인지기능과 도구적인 일상생활기능의 관계에서 인구통계학적 변인들의 조절효과
Moderating Effects of Demographic Variables on the Relationship Between Cognitive Functions and Instrumental Activities of Daily Living
장승민 (성균관대학교)
강연욱 (한림대학교)
초록
인지기능과 도구적인 일상생활기능은 경도인지장애와 치매를 변별하는데 있어 중요한 두 변인이다. 인지기능 수준과 도구적인 일상생활기능의 관계에 관해서는 일관적이지 않은 연구 결과가 보고되고 있는데 이는 연구에 포함된 대상 집단의 인구통계학적 특성이 다르기 때문인 것으로 사료된다. 본 연구는 인구통계학적 변인들이 인지기능 수준과 도구적인 일상생활기능의 관계에서 어떤 조절효과를 지니는지 탐색하기 위해서 수행되었다. 기억성 경도인지장애 환자 167명과 알츠하이머형 치매 환자 82명이 연구에 참여하였으며 전반적인 인지기능과 도구적인 일상생활기능을 평가하기 위해서 한국판 간이정신상태검사(K-MMSE)와 서울신경심리검사 2판(SNSB-II)을 개인검사로 환자에게 실시하였고 한국판 도구적인 일상생활기능척도(K-IADL)를 환자의 보호자에게 실시하였다. K-MMSE 점수와 SNSB-II에서 산출된 주의집중능력, 언어기능, 시공간기능, 기억력 및 전두엽/집행기능과 같은 5개의 인지영역 점수를 예측변인, K-IADL 점수를 준거변인, 인구통계학적 변인들(나이, 성별, 교육년수)을 조절변인으로 선정하고 위계적 회귀분석을 통해서 조절효과를 검증하였다. 그 결과 나이는 K-MMSE, 언어기능, 시공간기능, 기억력 및 전두엽/집행기능이 도구적인 일상생활기능에 미치는 영향을 조절하는 것으로 나타났고, 교육년수는 K-MMSE가 도구적인 일상생활기능에 미치는 영향을 조절하는 것으로 확인되었으나 성별의 조절효과는 발견되지 않았다. 이 결과는 경도인지장애와 알츠하이머형 치매 집단에서 나이와 교육년수가 인지기능이 도구적인 일상생활기능에 미치는 영향을 조절하고, 특히 나이의 조절효과가 크다는 사실을 시사한다.
- keywords
- demographic variables, cognitive functions, instrumental activities of daily living, moderation effect, 인구통계학적 변인, 인지기능, 도구적인 일상생활기능, 조절효과
Abstract
Cognitive functions and instrumental activities of daily living (ADL) are two crucial variables in distinguishing between mild cognitive impairment (MCI) and dementia. Inconsistent research findings have been reported in terms of the relationship between cognitive functions and instrumental ADL, which may be due to the different demographic characteristics of the subjects. The purpose of this study was to explore the moderating effect of demographic variables in the relationship between cognitive functions and instrumental ADL in patients with amnestic multi-domain MCI (amMCI, n=167) and dementia of the Alzheimer’s type (DAT, n=82). To evaluate the global cognitive ability, the Korean-Mini Mental State Examination (K-MMSE) and Seoul Neuropsychological Screening Battery 2nd Edition (SNSB-II) were administered to the patients as individual tests. The caregivers completed the Korean-Instrumental Activities of Daily Living (K-IADL) Scale. The K-MMSE and the five cognitive domain scores derived from SNSB-II such as attention, language, visuospatial function, memory, and frontal/executive function were used as predictor variables, the score of K-IADL as a criterion variable, and the demographic variables (age, sex, and years of education) as moderator variables. The moderating effect was verified by the hierarchical regression analysis. The results showed that age had a moderating effect on the relationship between K-MMSE, language, visuospatial function, memory, and frontal/executive function scores and instrumental ADL. Years of education had a moderating effect on the influence of K-MMSE on instrumental ADL, but no moderating effect was found in sex. The results imply that age and years of education in the MCI and DAT groups moderate the impact of cognitive functions on instrumental ADL, and age especially has a greater moderating effect.
- keywords
- demographic variables, cognitive functions, instrumental activities of daily living, moderation effect, 인구통계학적 변인, 인지기능, 도구적인 일상생활기능, 조절효과
참고문헌
강수진, 최성혜, 이병화, 권재철, 나덕렬, 한설희 (2002). 한국판 Instrumental Activities of Daily Living의타당도와 신뢰도. 대한신경심리학회지, 20(1), 8-14.
강연욱 (2006). K-MMSE (Korean-Mini Mental State Examination)의 노인 규준 연구. 한국심리학회지:일반, 25(2), 1-12.
강연욱, 장승민, 나덕렬 (2012). 서울신경심리검사 2판. 서울: 휴브알엔씨.
이현주, 강상경 (2011). 노년기 인지기능과 우울증상의상호관계에 관한 연구: 성별 차이를 중심으로. 사회복지연구, 42(2), 179-203.
조맹제, 배재남, 서국희, 함봉진, 김장규, 이동우, 강민희 (1999). DSM-III-R 주요우울증에 대한 한국어판Geriatric Depression Scale(GDS) 의 진단적 타당성 연구. 신경정신의학, 38(1), 48-63.
중앙치매센터 (2019). 치매로부터 자유로운 나라: 2018중앙치매센터 연차보고서. 성남: 중앙치매센터.
조유향 (1995). 농촌노인의 보건의료문제와 간호관리:사회학적 측면에서 본 노인건강. 한국농촌의학, 17(2), 149-155.
통계청 (2018). 2018 고령자 통계. 서울: 통계청
Aiken, L. S., & West, S. G., (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.
Alexopoulos, P., Grimmer, T., Perneczky, R., Domes, G., & Kurz, A. (2006). Progression to dementia in clinical subtypes of mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 22(1), 27-34.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders 5th Edition (DSM-5®). Arlington: American Psychiatric Association.
Armstrong, L., & Walker, K. (1994). Preliminary evidence on the question of gender differences in language testing of older people. International Journal of Language & Communication Disorders, 29(4), 371-378.
Bäckman, L., Small, B. J., & Fratiglioni, L. (2001). Stability of the preclinical episodic memory deficit in Alzheimer's disease. Brain, 124(1), 96-102.
Barnes, L. L., Wilson, R. S., Bienias, J. L., Schneider, J. A., Evans, D. A., & Bennett, D. A. (2005). Sex differences in the clinical manifestations of Alzheimer disease pathology. Archives of General Psychiatry, 62(6), 685-691.
Beydoun, M. A., & Popkin, B. M. (2005). The impact of socio-economic factors on functional status decline among community-dwelling older adults in China. Social Science & Medicine, 60(9), 2045-2057.
Buckwalter, J. G., Rizzo, A. A., McCleary, R., Shankle, R., Dick, M., & Henderson, V. W. (1996). Gender comparisons of cognitive performances among vascular dementia, Alzheimer disease, and older adults without dementia. Archives of Neurology, 53(5), 436-439.
Cahn-Weiner, D. A., Boyle, P. A., & Malloy, P. F. (2002). Tests of executive function predict instrumental activities of daily living in community-dwelling older individuals. Neuropsychology, 9(3), 187-191.
Cahn-Weiner, D. A., Malloy, P. F., Boyle, P. A., Marran, M., & Salloway, S. (2000). Prediction of functional status from neuropsychological tests in community-dwelling elderly individuals. Clinical Neuropsychologist, 14(2), 187-195.
Corey-Bloom, J., Wiederholt, W. C., Edelstein, S., Salmon, D. P., Cahn, D., & Barrett‐C., E. (1996). Cognitive and functional status of the oldest old. Journal of the American Geriatrics Society, 44(6), 671-674.
Craik, F. I. M., & Salthouse, T. A. (2000). Handbook of aging and cognition II. Mahwah, NJ: Erlbaum,
Evans, D. A., Beckett, L. A., Albert, M. S., Hebert, L. E., Scherr, P. A., Funkenstein, H. H., & Taylor, J. O. (1993). Level of education and change in cognitive function in a community population of older persons. Annals of Epidemiology, 3(1), 71-77.
Farias, S. T., Mungas, D., Reed, B. R., Harvey, D., & DeCarli, C. (2009). Progression of mild cognitive impairment to dementia in clinic- vs. community-based cohorts. Archives of Neurology, 66(9), 1151-1157.
Fleishman, J. A., Spector, W. D., & Altman, B. M. (2002). Impact of differential item functioning on age and gender differences in functional disability. Journal of Gerontology Series B:Psychological Sciences & Social Sciences, 57(5), 275-284.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
Glisky, E. L. (2007). Changes in cognitive function in human aging.. Brain aging: Models, methods, and mechanisms (pp. 3-20). Boca Raton, FL:CRC Press.
Goldstein, G., McCue, M., Rogers, J., & Nussbaum, P. D. (1992). Diagnostic differences in memory test based predictions of functional capacity in the elderly. Neuropsychological Rehabilitation, 2(4), 307-317.
Hyde, J. S., & McKinley, N. M. (1997). Gender differences in cognition: Results from meta-analyses. In P. J. Caplan, M. Crawford, J. S. Hyde & J. T .E. Richardson (Eds.), Gender differences in human cognition (pp. 30-51). New York: Oxford University Press.
Laws, K. R., Irvine, K., & Gale, T. M. (2018). Sex differences in Alzheimer's disease. Current Opinion in Psychiatry, 31(2), 133-139.
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179-186.
Li, R., & Singh, M. (2014). Sex differences in cognitive impairment and Alzheimer’s disease. Frontiers in Neuroendocrinology, 35(3), 385-403.
Marquis, S., Moore, M. M., Howieson, D. B., Sexton, G., Payami, H., Kaye, J. A., & Camicioli, R. (2002). Independent predictors of cognitive decline in healthy elderly persons. Archives of Neurology, 59(4), 601-606.
Marshall, G. A., Rentz, D. M., Frey, M. T., Locascio, J. J., Johnson, K. A., Sperling, R. A., &Alzheimer's Disease Neuroimaging Initiative. (2011). Executive function and instrumental activities of daily living in mild cognitive impairment and Alzheimer's disease. Alzheimer's & Dementia, 7(3), 300-308.
McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack Jr, C. R., Kawas, C. H., ... & Mohs, R. C. (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(3), 263-269.
Millán-Calenti, J. C., Tubío, J., Pita-Fernández, S., González-Abraldes, I., Lorenzo, T., Fernández-Arruty, T., & Maseda, A. (2010). Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Archives of Gerontology and Geriatrics, 50(3), 306-310.
Millán-Calenti, J. C., Tubío, J., Pita-Fernández, S., Rochette, S., Lorenzo, T., & Maseda, A. (2012). Cognitive impairment as predictor of functional dependence in an elderly sample. Archives of Gerontology and Geriatrics, 54(1), 197-201.
Nadler, J. D., Richardson, E. D., Malloy, P. F., Marran, M. E., & Brinson, M. E. H. (1993). The ability of the Dementia Rating Scale to predict everyday functioning. Archives of Clinical Neuropsychology, 8(5), 449-460.
Nebes, R. D., & Brady, C. B. (1989). Focused and divided attention in Alzheimer's disease. Cortex, 25(2), 305-315.
Njegovan, V., Hing, M.M., Mitchell, S. L., & Molnar, F. J. (2001). The hierarchy of functional loss associated with cognitive decline in older persons. Journal of Gerontology Series A: Biological Sciences & Medical Sciences, 56(10), 638-643.
Park D. (2000). The basic mechanisms accounting for age-related decline in cognitive function. In D. Park & N. Schwarz (Eds). Cognitive aging: A primer (p. 3). Philadelphia, PA: Psychology Press.
Perry, R. J., & Hodges, J. R. (1999). Attention and executive deficits in Alzheimer's disease: A critical review. Brain, 122(3), 383-404.
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G., & Kokmen, E. (1999). Mild Cognitive impairment: Clinical characterization and outcome. Archives of Neurology, 56(6), 303-308.
Razani, J., Casas, R., Wong, J. T., Lu, P., Alessi, C., & Josephson, K. (2007). Relationship between executive functioning and activities of daily living in patients with relatively mild dementia. Neuropsychology, 14(3), 208-214.
Reed, B. R., Jagust, W. J., & Scab, J. P. (1989). Mental status as a predictor of daily function in progressive dementia. Gerontologist, 29(6), 804-807.
Richardson, E. D., Nadler, J. D., & Malloy, P. F. (1995). Neuropsychologic prediction of performance measures of daily living skills in geriatric patients. Neuropsychology, 9(4), 565-572.
Rotarou, E. S., & Sakellariou, D. (2018). Structural disadvantage and (un) successful ageing: Gender differences in activities of daily living for older people in Chile. Critical Public Health, 28(1), 1-13.
Sattler, C., Toro, P., Schönknecht, P., & Schröder, J. (2012). Cognitive activity, education and socioeconomic status as preventive factors for mild cognitive impairment and Alzheimer's disease. Psychiatry Research, 196(1), 90-95.
Savage, R. M., & Gouvier, W. D. (1992). Rey Auditory-Verbal Learning Test: The effects of age and gender, and norms for delayed recall and story recognition trials. Archives of Clinical Neuropsychology, 7(5), 407-414.
Skurla, E., Rogers, J. C., & Sunderland, T. (1988). Direct Assessment of Activities of Daily Living in Alzheimer's Disease A Controlled Study. Journal of the American Geriatrics Society, 36(2), 97-103.
Tekin, S., Fairbanks, L. A., O'connor, S., Rosenberg, S., & Cummings, J. L. (2001). Activities of daily living in Alzheimer's disease: Neuropsychiatric, cognitive, and medical illness influences. American Journal of Geriatric Psychiatry, 9(1), 81-86.
Vaughan, L., & Giovanello, K. (2010). Executive function in daily life: age-related influences of executive processes on instrumental activities of daily living. Psychology and Aging, 25(2), 343.
Warren, E. J., Grek, A., Conn, D., Herrmann, N., Icyk, E., Kohl, J., & Silberfeld, M. (1989). A correlation between cognitive performance and daily functioning in elderly people. Journal of Geriatric Psychiatry & Neurology, 2(2), 96-100.
Weiss, E. M., Kemmler, G., Deisenhammer, E. A., Fleischhacker, W. W., & Delazer, M. (2003). Sex differences in cognitive functions. Personality &Individual Differences, 35(4), 863-875.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49.
Zihl, J., Reppermund, S., Thum, S., & Unger, K. (2010). Neuropsychological profiles in MCI and in depression: Differential cognitive dysfunction patterns or similar final common pathway disorder? Journal of Psychiatric Research, 44(10), 647-654.
- 다운로드 수
- 조회수
- 0KCI 피인용수
- 0WOS 피인용수