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뇌졸중 노인에서 전두엽-관리기능의 차별적 결손

Differential Deficits in Executive Function in Elderly Stroke Patients

한국심리학회지: 일반 / Korean Journal of Psychology: General, (P)1229-067X; (E)2734-1127
2009, v.28 no.1, pp.29-48
추은진 (대구대학교 재활심리학과)
김홍근 (대구대학교)
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초록

본 연구의 목적은 뇌졸중 노인에서 다른 인지기능에 비해 관리기능에 보다 심한 결손이 있다는 가설을 검증하는 것이었다. 이를 위해 뇌졸중 노인 31명과 일반 노인 31명을 대상으로 인지기능을 비교하였다. 뇌졸중 노인은 요양병원에 입원 중인 환자들에서 모집하였으며, 일반 노인은 뇌졸중 노인과 연령 및 학력이 균등하도록 표집 하였다. 연구 도구로는 ‘노인용 인지검사’(Cognition Scale for Older Adults)를 사용하였다. 주요 결과는 다음 세 가지였다. 첫째, 통제군에 비해 뇌졸중군이 낮은 정도는 Basic IQ에 비해 Executive IQ에서 보다 현저하였다. 둘째, 관리기능 의존도가 높은 과제와 낮은 과제의 환산점수를 짝지워 비교한 결과, 통제군은 차이가 없었지만 뇌졸중군은 관리기능 의존도가 높은 과제가 유의하게 낮았다. 이러한 차이는 주의, 작업 기억, 언어, 시공간기능 영역에서 공통적이었다. 셋째, 뇌졸중군을 세분한 무인지장애군, 경도인지장애군, 치매군 각각에서 Basic IQ에 비해 Executive IQ가 유의하게 낮았다. 관리기능과 관련된 진단적 지표에서 ‘정상’이라고 평가되는 뇌졸중 환자는 전체의 10%에 불과하였다. 이 결과들은 뇌졸중 환자에서 다른 인지기능에 비해 관리기능의 결손이 보다 현저함을 제시한다. 뇌졸중 환자에서 관리기능 결손이 특징적인 것은 다수의 환자들이 피질하 부위에 소혈관 경색이 있는 것과 관련될 수 있다.

keywords
뇌졸중, 치매, 관리기능, 실행기능, 전두엽, stroke, dementia, executive function, neuropsychological function, stroke, dementia, executive function, neuropsychological function

Abstract

The goal of the present study was to investigate whether elderly stroke patients show differential deficit in executive function relative to other cognitive functions. To this end, we compared cognitive functions of 31 elderly stroke patients and 31 normal elderly subjects. The stroke patients were sampled from nursing hospitals for elderly persons and the normal older adults were sampled from the local community. Cognition Scale for Older Adults(CSOA) was used to measure executive and other cognitive functions. The study yielded three main findings. First, the stroke patients showed greater deficits in Executive IQ than in Basic IQ. Second, the stroke patients performed more poorly on tasks that demand executive processing than on tasks that do not demand executive processing. This differential performance was confirmed in cognitive tasks of attention, working memory, language, and visuospatial function. Third, the stroke patients were classified into normal, mild cognitive impairment, and dementia subgroups, based on their MMSE-KI scores. Each subgroup showed greater deficits in Executive IQ than in Basic IQ. Diagnostic indices indicated that only 10% of the stroke patients have normal executive function. These results indicate that most stroke patients have more severe deficits in executive function relative to other cognitive functions. High prevalence of executive dysfunction among stroke patients may reflect high incidence of subcortical small-vessel infarcts.

keywords
뇌졸중, 치매, 관리기능, 실행기능, 전두엽, stroke, dementia, executive function, neuropsychological function, stroke, dementia, executive function, neuropsychological function

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