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Choi, Junbae,Myung, Woojae,Chung, Jae Won,Kang, Hyo Shin,Na, Duk L.,Kim, Seong Yoon,Lee, Jae-Hong,Han, Seol-Heui,Choi, Seong Hye,Kim, SangYun,Kim, Seonwoo,Carroll, Bernard J.,Kim, Doh Kwan SAGE Publications 2013 Journal of geriatric psychiatry and neurology Vol.26 No.3
<P><B>Background:</B></P><P>Extrapyramidal signs (EPSs) are commonly observed in patients with Alzheimer disease (AD). We report here the base rate of EPS in a large cohort of patients with AD who were not receiving neuroleptic drugs, and the associations of EPS with functional outcomes and depressive symptoms.</P><P><B>Methods:</B></P><P>In a consortium involving 56 clinics, we recruited 2614 patients with AD. We estimated basic activities of daily living (ADL) and instrumental ADL by the Barthel index and the Seoul-Instrumental Activities of Daily Living (S-IADL) scales, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The EPS group was defined by the presence of at least 1 EPS based on a focused neurologic examination.</P><P><B>Results:</B></P><P>The prevalence of EPS-positive patients was 12%. These had lower Korean version of the Mini-Mental State Examination (K-MMSE) scores than the EPS-negative cases (<I>P</I> < .001). After controlling for demographic, medical, radiological, genetic, and cognitive (K-MMSE) factors, the proportion of patients with impaired ADL was significantly higher in the EPS group than in the non-EPS group (<I>P</I> < .001, odds ratio = 1.90, 95% confidence interval, 1.45–2.48, and logistic regression). The S-IADL scores were significantly higher in the EPS group than this in the non-EPS group (<I>P</I> < .001, regression coefficient = 3.19, and median regression). The GDS-15 scores were higher in the EPS group (<I>P</I> = .04, regression coefficient = 0.89, and median regression).</P><P><B>Conclusion:</B></P><P>The presence of EPS in patients with AD who were not receiving neuroleptic drugs was associated with more impaired basic and instrumental ADL functioning and with greater depression symptoms.</P>
알츠하이머 치매 환자에서의 추체외로 증상과 영역별 인지기능의 연관성
최준배(Junbae Choi),명우재(Woojae Myung),송지혜(Jihye Song),김상하(Sang Ha Kim),윤혜연(Hyeyeon Yoon),강효신(Hyo Shin Kang),나덕렬(Duk L. Na),김성윤(Seong Yoon Kim),이재홍(Jae-Hong Lee),한설희(Seol-Heui Han),최성혜(Seong Hye Choi),김상윤 대한노인정신의학회 2013 노인정신의학 Vol.17 No.1
Objectives:We aimed to investigate the prevalence of Extrapyramidal signs (EPS) and the associations between EPS and cognitive subdomains in patients with Alzheimer disease (AD). Methods:We recruited 1,324 patients with AD from the Clinical Research of Dementia of South Korea (CREDOS), a hospital based cohort study with fifty-six participating hospitals. We estimated cognitive subdomain using the Seoul Neuropsychological Screening Battery-Dementia version (SNSB-D). Dementia severity was measured by Clinical Dementia Rating Sum of Boxes (CDR- SB) and Korean version of Mini-Mental Status Examination (K-MMSE). The EPS group was defined by the presence of at least one EPS based on a focused neurologic examination. Results:The prevalence of patients with EPS was 11%. These had higher CDR-SB scores than non-EPS group. After controlling for demographic, radiological, and dementia severity (CDR-SB) factors, EPS group showed lower cognitive ability in the subdomains for visuospatial and frontal-executive function than non-EPS group. The patients with EPS were showed significantly higher scores in the subdomain for memory function. Conclusion:The presence of EPSs in patients with AD was associated with lower visuospatial, frontal-executive function and higher memory function.
최병옥 ( Byungok Choi ),여승호 ( Seungho Yeo ),조준배 ( Junbae Cho ),김근량 ( Geunryang Kim ),김신혜 ( Shinhye Kim ),성규석 ( Gyuseok Sung ) 국군의무사령부 2022 대한군진의학학술지 Vol.53 No.1
Objective: Proposal of the optimal organizational model for the operation of aero medical evacuation force response to future environmental changes. Method: Based on literature study, analysis of mission performance evaluation results, and comparative analysis of similar private organizations, organization development techniques are applied to derive research results. Results: In order to improve the organizational model of the aero medical evacuation force, evacuation policies, education, training, equipment introduction, maintenance, and manpower management must be integrated and processed. Therefore, there is a need for an independent organization specialized in medical evacuation with a legal basis. Conclusion: In requires an independent organization with expertise and integrity to adapt to future environmental changes.
Lee, Hyewon,Kang, Jae Myeong,Myung, Woojae,Choi, Junbae,Lee, Chunsoo,Na, Duk L.,Kim, Seong Yoon,Lee, Jae-Hong,Han, Seol-Heui,Choi, Seong Hye,Kim, Sang Yun,Cho, Seong-Jin,Yeon, Byeong Kil,Kim, Doh Kwan Elsevier 2019 Science of the Total Environment Vol.668 No.-
<P><B>Abstract</B></P> <P>There is a growing concern that air pollution, especially those particles <2.5 μm (PM<SUB>2.5</SUB>), could increase the risk of cognitive impairment and mental disorders. However, the relationship between ambient PM<SUB>2.5</SUB> and neuropsychiatric symptoms in people with cognitive impairment is still undetermined. This longitudinal study included 645 pairs of cognitively impaired subjects, who had not changed residence within Seoul, and their caregivers from the Clinical Research Center for Dementia of South Korea study cohort between September 2005 and June 2010 (1763 days). Neuropsychiatric symptoms were measured by the Korean version of the Neuropsychiatry Inventory, and caregiver burden was examined by the Neuropsychiatry Inventory Caregiver Distress Scale at the first and second visits at the outpatient clinic. District-specific PM<SUB>2.5</SUB> concentrations were constructed over 1 month to 1 year prior to each visit. A log-linear regression using generalized estimating equations to account for repeated measures was used to assess the relationship between PM<SUB>2.5</SUB> exposure and neuropsychiatric symptoms or caregiver burden. Aggravated neuropsychiatric symptoms were associated with exposure to high PM<SUB>2.5</SUB> levels (adjusted percent change: 16.7% [95% confidence interval (CI), 5.0–29.7] per 8.3 μg/m<SUP>3</SUP> increase in 1-month moving averages). Increased caregiver burden was associated with high PM<SUB>2.5</SUB> exposures only in caregivers for patients with Alzheimer's disease (adjusted percent change: 29.0% [95% CI, 8.1–53.9] per 8.3 μg/m<SUP>3</SUP> increase in 1-month moving averages). The present results indicate that PM<SUB>2.5</SUB> exposure is associated with aggravated neuropsychiatric symptoms and increased caregiver burden in subjects with cognitive impairment. The findings in this study suggest that the role of air pollution deserves great consideration in the aging population with cognitive impairment.</P> <P><B>Highlights</B></P> <P> <UL> <LI> The association between PM<SUB>2.5</SUB> exposure and mental disorders is concerning. </LI> <LI> PM<SUB>2.5</SUB> exposure aggravated neuropsychiatric symptoms in cognitively impaired patients. </LI> <LI> Association between PM<SUB>2.5</SUB> exposure and mild cognitive impairment (MCI) was high. </LI> <LI> PM<SUB>2.5</SUB> was associated with increased caregiver burden for Alzheimer's patients. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>
Lee, Hyewon,Myung, Woojae,Lee, Chunsoo,Choi, Junbae,Kim, Ho,Carroll, Bernard J.,Kim, Doh Kwan Pergamon Press 2018 Journal of psychiatric research Vol.100 No.-
<P>We investigated the effects of a large range of clinical factors on the long-term risk of suicide in the general population of South Korea. We analyzed the National Health Insurance Service-National Sample Cohort (NHISNSC) database in South Korea. A total of 300,232 individuals were followed for up to 12 years. We obtained information on demographic variables (age and sex), lifestyle variables (cigarette smoking, alcohol drinking and exercise), psychiatric and physical disorders, laboratory examination results and physical examination findings. We conducted a competing risk survival analysis to estimate the risk of completed suicide. 725 individuals (241/100,000) died by suicide in the follow-up period. After Bonferroni correction, we found a significant suicide risk associated with 6 variables: Parkinson's disease, depressive disorder, obsessive-compulsive disorder (inverted association), elevated serum aspartate aminotransferase levels, male gender and age. Before Bonferroni correction, variables such as cigarette smoking, heavy alcohol drinking, psychotic disorder, other psychiatric disorder, benzodiazepine use and higher fasting glucose showed some significant association. In addition, body mass index and height were inversely related to completed suicide before Bonferroni correction. However, only the 6 variables listed above were robust predictors of suicide in the fully adjusted analyses with multiple test correction. Common medical conditions had no clear influence on suicide. Diverse clinical factors influenced the long-term risk of completed suicide in this general population sample. Comprehensive assessment of these risk factors will facilitate more focused suicide surveillance measures.</P>
Extrapyramidal Signs and Cognitive Subdomains in Alzheimer Disease
Park, Jin Hong,Myung, Woojae,Choi, Junbae,Kim, Sangha,Chung, Jae Won,Kang, Hyo Shin,Na, Duk L.,Kim, Seong Yoon,Lee, Jae-Hong,Han, Seol-Heui,Choi, Seong Hye,Kim, Sang Yun,Kim, Doh Kwan Lippincott Williams & Wilkins 2016 American Journal of Geriatric Psychiatry Vol. No.
<P>Objective: Extrapyramidal signs (EPS), commonly observed in Alzheimer disease (AD), predict cognitive impairment and functional decline. This study investigated the association between EPS and five cognitive subdomains in a large number of participants with AD. Design: Cross-sectional analyses of the nationwide Clinical Research of Dementia of South Korea (CREDOS) study, 2005-2012. Setting: Multicenter clinical settings. Participants: 1,737 participants with AD drawn from the CREDOS study. Measurements: The EPS group was defined by the presence of at least one EPS based on neurologic examination. We assessed five cognitive subdomains: attention, language, visuospatial function, memory, and frontal/executive function using the Seoul Neuropsychological Screening Battery-Dementia version. The associations of EPS with each cognitive subdomain were analyzed with a multiple linear regression model after controlling for confounding factors: sex, age, years of education, severity of dementia (Clinical Dementia Rating Sum of Boxes), and white matter hyperintensities. Results: 164 AD participants (9.4%) had EPS. AD participants with EPS showed lower performance compared with those without EPS in two cognitive subdomains: attention and visuospatial function. The language, memory, and frontal/executive subdomains did not differ between the EPS-positive and the EPS-negative groups. In addition, we found a significant moderating relationship between EPS and deep white matter hyperintensities on visuospatial function score. Conclusions: EPS in AD are associated with severe cognitive impairment in attention and visuospatial function. Careful screening for EPS in patients with AD may assist in prediction of cognitive profile.</P>
이준노(Jun Ro Lee),이춘수(Chunsoo Lee),최준배(Junbae Choi),강효신(Hyo Shin Kang),임신원(Shin Won Lim),나덕렬(Duk L. Na),김성윤(Seong Yoon Kim),이재홍(Jae-Hong Lee),한설희(Seol-Heui Han),최성혜(Seong Hye Choi),김상윤(Sang Yun Kim),김도관 대한노인정신의학회 2017 노인정신의학 Vol.21 No.2
Objective:We aimed to find the sex differences of the way how educational attainment influence on cognitive function in patients with Alzheimer’s disease (AD). Methods:We recruited 424 patients with AD from a large hospital-based multi-center cohort. We evaluated cognitive subdomains using the Seoul Neuropsychological Screening Battery-Dementia version. We employed multiple linear regression analysis to compare the score of cognitive subdomains between the groups with high versus low educational attainment based on the high school graduate. Interaction between educational attainment and sex was also included in the analysis. Results:High and low educational attainment group had 33.0% and 67.0% of patients in the study population. In the multiple regression analysis, score of all cognitive subdomains were significantly higher in the high educational attainment group. The score of attention was also significantly affected by interaction between educational attainment and sex. This result may be helpful to develop cognitive intervention therapy. Conclusion:In the female patients with AD, educational attainment showed higher influence on the attention score.
경도인지장애에서 추체외로 증상과 영역별 인지기능 저하 :A Clinical Research Center for Dementia of South Korea (CREDOS) Study
박진홍(Jin Hong Park),명우재(Woojae Myung),최준배(Junbae Choi),김상하(Sangha Kim),강효신(Hyo Shin Kang),나덕렬(Duk L. Na),김성윤(Seong Yoon Kim),이재홍(Jae-Hong Lee),한설희(Seol-Heui Han),최성혜(Seong Hye Choi),김상윤(SangYun Kim),김도 대한노인정신의학회 2015 노인정신의학 Vol.19 No.2
Objective:This study investigated the association between extrapyramidal signs (EPS) and five cognitive sub-domains in a large number of patients with mild cognitive impairment (MCI). Methods:Our analyses considered 1,943 patients with MCI drawn from the nationwide Clinical Research of Dementia of South Korea study. EPS were defined as presence in patients with at least 1 of 11 operationally specified features. We assessed five cognitive sub-domains : attention, language, visuospatial function, memory, and frontal/executive function using the Seoul Neuro-psychological Screening Battery-Dementia version. The associations of EPS with each cognitive sub-domain were analyzed with a multiple linear regression model after controlling for confounding factors : sex, age, education years, diabetes, hypertension, sever-ity of global function, depressive symptoms, and white matter hyperintensities (WMH). Results:138 MCI patients (7.1%) had EPS. This group had more global cognitive deterioration and severe WMH. MCI pa-tients with EPS showed lower performance compared to those without EPS in 3 cognitive sub-domains: attention (p=0.05), vi-suospatial function (p=0.02), and frontal/executive function (p<0.0001). The language sub-domain and the memory sub-domain did not differ between the EPS positive and the EPS negative groups. Conclusion:EPS in MCI are associated with greater cognitive impairment in specific functional sub-domains rather than with global greater cognitive deterioration.
알츠하이머 치매 환자에서의 인지영역별 기능과 병식과의 연관성
김영돈(Youngdon Kim),김상하(Sang Ha Kim),명우재(Woojae Myung),최준배(Junbae Choi),윤혜연(Hyeyeon Yoon),강효신(Hyo Shin Kang),나덕렬(Duk L. Na),김성윤(Seong Yoon Kim),이재홍(Jae-Hong Lee),한설희(Seol-Heui Han),최성혜(Seong Hye Choi),김 대한노인정신의학회 2014 노인정신의학 Vol.18 No.2
Objective:The aim of this study was to investigate the association between cognitive subdomains and insight into one’s cognitive impairment in patients with Alzheimer disease (AD). Methods:We recruited 1,722 patients with AD from the Clinical Research of Dementia of South Korea study and designed a cross-sectional study. Each patient’s cognitive subdomain was assessed by using the Seoul Neuropsychological Screening Battery-Dementia version. Severity of dementia was evaluated by Korean version of Mini-Mental Status Examination (K-MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SB). Insight into one’s cognitive impairment was categorized as ‘with insight’ and ‘without insight’ through interview with patient’s caregivers. Results:Among the 1,722 patients with AD, 1,475 patients were included in the ‘with insight’ group and the remaining 247 patients were included in the ‘without insight’ group. Subjects in the ‘without insight’ group had lower K-MMSE and CDR-SB scores than those in the ‘with insight’ group. After controlling for demographic data and dementia severity, higher scores on both attention function (odds ratio=1.12, 95% confidence interval : 1.03-1.21) and frontal-executive function (odds ratio=1.03, 95% confidence interval : 1.01-1.05) significantly predicted the membership to ‘with insight’ group. Conclusion:In patients with AD, attention and frontal-executive function were associated with insight into one’s cognitive impairment.