군(483.3±89.4mg/L) 및 65세 이상의 정상대조군(OC, 382.4±20.0mg/L)과 비교하여 차이가 관찰되지 않았다. 2) VD군의 평균 혈청 ACT 수치는 OC군에 비해 의미있게 높았으며(p<0.05) 네 군을 혈관 요인이 존재하지 않는 OC과 probable AD 통합군과 혈관 요인이 존재하는 VD와 possible AD 통합군으로 재분류 하였을 때 재분류한 두 그룹사이의 평균 혈청 ACT 수치(402.1±58.3mg/L, 462.3±73.5mg/L)는 의미있는 차이를 나타냈다(p<0.05). 3) 정상 대조군의 혈청 ACT 수치는 연령이 높아짐에 따라 의미있게 증가하였다(r=0.5161;p<0.01)(Fig.3). 4) AD와 VD 환자의 clinical dementia rating, Blessed dementia scale 및 Short Blessed test 점수상의 치매의 정도와 혈청 ACT 수치 사이에는 상관 관계가 관찰되지 않았다. 이상의 결과는 혈청 ACT 수치의 증가가 치매 환자의 혈관 요인 및 정상적인 노화 과정과 연관되어 있음을 시사한다. 그러나 혈청 ACT 수치가 AD의 말초 지표일 가능성은 적을 것으로 판단된다. Objectives : The authors measured serum alpha-1-antichymotrypsin(ACT) level to elucidate its possibility to be a peripheral marker in Alzheimer's disease(AD) and to examine its relationship with aging. Methods : The subjects were 19 AD patients(age : 71.9±7.6, range : 55∼89) diagnosed by NINCDS-ADRDA criteria, 8 vascular dementia(VD) patients(age : 72.5±9.4, range : 56∼85), 32 normal control subjects(age : 42.4±21.4, range : 21∼82). Serum ACT levels were determined with radial immunodiffusion plates purchased from the Binding Site after 72-hour incubation. Results : The serum ACT levels of AD patients were not significantly different from those of old control(OC) subjects(age : 70.9±4.6, range : 66∼82), but ACT levels of VD patients were significantly higher than those of OC subjects(p<0.05). And there was significant correlation between ACT levels and age(r=0.5820, p<0.01). Conclusion : These results suggest that the increment of serum ACT level appears to be associated with the vascular component in dementia patients as well as with aging factor. However, its possibility to be a peripheral marker of AD seems to be low.

두 가지 한글판 간이정신상태평가(Mini-Mental State Examination)의 비교 : MMSE-KC와 K-MMSE

주진형,김기웅,이동영,윤종철,이태주,추일한,고혜정,서은현,우종인 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.1

Objectives : We compared the scores of the MMSE-KC (Korean version of MMSE in the Korean version of CERAD As-sessment Packet) and K-MMSE (Korean MMSE), and analyzed the influences of age, gender, and educational level on the differences between the two. Methods : We administered the MMSE-KC and K-MMSE simultaneously along with geriatric depression scale (GDS-K) to 733 community-dwelling elderly aged 50 or over in three districts of Suwon. The differences between the MMSE-KC scores and K-MMSE scores were examined by repeated measure ANOVA computing the MMSE for intra-individual factor, age, gender, and educational level as inter-individual factor, and GDS-K score as a covariate. Results : The scores of MMSE-KC and K-MMSE were identical only in the 17.8% of the subjects and the difference between the MMSE-KC score and K-MMSE score were significantly influenced by the educational level of the subjects (F (3,173) =8.21, p<0.001). The MMSE-KC score was higher than the K-MMSE score in illiterate subjects, and lower than the K-MMSE score in literate or educated subjects. Although the main effect of the kind of MMSE was not significant in total MMSE scores (F (1,731)=0.91, p>0.1), it was highly significant in 'judgement and writing/reading' subscores (F (1,731)=16.35, P<0.001) and its influences were significantly varied by the educational level of the subjects (F (1,731) =20.82, P<0.001). Conclusion : The MMSE-KC and K-MMSE which were standardized differently are not identical in scores as well as in content, and the difference between the two is greatly influenced by the educational level of the subject. When interpreting or comparing the MMSE scores of the two different versions of Korean MMSE, the comparability of the scores among them observed in this study should be considered.

急性精神分裂障碍患者의 Haloperidol 治療時 臨床 好轉度와 血中 Prolactin 濃度의 關係

김성윤,주진형,우종인 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.2

저자들은 혈청 PRL농도가 급성 정신증에서의 haloperidol의 치료 반응에 대한 지표로서 임상적으로 이용가능한가를 규명하기 위하여 22명(남자 4, 여자 7)의 초발 정신분열양장애 환자들을 대상으로 하여 이 중 10명의 남자 환자군에 대해서는 11명의 남자 대조군과 기저 혈청 PRL치의 비교를 하였고 경구 haloperidol 치료를 받은 11명(남자 4, 여자 7)에 대해서는 치료전과 4주째의 혈청 PRL치와 haloperidol의 혈중 농도를 측정하고 동시에 Positive and Negative Syndrome Scale(PANSS)로 정신병리를 평가하였다. 결과는 다음과 같다. 1) 남자 환자군 10명의 치료전 혈청 PRL치는 정상 대조군의 혈청 PRL치와 유의한 차이를 보이지 않았다. 환자군에서 치료 개시전 PANSS로 측정한 정신상태 중 음성증상 subscale만이 혈청 PRL치와 유의한 상관관계(r=0.6636, p<0.05)를 보였다. 2) 4주간의 치료후 PANSS 점수 변화율은 기초 및 4주째의 혈청 PRL치와 유의한 상관관계를 보이지 않았고 PRL치의 변화율 및 변화치와도 유의한 상관관계를 보이지 않았다. 3) 4주간의 HALOPERIDOL 치료를 통해 PANSS 전체 점수는 유의한 감소를 보였으며(p<0.05), 양성증상(p<0.05)과 일반정신병리(p<0.05) subscale 점수상에서도 유의한 감소를 보였다. 혈청 PRL치도 기초 측정치에 비하여 4주째 혈청 PRL치, PRL치의 변화율 또는 변화치와 통계적으로 유의한 상관관계를 보이지 않았다. Objects : The authors investigated to evaluated the clinical utillity of serum prolactin(PRL) level as a therapeutic index of haloperidol treatment for acute psychotic patients. Methods : 22 patients(10 males, 12 females) first-onset schizophreniform disorder were studied. Among them 10 male patients' baseline PRL levels were compared to those of 11 agematched male volunteers and 11 patients who were treated with oral haloperidol(4 males, 7 females) were studied by measuring baseline and 4the week levels of serum PRL and haloperidol and administering Positive and Negative Syndrome Scale(PANSS) concurrently. Results : 1) The serum PRL level of 10 male patients showed no statistical difference from 11 healthy males. Only the patients' pre-treatment PANSS negative subscale score had significant correlation with the baseline serum PRL level. 2) Percentage of PANSS score change didn't show significant correlation with the baseline and 4th-week serum PRL level nor with amount and percentage of serum PRL level change. 3) The total PANSS score decreased significantly after 4 week treatment with haloperidol s well as positive symptoms subscale and general psychopathology(all, p<0.05), and 4th-week serum PRL level significantly increased(p<0.01) compared with the baseline. 4) The 4th-weeks plasma haloperidol level didn't show correlation with serum PRL level nor with amount and percentage of serum PRL level change. Conclusions : The findings suggest that serum PRL level has limitation for use as therapeutic index of haloperidol treatment for acute psychotic patients.

경도인지손상 환자에서 야간수면과 전두엽기능의 연관성

김성재,정재석,주진형,이정희 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.3

Objectives : Nocturnal sleep disruption has been considered as a risk factor for cognitive impairment in the elderly. And the frontal lobe dysfunction was suggested to predict the progression to dementia. We aimed to illustrate the relationship of nocturnal sleep with frontal lobe function in mild cognitive impairment (MCI) patients. Methods : Thirty MCI patients and 30 age- and sex-matched normal control (NC) subjects were selected. Frontal lobe function tests including Stroop Test, Similarity Test, Digit Span Test (DST), and Benton Visual Retention Test (BVRT) were administrated. Nocturnal polysomnography was done for each subject. Results : There was no significant difference in the sleep parameters and diagnostic distributions of sleep disorders between the MCI and NC groups. In MCI patients, the mean hypopnea index (HI) of the ApoE4 positive group was higher than that of ApoE4 negative group. In the NC group, the wake time after sleep onset (WASO) was negatively correlated with the DST score (r=-0.545). In the MCI group, WASO tended to be negatively correlated with the Similarity Test score (r=-0.376, p=0.053), and slow wave sleep amount (SWS) was negatively correlated with the error score of BVRT(r=-0.489). Conclusion : Although there was no difference in the sleep quality and frequency of SAS between the MCI and NC groups, the severity of SDB was higher in MCI patients with ApoE4 compared to those without ApoE4. In the MCI group, the difficulty in maintaining sleep was associated with decreased executive function, and the decreased SWS was associated with impaired working memory. The relationship of nocturnal sleep with the frontal lobe function in MCI patients appears to be different from that of normal elderly subjects.