뇌 영상 검사를 이용한 알쯔하이머병 조기 진단 : 최근 MRI 및 PET 연구를 중심으로

추일한(IL Han Choo) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.1

Alzheimer's disease (AD) is the most common form of dementia. Because any antidementia treatment is not likely to reverse existing neuronal damage but rather to slow disease progression, early diagnosis is an important approach to identifying candidates for antidementia drug applications before the dementing process causes permanent brain damage. Neuroimaging could be the best alternative to pathologic confirmation of AD with biopsy that is invasive to subjects or post-mortem evaluation. In this manuscript, author summarized recent studies for early diagnosis of AD using neuroimaging techniques that have relatively high spatial resolution of regional volumetry using three dimensional magnetic resonance imaging (MRI), Fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), Diffusion tensor imaging, and PET imaging of Alzheimer pathology with ligand. Moreover, author comments the future direction for early diagnosis of AD using neuroimaging.

경도인지장애 대상 운동-인지 영양 융합 프로그램 개발 : 예비 연구

추일한(IL Han Choo) 대한노인정신의학회 2020 노인정신의학 Vol.24 No.2

Objective: Mild cognitive impairment (MCI) is transition state between cognitively normal and Alzheimer’s disease (AD) dementia. Physical exercise (PE) and cognitive training (CT) are known to have effect on risk factor reduction on AD prevalence. This study aimed to explore combined PE and CT, named as Exercise-Cognitive Cooking Program (ECCP) influencing on cognition, physical function, and cerebral cortical thickness or volume in MCI subjects. Methods: Eleven MCI patients participated who were randomized into experimental group (EXP, n=5) and control group (CTR, n=6). EXP subjects were given ECCP sessions, 3 times a week for 6 months. And CTR participants had regular daily activity similar before. Baseline and follow-up assessments of neuropsychological tests, physical function, and brain MRI were performed for all subjects. Results: There were no significant difference between EXP and CTR in baseline, follow-up, and differences between two assessments. However, CTR had significant fasting blood sugar increase (effect size, ES=0.8; p=0.03) and systolic/diastolic blood pressure decrease (ES=0.7, p=0.04; ES=0.6, p=0.04). EXP showed significant decrease of trace length and velocity in Romberg test (ES=1.0, p=0.04; ES=1.0, p=0.04), and increase of chair stand times in 30 seconds (ES=1.1, p=0.04). MRI results showed that CTR had significantly decreased cortical thickness in right precuneus (ES=0.5, p=0.04) and decreased volume in bilateral inferior parietal and cuneus (ES=0.5, p=0.04; ES=0.2, p=0.04). Conclusion: This preliminary study suggest that ECCP for 6 months might have possibility of preventive effect on MCI progression to AD.

시각 즉각 회상 검사를 이용한 지역사회 경도인지장애 조기발견

추일한(IL Han Choo) 대한노인정신의학회 2021 노인정신의학 Vol.25 No.1

Objective: Mild cognitive impairment (MCI) is transitional state between cognitively normal and dementia. It is not easy to detect MCI patient early in the community. This study aimed to detect MCI early performing learning memory tests of neuropsychological test domains in the community sample. Methods: Overall 7,307 individuals were already registered with Korean version of Mini-Mental Status Examination for Dementia Screening (MMSE-DS) evaluation. It was conducted across all 5 districts of Gwangju, Republic of Korea from April 1, 2020 to September 30, 2020. As first step, we screened them applying inclusion criteria of age, sex, education adjusted norm based MMSE Z score between -1.5 and 0, and MMSE delayed recall score less than 2. And second assessments of neuropsychological tests and clinical diagnosis with visit were performed. We examined whether verbal and constructional learning memory tests can improve the detection of MCI by receiver operating curve (ROC) analysis. Results: Clinical diagnosis finally defined 100 amnestic MCI, 8 non-amnestic MCI and 6 cognitively normal (CN). Visual immediate and delayed recall test had the highest ROC overall accuracy of 79.2% (95% confidence interval 67.8-90.6%) differentiating MCI from CN. Conclusion: Our study suggests that visual immediate recall test might be time saving and cost-effective in addition to accuracy to early detect MCI in the community.

지역사회 기억상실 경도인지장애 조기발견을 위한 2가지 다단계 프로그램 비교

추일한(IL Han Choo) 대한노인정신의학회 2020 노인정신의학 Vol.24 No.1

Objective: Amnestic mild cognitive impairment (aMCI) has high conversion risk to dementia. However, it is not easy to detect aMCI patient early in the community. This study aimed to compare two-step and three-step program for early detection of aMCI in the community. Methods: Overall 5,155 persons participated who were already registered with Korean version of Mini-Mental Status Examination for Dementia Screening (MMSE-DS) evaluation. It was conducted across 5 all districts of Gwangju, Republic of Korea from Jan 1, 2018 to March 31, 2018. As first step, we screened them applying inclusion criteria of age, sex, education adjusted norm based MMSE Z score between -1.5 and 0. Second evaluations which are not included in two-step program, were done by telephone interviews with asking subjective memory complaints and 5 word lists recall tests. And third assessments of neuropsychological tests and clinical diagnosis with visit were performed. Author compared two-step program and three-step program for aMCI diagnostic rate. Results: Two multi-step programs had no significant difference on aMCI diagnostic rate (p=0.81). Conclusion: Our study suggests that two multi-step programs are similar for early detection of aMCI in the community.

지역사회 기억상실형 경도인지장애 조기발견 프로그램 개발 : 예비 연구

추일한(IL Han Choo) 대한노인정신의학회 2018 노인정신의학 Vol.22 No.2

Objective:Mild cognitive impairment (MCI) has high conversion risk to dementia. However, it is not easy to detect amnestic MCI patient early in the community. This study aimed to evaluate the three-stage design for early detection of amnestic MCI in the community. Methods:Overall 4,385 persons participated who were already registered with Mini Mental Status Examination (MMSE) evaluation. It was conducted in Nam-Gu district, one of the 5 districts of Gwangju, Korea from Jan 1, 2017 to May 31, 2017. We first screened them applying inclusion criteria of over 5-year education and age, gender, education adjusted norm based MMSE Z score between -1.5 and 0. Second stage assessments were done by telephone interviews with asking subjective memory complaints and 5 words list recall tests. And 3rd stage evaluation of neuropsychological tests and clinical interview with visit were performed. Results:We screened 456 of the 4,385 persons and 2nd stage included 51 of the 211 participants telephone interview completed. Twenty-four individuals visited clinic center for 3rd stage evaluation. We finally diagnosed 17 MCI including 16 amnestic MCI and 1 non-amnestic MCI. Conclusion:Our three-stage evaluation detected 16 amnestic MCI patients of the 4,385 community dwelling persons with primary screening of MMSE. Our study suggests that this three-stage performance could be effective for early detection of amnestic MCI in large sample community.

일개 지역사회주민의 생활사건 스트레스 인지수준과 그 관련요인

한금선(Kuem-Sun Han),추진아(Jina Choo),오연재(Youn-Jae Oh),추일한(Il-Han Choo) 대한스트레스학회 2009 스트레스硏究 Vol.17 No.2

산업화와 세계화로 인한 생존경쟁의 증가로 현대인들은 정신건강에 위협을 받고 있다. 생활사건 스트레스(Stress of life events)는 정신건강을 위협하는 요인일 수 있다. 본 연구의 목적은 안산시 지역사회 주민 933명을 대상으로 생활사건 스트레스 인지수준을 파악하고, 이와 관련된 요인을 남녀별로 규명하기 위함이었다. 생활사건 스트레스 인지수준은 국문번역 Global Assessment of Recent Stress (GARS)를 사용했으며, 개인적 특성으로서 인구학적 요인으로서 연령과 성별을, 사회경제적 요인으로 결혼상태, 교육정도, 직업, 종교, 월가구 수입을, 정신적 요인으로서 가족구성원의 정신과문제 유무를, 사회지지 요인으로서 동거가족수를 조사하였다. 총스트레스 인지수준의 독립변인을 규명하기 위해서 다중회귀분석을 수행하였다. 연구결과는 안산시 지역주민의 약 3분의 1정도(32%)가 중간정도 이상의 스트레스를 인지하고 있었다. 그 중 재정적 스트레스 인지수준이 가장 높았다. 남성에서는 이혼/별거/사별과 높은 총스트레스 인지수준은 독립적으로 밀접한 연관성이 있었으며, 여성에서는 월가구수입 그리고 가족구성원 중 정신과문제와 높은 총스트레스 인지수준과 독립적으로 연관성을 보였다. 결론적으로 지역사회 중심 정신건강 사업은 남녀 별 스트레스에 취약한 특성이 상이하고 이에 남녀별 표적집단을 중심으로 차등을 둔 중재개발이 이루어져야 함을 시사하는 바이다. As society is getting industrialized and globalized, competitive endeavor for survival has been rising and being a threat to mental health toward people living in modern society. Perceived stress of life events may be a contributing factor to mental illness as well as physical illness. The purpose of our study is to identify the level of perceived stress of recent life events and to determine its gender-specific correlates among 933 residents in Ansan city. The Korean version of the Global Assessment of Recent Stress (GARS) was administrated to assess the perceived of recent stress. As physical, psychological and socioeconomical variables, age, sex, marital status, education, job, religion, household income per month, the presence of family members having mental illness, and the number of cohabitants were collected as candidate correlates of total GARS scores. About one third of the residents (32%) showed the moderate or severe levels of total GARS scores and the highest levels of perceived stress in financial pressure among eight domains of GARS. Divorced/separated/widowed status was a significant and independent correlate for men, whereas both monthly household income and the presence of family members having mental illness were significant and independent correlates for women. Therefore, when planning a community-based program, identifying target groups vulnerable to stress and creating gender-specific strategies for promoting mental and physical health are needed. (Korean J Str Res 2009;17:91∼98)

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.

일 대학병원 전공의 대상 개별 동의 없이 구성된 그룹채팅과 심리부담간 연관성

문석현 ( Seock Hyeon Moon ),추일한 ( Il Han Choo ) 한국정신병리진단분류학회 2022 精神病理學 Vol.26 No.1

Objectives The aim of this study was to investigate the association between disagreed group chat and perceived stress among medical residents in university hospital. Methods The participants were 62 medical residents in Chosun university hospital. Stress were evaluated by the Perceived Stress Scale. Pearson correlation was carried out to examine the association between numbers of group chat room and total scores of stress scale. In addition, χ2 test was performed to compare frequency of each perceived stress scale with or without disagreed chat rooms in study participants. Results There is no significant correlation between numbers of disagreed group chat and total scores of stress scale. However, for the 10th perceived stress subscale, “You feel calm”, the frequency of those who checked the low score in the group with the disagreed group chat was significantly higher (p-value = 0.030). In addition, for the 27th perceived stress subscale, “You have trouble relaxing”, the frequency of those who checked the high score in the group with the disagreed group chat was significantly higher (p-value = 0.037). Conclusion This study demonstrates the perceived stress frequency is higher in the group with disagreed group chat room than in the other group without. Our findings suggest that using one or more disagreed group chat room might be stressful for medical residents.

이명 심각도에 따른 정신의학적 특징

김재홍,김정호,조성일,박상학,김상훈,추일한,김승곤,Kim, Jae Hong,Kim, Jung Ho,Cho, Sung Il,Park, Sang Hag,Kim, Sang Hoon,Choo, Il Han,Kim, Seung Gon 대한생물정신의학회 2015 생물정신의학 Vol.22 No.1

Objectives The purpose of this study was to examine the psychiatric characteristics of outpatients with tinnitus. Methods A total of 88 subjects were included in this study. According to Tinnitus Handicap Inventory (THI) scores, the subjects were classified into two group ; a mild tinnitus symptoms (mild-tinnitus) group and a severe tinnitus symptoms (severe-tinnitus) group. A questionnaire was used for an assessment of demographic characteristics, and the THI, the Visual Analogue Scale (VAS) about tinnitus, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) are applied for evaluation of other clinical psychiatric characteristics. Results Higher THI scores were positively correlated with tinnitus course, the number of accompanying symptoms, and the VAS. BDI total scores, BDI factors, and BAI total scores were significantly higher in the severe-tinnitus group than in the mild-tinnitus group. Also suicidal ideation, interpersonal problems, sleep problems, occupational impairment, and fatigue were significantly higher in the severe-tinnitus group than in the mild-tinnitus group. Conclusions Tinnitus is a common disorder of hearing which is associated frequently with psychiatric problems. This study suggests that psychiatric interventions should be taken into consideration in the treatment of patients suffering from tinnitus.

정신건강의학과 치료 과거력이 없는 외상후 스트레스 장애 환자에서 나이와 손상 심각도가 중증 불안에 미치는 영향

박운영,박상학,김상훈,김승곤,박정인,추일한,Park, Woon Yeong,Park, Sang Hag,Kim, Sang Hoon,Kim, Seung Gon,Park, Jung In,Choo, Il Han 대한불안의학회 2013 대한불안의학회지 Vol.9 No.1

Objectives : Posttraumatic stress disorder (PTSD) is classified as an anxiety disorder. PTSD occurrence is known to be increased in middle-aged and older people, female, and individuals with a previous history of psychiatric disorders, lower education levels, low socioeconomic status, and severely injured patients. Anxiety symptoms are also related to later development of PTSD. In this study, we investigate the influences of injury severity and sociodemographic factors on severe anxiety in PTSD patients with no previous history of psychiatric disorders. Methods : Forty-one PTSD patients without previous history of psychiatric disorders were recruited from the psychiatric clinic at Chosun University Hospital. Subjects underwent psychiatric and physical examinations including the Injury Severity Score (ISS), Beck Anxiety Inventory (BAI), and Korean-Wechsler Adult Intelligence Scale (K-WAIS). We defined severe anxiety as a BAI scores of 30 or more. Logistic regression analyses and multi-step model selection were applied to identify predictive factors for severe anxiety. Results : In univariate analysis, age, ISS, and socioeconomic status were found to be significant factors. Through multivariate logistic regression analyses and a stepwise model selection, we found the combination of age and ISS to be the best-fitted model for affecting severe anxiety in PTSD patients without a previous history of psychiatric disorders. Conclusion : Our findings suggest that the combination of age and ISS could develop severe anxiety in PTSD patients with no previous history of psychiatric disorders.