한국 노인에서의 Executive Clock Drawing Task(CLOX) 정상규준 연구

김신겸,이동영,서은현,추일한,김지욱,도연자,김기웅,주진형,윤종철,박신영,우종인 대한신경정신의학회 2009 신경정신의학 Vol.48 No.6

Objectives The CLOX (an executive clock drawing task) consists of an unprompted task that is sensitive to executive function (CLOX1) and a copied version that is more dependent on visuoconstructive function (CLOX2). This study aimed to explore the effects of age, education, and gender on the performance of the CLOX and to provide normative information on the test in the Korean elderly. Methods We administered the CLOX to 608 community-dwelling healthy volunteers aged 60-90, excluding people with serious neurological, medical, and psychiatric disorders, including dementia. Multiple linear regression analysis was performed to assess the relative contributions of the demographic factors to the CLOX scores. Results Education had a considerable influence on performance of both CLOX1 and CLOX2. Age and gender also had significant effect on both. There were significant interactions between education and gender for both CLOX1 and CLOX2. We also found interactions between education and age on CLOX2. Based on these results, we created normative data for the CLOX, stratified by age (60- 74 and 75-90 years), education (0-3, 4-9, and 10+ years), and gender. Conclusion Our normative data, based on a large, healthy elderly population, provides accurate reference information on CLOX performance and should be very useful for proper interpretation of CLOX scores in the Korean elderly.

정보속으로 : 정보화정책 ; 스마트폰 보안에도 관심을

김신겸 한국지역정보개발원(구 자치정보화조합) 2011 지역정보화 Vol.71 No.-

도파민/세로토닌 길항성 비정형 항정신병약물로 치료 중인 정신분열병 환자에서 체중 증가의 관련 요인

김신겸,장원석,최경숙,박동연,한우상,이동수,홍경수 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.3

치매 개념의 역사적 변천

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.1

Most histories of senile dementia begin with Alois Alzheimer's description in 1906 of the first case of Alzheimer's disease. However, the history of senile dementia is quite rich, dating back to the ancient Greek and Roman philosophers and physicians, so the history of dementia is probably as old as mankind itself. Although senile dementia has been recognized as a condition of aged individuals since at least the time of Pythagoras in the 7th century B.C., because it was dismissed as an inevitable feature of aging, it remained largely an uninvestigated disorder until the 19th century. An introduction of a scientific approach to clinical observation and the systematized classification of mental disorders in the mid-19th century that senile dementia began to be differentiated from other dementias, and was established as its own defined class of mental disorder. The identification of Alzheimer's disease at the onset of the 20th century was a turning point for the understanding of senile dementia, and the concepts and histological findings presented by the early researchers of Alzheimer's disease remain relevant still today. Here the author traces the history of the evolution of our current conceptualization of Alzheimer's disease from the Greek-Roman concept of age-associated dementia.

루이체 치매

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.2

Here the author reviews the clinical and pathologic characteristics of dementia with Lewy bodies (DLB). DLB took many years to crystallize into a recognizable clinico-pathologic entity. Based on sensitive immunostaining technique, DLB is now considered the second most commonest cause of neurodegenerative dementia in the elderly. It is part of the range of clinical presentations that share a neuritic pathology based on abnormal aggregation of the synaptic protein α-synuclein. Lewy body pathology is found from the brainstem to the cortex and, in many cases, associated with concurrent Alzheimer' disease pathology. A recent international consortium on DLB has resulted in revised criteria for the clinical and pathological diagnosis of DLB incorporating new information about the clinical features and improved methods for their assessment. Neuropathologic diagnosis now assigns a weight to both α-synuclein and Alzheimer tangle pathology. Accurate identification of patients is important because they have specific symptoms, impairments, and functional disabilities that differ from those of other dementing illness including Alzheimer's disease.

노인학대

김신겸(Shinkyum Kim),박인수(In Soo Park) 대한노인정신의학회 2010 노인정신의학 Vol.14 No.1

Just these days elder abuse receives increasing social attention even though Korea already entered the ageing society with the steep increase of elderly population and this causes many social problems including elderly suicides. We need to develop methods to deal with these severe social problems, but, owing to lack of reliable data and studies, it is even difficult to document actual conditions of elder maltreatment. In a Korean nationwide epidemiological study conducted in 2007, the prevalence rate of elder abuse for last one year was 6.0%. Emotional abuse showed the highest prevalence (5.2%), and followed by neglect (2.3%), physical abuse (0.2%). The purpose of this study is to investigate the current prevalence and condition of elder maltreatment and provide the information about concept, types, risk factors and intervention of elder maltreatment.

알쯔하이머병 환자에서 백질 변화와 혈중 호모시스테인 및 엽산 농도의 상관관계

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung),이소영(So Young Lee),신은영(Eun Young Shin),정우열(Woo Yeol Jung),박준호(Jun Ho Park) 대한노인정신의학회 2009 노인정신의학 Vol.13 No.2

Objectives : To explore the relationship of white matter changes (WMC) on magnetic resornance imaging (MRI) with plasma homocysteine and folate levels in Alzheimer's disease (AD) patients. Methods : Forty-one patients with probable AD were evaluated on WMC on brain MRI, plasma homocysteine and folate levels, and cerebrovascular risk factors. Subjects were divided into two groups according to WMC scores (lower group with <5 and higher group with ≥5). WMC were assessed by a scale of the European Task Force on Age-Related WMC. Results : Plasma homocysteine levels were correlated with right frontal WMC and have a tendency of correlation with left frontal WMC. When subjects were divided into two groups: higher plasma homocysteine group (≥14 μmol/L) and lower plasma homocysteine group (<14 μmol/L), the former was significantly higher than the latter in both frontal WMC. In a logistic regression analysis, higher plasma homocysteine were not a significant risk factor for higher WMC. Increasing age was a only significant risk factor for higher WMC and correlated with both frontal WMC. There was no relationship folate with any WMC. Conclusion : It is possible that plasma homocysteine levels have a region-specific correlation with frontal WMC in AD. However, it is important that effect of age on the relationship should be considered.

노인에서의 약물 유도성 섬망

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.2

The elderly is accompanied by an increased likelihood of illness, and old people take a disproportionate amount of self-administered and prescribed medications. They are more likely to develop delirium as a result of taking medications than younger patients. Psychoactive drugs such as narcotics, long acting benzodiazepines, and tricyclic antidepressants are important causes of delirium. Drug induced confusion with nonpsychoactive drugs is often idiosyncratic in nature, and the diagnosis is easily missed. Anticholinergic medications are the most common causes of drug induced delirium in the elderly. Successful treatment of delirium depends on identifying the contributing factors, and drugs are the most common reversible cause of delirium. This article provides an clinical approach to prevent, recognize, and manage drug induced delirium.

세로토닌/도파민 길항성 항 정신병약물을 복용하는 정신분열병 환자에서 체중 증가와 세로토닌 2C 수용체 유전자 다형성의 관련성

장원석,김신겸,유승형,조은영,윤세창,이동수,홍경수 대한정신약물학회 2005 대한정신약물학회지 Vol.16 No.2

Objectives: Several lines of pharmacological evidences including the data of animal studies indicate that serotonin 2C receptor(5HT2C) is involved in the pharmacodynamic process of serotonin dopamine antagonists (SDA)-induced weight gain. Controversial data have been reported on the association between the polymorphisms of 5HT2C receptor gene and antipsychotics-induced weight gain. This study aims at investigating the association between the polymorphisms of 5HT2C receptor gene and SDA-induced weight gain in korean schizophrenic patients. Methods: Seventy-seven schizophrenia patients in their first episode or patients who did not take any antipsychotics for the previous two months were recruited. All the patients were administered with one of the SDAs(risperidone, olanzapine, quetiapine,clozapine) for 8weeks. Body mass index(BMI) were measured weekly during the 8weeks. The subjects were genotyped for the -759C/T and -697G/C polymorphism of the 5HT2C receptor gene. Results: The degree of linkage disequilibrium between the two polymorphic loci genotyped are almost 100%. Significant association was not observed between polymorphisms of the 5HT2C receptor gene(-759C/T and -697G/C) and SDA-induced weight gain after 8 weeks of treatment. Conclusions: Our data do not support the involvement of the polymorphisms of 5HT2C receptor gene(-759C/T and -697G/C) in SDA- induced weight gain. Further studies with sufficient sample size are warranted to follow up on the trend of high weight gain in the male patients having -759 T (-697 C) allele. Objectives: Several lines of pharmacological evidences including the data of animal studies indicate that serotonin 2C receptor(5HT2C) is involved in the pharmacodynamic process of serotonin dopamine antagonists (SDA)-induced weight gain. Controversial data have been reported on the association between the polymorphisms of 5HT2C receptor gene and antipsychotics-induced weight gain. This study aims at investigating the association between the polymorphisms of 5HT2C receptor gene and SDA-induced weight gain in korean schizophrenic patients. Methods: Seventy-seven schizophrenia patients in their first episode or patients who did not take any antipsychotics for the previous two months were recruited. All the patients were administered with one of the SDAs(risperidone, olanzapine, quetiapine,clozapine) for 8weeks. Body mass index(BMI) were measured weekly during the 8weeks. The subjects were genotyped for the -759C/T and -697G/C polymorphism of the 5HT2C receptor gene. Results: The degree of linkage disequilibrium between the two polymorphic loci genotyped are almost 100%. Significant association was not observed between polymorphisms of the 5HT2C receptor gene(-759C/T and -697G/C) and SDA-induced weight gain after 8 weeks of treatment. Conclusions: Our data do not support the involvement of the polymorphisms of 5HT2C receptor gene(-759C/T and -697G/C) in SDA- induced weight gain. Further studies with sufficient sample size are warranted to follow up on the trend of high weight gain in the male patients having -759 T (-697 C) allele.

노인장기요양보험제도와 요양병원에 대하여

박인수,김신겸 대한노인병학회 2008 Annals of geriatric medicine and research Vol.12 No.2

Korea is becoming aging society and the number of the aged who need long-term care service is increasing. Korean Elderly Long-Term Care Insurance System will be newly adopted soon and to make the system work successfully, comprehensive evaluation and management by professionals with have knowledge of geriatrics is necessary. In addition, long-term care hospitals should play their role between medical services and nursing care facilities as central organizations and form mutual system. The new insurance system only focuses on nursing care without regards of above facts. Other problems of it will be discussed in this study.