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  • 한국과학기술정보연구원(KISTI) 서울분원 대회의실(별관 3층)
  • 2024년 07월 03일(수) 13:30
 

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기억성 경도인지장애와 알츠하이머병의시계 그리기 검사의 수행양상

Quantitative and Qualitative Analyses of Clock Drawings in Mild Cognitive Impairment and Alzheimer's Disease

초록

시계 그리기 검사(Clock Drawing Test: CDT)는 치매 선별검사로, 임상 장면에서 많이 사용되는 신경심리검사 중 하나이다. 본 연구에서는 기억성 경도인지장애(amnestic Mild Cognitive Impairment, aMCI)와 임상치매평가척도(Clinical Dementia Rating scale: CDR)에 따라 CDR 0.5로 분류된 알츠하이머병 치매(Alzheimer's disease, AD), 그리고 CDR 1로 분류된 AD 환자를 대상으로 시계 그리기 검사(CDT)의 수행을 양적 및 질적 오류 분석을 통해 비교하고자 하였다. 서울 소재 한 종합병원 신경과를 방문한 환자 중 aMCI 환자 97명, AD-CDR 0.5 환자 37명, AD-CDR 1 환자 50명을 대상으로 CDT와 종합적인 신경심리평가가 시행되었다. 연구 결과, CDT의 양적 점수는 유의한 차이가 있었으나 사후분석에서 aMCI와 AD-CDR 0.5 간의 유의한 차이는 보이지 않았다. 그러나 질적 오류 분석에서, <개념적 결함> 오류 중 <잘못된 표상: 시계>, <공간과 계획 결함> 오류 중 <불특정형태 오류>, 그리고 <그리기 어려움: 중도>에서 aMCI와 AD-CDR 0.5 간의 유의한 차이를 확인할 수 있었다. 다른 신경심리평가와 CDT의 상관관계를 분석한 결과, 한국판 보스톤 이름 대기 검사, 레이 복합 도형 검사: 모사, 언어적/시각적 기억 과제 및 전두엽/집행기능 과제들과 유의한 상관관계를 보였다. 따라서 본 연구 결과는 CDT 수행의 양적 점수만으로는 AD 초기 인지 변화를 살펴보는데 제한이 있으나 질적 오류 특성이 AD 초기 인지 변화를 살펴보는데 유용할 것이라는 점과 CDT를 수행하는데 의미적 지식, 시공간 구성 능력 및 집행기능이 영향을 미친다는 점을 시사한다.

keywords
Clock Drawing Test, Amnestic Mild Cognitive Impairment, Alzheimer's disease, Clinical Dementia Rating Scale, Questionable Alzheimer's disease, 시계 그리기 검사, 기억성 경도인지장애, 알츠하이머병, 임상치매평가척도, 알츠하이머병 의심단계

Abstract

The clock drawing test (CDT) has been consistently used as part of neuropsychological assessment, specifically as a screening tool for dementia. This study compared the quantitative and qualitative performance on the CDT among patients with amnestic mild cognitive impairment (aMCI), very mild Alzheimer's disease (AD) with a clinical dementia rating (CDR) of 0.5, and mild AD with a CDR of 1. Ninety-seven subjects with aMCI, 37 subjects with AD-CDR 0.5, and 50 subjects with AD-CDR 1, who visited the Memory Disorders Clinic in the Department of Neurology at the general hospital located in Seoul, underwent CDT and standardized neuropsychological battery tests. Although significant differences were found in the total quantitative scores among the three patient groups, there were no significant differences between aMCI and AD-CDR 0.5 patients. However, the qualitative error analysis revealed differences between the two groups in several areas: misrepresentation of clock (conceptual deficit error), deficit in spatial layout of numbers without any specific pattern (spatial disorganization), and moderate graphic difficulty. In correlational analysis between the CDT and other neuropsychological measures, the CDT was significantly correlated with the Korean-Boston Naming Test, Rey-Osterrieth Complex Figure copying test, verbal/visual memory tests, and frontal/executive function tests. Therefore, the findings of this study suggested that the characteristics of qualitative errors in the CDT can help identify cognitive changes in the early stage of AD; however, the quantitative scores of the CDT revealed limited information about these changes. Additionally, our results indicated that performance in the CDT was associated with semantic knowledge, visuospatial function, and executive function

keywords
Clock Drawing Test, Amnestic Mild Cognitive Impairment, Alzheimer's disease, Clinical Dementia Rating Scale, Questionable Alzheimer's disease, 시계 그리기 검사, 기억성 경도인지장애, 알츠하이머병, 임상치매평가척도, 알츠하이머병 의심단계

참고문헌

1.

강연욱 (2006). K-MMSE(Korean-Mini Mental State Examination)의 노인 규준 연구. 한국심리학회지: 일반, 25(2), 1-12.

2.

강연욱, 나덕렬 (2003). 서울언어학습검사(SVLT). 서울: Human Brain Research & Consulting co.

3.

강연욱, 장승민, 나덕렬 (2012). 서울신경심리검사 2판(SNSB-Ⅱ). 서울: Human Brain Research & Consulting co.

4.

구형모, 김지혜, 권의정, 김성환, 이형석, 고혜정, 안상미, 김도관 (2004). 일상활동평가-복합(Seoul-Instrumental Activities of Daily Living: S-IADL)의 신뢰도 및 타당도 연구. 대한신경정신의학회, 43(2), 189-199.

5.

기경아 (1999). 시계 그리기 검사의 규준 연구. 성신여자대학교 대학원 석사 학위 논문.

6.

김향희, 나덕렬 (1997). 한국판 보스톤 이름대기 검사(K-BNT). 서울: 학지사.

7.

김호영 (2002). 한국 노인의 시계 그리기 검사의 표준화 연구. 서울대학교 대학원 석사 학위 논문.

8.

대한치매학회 (2011). 치매 임상적 접근 2판. 아카데미아.

9.

최성혜, 나덕렬, 이병화, 함동석, 정지향, 윤수진, 유경희, 하충건, 한일우, 치매연구회 (2001). 한국판 expanded clinical dementia rating (CDR) 척도의 타당도. 대한신경과 학회지, 19(6), 585-591.

10.

Ahmed, S., Brennan, L., Eppig, J., Price, C. C., Lamar, M., Delano-Wood, L., Bangen, K. J., Edmond, E. C., Clark, L., Nation, D. A., Jak, A., Au, R., Swenson, R., Bondi, M. W., Libon, D. J. (2016). Visuoconstructional impairment in subtypes of mild cognitive impairment. Applied Neuropsychology: Adult, 23, 43-52.

11.

Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C., Gamst, A., Holtzman, D. M., Jagust, W. J., Petersen, R. C., Snyder, P. J., Carrillo, M. C., Thies, B., & Phelps, C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 270-279.

12.

Babins, L., Slater, M., Whitehead, V., & Chertkow, H. (2008). Can an 18-point clock-drawing scoring system predict dementia in elderly individuals with mild cognitive impairment? Journal of Clinical and Experimental Neuropsychology, 30(2), 173-186.

13.

Bayles, K. A., & Tomoeda, C. K. (1983). Confrontation naming and dementia. Brain and Language, 19, 98-114.

14.

Blair, M., Kertesz A., McMonagle, P., Davidson, W., & Bodi, N. (2006). Quantitative and qualitative analyses of clock drawing in frontotemporal dementia and Alzheimer's disease. Journal of the International Neuropsychological Society, 12, 159-165.

15.

Cacho J., Benito-Leon J., Garcia-Garcia R., Fernandez-Calvo B., Vicente-Villardon J. L., & Mitchell A. J. (2010). Does the combination of the MMSE and clock drawing test (Mini-Clock) improve the detection of mild Alzheimer's disease and mild cognitive impairment? Journal of Alzheimer's Disease, 22, 889-896.

16.

Cahn, A. D., Salmon, P. D., Monsch, U. A., Butters, N., Weiderholt, C. W., Corey-Bloom, J., & Barrett-Connor, E. (1996). Screening for dementia of the Alzheimer type in community: the utility of the clock drawing test. Archives of Clinical Neuropsycholgy, 11(6), 529-539.

17.

Conner D. J., Seward J. D., Bauer J. A., Golden K. S., Salmon D. P. (2005). Performance of three clock scoring systems across different ranges of dementia severity. Alzheimer Disease & Associated Disorders. 19, 119-127.

18.

Cosentino, S., Jefferson, A., Chute, D. L., Kaplan, E., & Libon, D. J. (2004). Clock drawing errors in dementia: neuropsychological and neuroanatomical consideration. Cognitive and Behavioral Neurology, 17, 74-84.

19.

Cummings, J. L., & Mendez, M. F. (2003). Dementia: A clinical approach(3rd Ed.). Philadelphia, PA: Butterworth Heinemann.

20.

Daly, E., Zaitchik, D., Copeland, M., Schmahmann, J., Gunther, J., & Albert, M. (2000). Predicting conversion to Alzheimer disease using standardized clinical information. Archives of Neurology, 57, 675-680.

21.

de Paula, J. J., de Miranda, D. M., de Moraes, E. N., & Malloy-Diniz, L. F. (2013). Mapping the clockworks: what does the clock drawing test assess in normal and pathological aging? Arquivos de Neuro-Psiquiatria, 71(10), 763-768.

22.

Dubois, B., Feldman, H. H., Jacova, C., Cummings, J. L., DeKosky, S. T., Barberger-Gateau, P., Delacourte, A., Frisoni, G., Fox, N. C., Galasko, D., Gauthier, S., Hampel, H., Jicha, G. A., Meguro, K., O'Brien, J., Pasquier, F., Robert, P., Rossor, M., Salloway, S., Sarazin, M., de Souza, L. C., Stern, Y., Visser, P. J., & Scheltens, P. (2010). Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurology, 9, 1118-1127.

23.

Freedman, M., Kaplan, E., Delis, D., & Morris, R. (1994). Clock Drawing: A Neuropsychological Analysis. New York: Oxford University Press.

24.

Goldberg, E., & Bilder, R. (1986). Neuropsychological perspectives: Retrograde amnesia and executive deficits. In L. W. Poon(Ed.), Handbook of clinical memory assessment of older adults (pp. 888-999). Washington, DC: American Psychological Association.

25.

Goodglass, H., & Kaplan, E. (1983). The assessment of aphasia and related disorders. Philadelphia: Lea & Febiger.

26.

Hodge, J. R., Salmon, D. P., & Butters, N. (1991). The nature of the naming deficit in Alzheimer’s and Huntington's disease. Brain, 114, 1547-1558.

27.

Ino, T., Asada, T., Ito, J., Kimura, T., Fukuyama, H. (2003). Parieto-frontal networks for clock drawing revealed with fMRI. Neuroscience Research, 45, 71-77.

28.

Jack, C. R., Jr., Albert, M. S., Knopman, D. S., McKhann, G. M., Sperling, R. A., Carrillo, M.. C., Thies, B., Phelps, C. H. (2011). Introduction to the recommendations from the National Institute on Aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 257-262.

29.

Kirby, M., Denihan, A., Bruce, I., Coakley, D., & Lawlor, B. A. (2001). The clock drawing test in primary care: sensitivity in dementia detection and specificity against normal and depressed elderly. International Journal of Geriatric Psychiatry, 16, 935-940.

30.

Kitabayashi, Y., Ueda, H., Narumoto, J., Nakamura, K., Kita, H., & Fukui, K. (2001). Qualitative analyses of clock drawing in Alzheimer's disease and vascular dementia. Psychiatry and Clinical Neurosciences, 55, 485-491.

31.

Lee, K. S., Kim, E. A., Hong, C. H., Lee D., Oh, B. H., & Cheong, H. (2008). Clock drawing test in mild cognitive impairment: quantitative analysis of four scoring methods and qualitative analysis. Dementia and Geriatric Cognitive Disorders, 26, 483-489.

32.

Lezak, D. M., Howieson, B. D., Loring, W. D., Hannay H. J., & Fisher, S. J. (2004). Neuropsychological assessment. New York: Oxford University Press.

33.

Libon, D. J., Malamut, B. L., Swenson, R., Sands, L. P., & Cloud, B. S. (1996). Further analyses of clock drawing among demented and nondemented older subjects. Archives of Clinical Neuropsychology, 11, 193-205.

34.

McKhann, G. M., Knopman, D. S., Cherkow, H., Hyman, B. T., Jack. C. R. Jr., Kawas, C. H., Klunk, W. E., Koroshetz, W. J., Manly, J. J., Mayeux, R., Mohs, R. C., Morris, J. C., Rossor, M. N., Scheltens, P., Carrillo, M. C., Thies, B., Weintraub, S., & Phelps, C. H. (2011). The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 263-269.

35.

McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M.. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34(7), 939-944.

36.

Meyers, J. E., & Meyers, K. R. (1995). Rey Complex Figure Test and recognition trial: Professional manual. Lutz, FL: Psychological Assessment Resources.

37.

Mirsen, T., & Hachinski, V. (1988). Epidemiology and classification of vascular and multi-infarct dementia. In Meyer, J. S., Lechner, H., Marshall, J., & Toole, J. F. (Eds.), Vascular and Multi-infarct Dementia. Mount Kisko, NY: Future Publishing.

38.

Morris, JC. (1993). The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43(11), 2412-2414.

39.

Nair, A. K., Gavett, B. E., Damman, M., Dekker, W., Green, R. C., Mandel, A., Auerbach, S., Steinberg, E., Hubbard, E. J., Jefferson, A., & Stern, R. A. (2010). Clock drawing test ratings by dementia Specialists: interrater reliability and diagnostic accuracy. Journal of Neuropsychiatry and Clinical Neurosciences, 22(1), 85-92.

40.

Parsey CM., & Schmitter-Edgecombe M. (2011). Quantitative and qualitative analyses of the clock drawing test in mild cognitive impairment and Alzheimer's Disease: evaluation of a modified scoring system. Journal of Geriatric Psychiatry and Neurology, 24, 108-118.

41.

Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183-194.

42.

Petersen, R. C. (2003). Mild cognitive impairment clinical trials. Nature reviews drug discovery, 2, 646-653.

43.

Petersen, R. C., Doody, R., Kurz, A., Mohs, R. C., Morris, J. C., Rabins, P. V., Ritchie, K., Rossor, M., Thal, L., & Winblad, B. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58, 1985-1992.

44.

Petersen, R. C. (2000). Mild Cognitive Impairment or questionable dementia? [editorial] Archives of Neurology, 57, 643-644.

45.

Petersen, R. C., Smith, G. E., Waring, S. C., Lvnik, R. J., Tangalos, E. G., & Kokmen, E. (1999). Mild Cognitive Impairment: Clinical characterization and outcome. Archives of Neurology, 56, 303-308.

46.

Petersen, R. C. (1995). Normal aging, mild cognitive impairment, and early Alzheimer's disease. Neurologist. 1, 326-344.

47.

Pillon, B. (1981). Troubles visuo-constructifs et méthodes de compensation: Résultats de 85 patients atteints de lésions cérébrales. Neuropsychologia, 19, 375-383.

48.

Powlishta, K., Von Dras, D., Stanford, A., Carr D., Tsering C., Miller J., & Morris J. (2002). The clock drawing test is a poor screen for very mild dementia. Neurology, 59, 898-903.

49.

Rouleau, I., Salmon, D. P., & Butters, N. (1996). Longitudinal analysis of clock drawing in Alzheimer's disease patients. Brain and cognition, 31, 17-34.

50.

Rouleau, I., Salmon, D. P., Butters, N., Kennedy, C., & McGuire, K. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain and cognition, 18, 70-87.

51.

Seigerschmidt, E., Mosch, E., Siemen, M., Frstl, H., & Bickel, H. (2002). The Clock Drawing Test and questionable dementia: reliability and validity. International Journal of Geriatric Psychiatry, 17, 1048-1054.

52.

Shon, J. M., Lee, D. Y., Seo, E. H., Sohn, B. K., Kim J. W., Park, S. Y., Kim, S. G., Jhoo, J. H., & Woo, J. I. (2013). Functional neuroanatomical correlates of the executive clock drawing task (CLOX) performance in Alzheimer's disease: A FDG-PET study. Neuroscience, 246, 271-280.

53.

Shulman, K. I. (2000). Clock-drawing: Is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry, 15, 548-561.

54.

Sperling R. A., Aisen P. S., Beckett, L. A., Bennett, D. A., Craft, S., Fagan, A. M., Iwatsubo, T., Jack, C. R. Jr., Kaye, J., Montine, T. J., Park, D. C., Reiman, E. M., Rowe, C. C., Siemers, E., Stern, Y., Yaffe. K., Carrillo, M. C., Thies, B., Morrison- Bogorad, M., Wagster, M. V., & Phelps, C. H. (2011). Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging- Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & dementia, 7, 280-292.

55.

Takahashi, M., Sato, A., Nakajima, K., Inoue, A., Oishi, S., Ishii, T., & Miyaoka, H. (2008). Poor performance in clock-drawing test associated with visual memory deficit and reduced bilateral hippocampal and left temporoparietal regional blood flows in Alzheimer's disease patients. Psychiatry and Clinical Neurosciences, 62, 167-173.

56.

Tierney, M. C., Szalai, J. P., Snow, W. G., Fisher, R. H., Nores, A., Nadon, G., Dunn, E., & St George-Hyslop, P. H. (1996). Prediction of probable Alzheimer's disease in memory-impaired patients: a prospective longitudinal study. Neurology, 46(3), 661-665.

57.

Teixeira, FA., Aprahamian I., & Sanches YM. (2014). Qualitative analysis of the clock drawing test by educational level and cognitive profile. Arquivos de Neuro-Psiquiatria, 72(4), 289-295.

58.

Tuokko, H., Hadjistavropuolo, T., Miller, J. A., & Beattie, B. L. (1992). The clock test: a sensitive measure to differentiate normal elderly from those with Alzheimer's disease. Journal of American Geriatric Society, 40, 579-584.

59.

Wang, P., Shi, L., Zhao, Q., Hong, Z., & Guo, Q. (2014). Longitudinal changes in clock drawing test (CDT) performance before and after cognitive decline. PLoS ONE, 9(5), e97873.

60.

Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L. O., Nordberg, A., Backman, L., Albert, M., Almkvist, O., Arai, H., Basun, H., Blennow, K., de Leon, M., DeCarli, C., Erkinjuntti, T., Giacobini, E., Graff, C., Hardy, J., Jack, C., Jorm, A., Ritchie, K., van Duijin, C., Visser, P., & Petersen, R. C. (2004). Mild cognitive impairment-Beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240-246.

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