신경계 질환자들의 우울 수준 및 우울 요인과 신경인지기능과의 관계성
The relationship of depression level and depression factors to neuro-cognitive functions in neurological outpatients
윤영철 (중앙대학교)
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초록
본 연구는 신경계 질환의 진단에 따라 우울 양상에 어떤 차이가 있는지 조사하고, 이들의 우울 수준 및 우울 요인들과 신경인지기능 및 일상생활기능과의 관계성에 대해 알아보고자 하였다. 연구대상은 신경과에서 알쯔하이머 치매, 혈관성 치매, 경도 인지장애로 진단된 142명의 환자들이다. 이들에게 신경심리검사(SNSB)를 실시하였고, 그 외 노인 우울(GDS), 일상생활기능(ADL)을 평가하였다. 노인 우울척도를 요인분석하여 우울(depression), 걱정(worry), 불쾌감(dysphoria), 무감동(apathy) 4개 요인을 추출하였으며 총 48%의 설명량을 보였다. 연구결과, 신경과 환자들 중 알쯔하이머 환자들이 다른 집단에 비해 우울 비율이 가장 높았으나, 우울 수준은 혈관성 치매에서 높게 나타났다. 이들 환자 중 우울 수준이 높은 집단은 낮은 집단에 비해, 주의력, 주의집중능력, 정신운동속도, 시각적 기억력, 실행기능, 일상생활기능의 저하가 유의하게 나타났다. 그러나 세부적으로 우울 요인들이 관련되는 신경인지기능에 차이가 있었다. 우울 요인은 주의력, 주의집중력, 시각적 즉시회상, 실행기능과 관련되는 반면 무감동 요인은 기억인출 및 재인과 같이 치매의 핵심 증상인 기억 기능과 관련되는 것으로 나타났다. 즉 신경계 질환자들의 우울증은 정서반응으로 인한 우울 이외에 신경학적 결손으로 유발되는 우울 증상을 포함하고 있으므로, 우울 요인들의 기저 원인이 다를 수 있음을 시사한다. 따라서 치매 환자들의 우울증은 우울 요인에 대한 정확한 평가를 통해 적절한 치료가 제공되어야 할 것이다.
- keywords
- 우울수준, 우울 요인, 무감동 요인, 신경인지기능, 일상생활기능, depression level, depression factor, apathy factor, neuro-cognitive functions, daily activity, depression level, depression factor, apathy factor, neuro-cognitive functions, daily activity
Abstract
The purpose of this study investigated the differences of depression figure according to diagnosis, and the relation of depression level and depression factors to neuro-cognitive functions. The subjects were 142 patients diagnosed as Alzheimer disease, vascular dementia and mild cognitive impairment. The patients were given brain MRI, neurological examination, the Seoul Neuro-psychological Screening Battery(SNSB), the geriatric depression scale(GDS) and the activity of daily living scale (ADL). The depression rate of Alzheimer patients were the highest compared with other group. However, the vascular dementia showed the highest depression level. In higher depression level, there were significantly lower in attention abilities, psychomotor velocities, visual memory, executive function and ADL. The results of factor analysis for the GDS was classified 4 factors such as depression, worry, dysphoria, and apathy. The depression factor of GDS was related to the attention, immediate visual recall, and executive function. On the other hand, the apathy factor was related to the core symptoms of dementia, such as recall and recognition of memory. Because the depressive symptoms of the dementia patients were often originated from both emotional reaction to their defect and neurological disease itself, the factors of depression might be affected by causes of dementia. So, it is important to ensure that the dementia patients with depression need appropriate treatment through the evaluation of depression factors.
- keywords
- 우울수준, 우울 요인, 무감동 요인, 신경인지기능, 일상생활기능, depression level, depression factor, apathy factor, neuro-cognitive functions, daily activity, depression level, depression factor, apathy factor, neuro-cognitive functions, daily activity
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