파킨슨병에서 관리기능의 결손: 짝과제를 사용한 검증
Executive Function Impairment in Parkinson’s Disease: Evidence from Paried-task Comparisons
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초록
여러 선행 연구들이 파킨슨병 환자들이 관리기능검사에서 저조한 수행을 보임을 보고하였다. 그러나 관리기능검사의 특이성이 낮기 때문에 이 결과는 관리기능 결손의 분명한 증거가 되지 못한다. 이에 따른 본 연구의 목적은 파킨슨병 환자가 관리기능검사에서 저조한 수행을 보이는 것이 관리기능의 결손 때문인지 혹은 다른 인지기능의 결손 때문인지를 변별하는 것이었다. 이를 위해 30명의 파킨슨병 환자와 26명의 일반 노인에게 노인용 인지검사를 실시하고, 관리기능이 높고 낮음에 따라 구성한 6개의 짝과제에서 두 집단을 비교하였다. 주요 결과는 다음과 같았다. 첫째, 파킨슨병 집단은 기본지식문제에 비해 단어유창성, 그림이름대기에 비해 보고그리기, 지연재인에 비해 지연회상, 기초기능지표에 비해 관리기능지표에서 더욱 심한 결손을 나타내었다. 이 결과는 파킨슨병 집단이 단어유창성, 보고그리기, 지연회상, 관리기능지표에서 저조한 수행을 보이는 것에 관리기능의 결손이 관여된다는 더욱 분명한 증거이다. 둘째, 스트룹검사 단순시행과 간섭시행의 짝과제에서는 두 시행 모두에서 같은 정도의 심한 결손이 있었다. 이 결과는 파킨슨병이 신체적 운동뿐 아니라 정신운동속도도 심하게 저하시킴을 시사한다. 셋째, 숫자 바로 따라 외우기와 숫자 거꾸로 따라 외우기의 짝과제에서는 두 시행 모두에서 유의한 결손이 없었다. 이 결과는 작업기억에서는 기능 저하가 비교적 약함을 시사한다. 결론적으로, 파킨슨병 환자들은 관리기능과 정신운동속도의 영역에서 가장 심한 인지장애가 있는 것으로 나타났다.
Abstract
A number of previous studies reported that patients with Parkinson’s disease (PD) perform poorly on executive function tests. However, due to the low specificity of most executive function tests, it is uncertain whether these results reflect deficits in the executive function or some other cognitive functions. Accordingly, the aim of this study was to distinguish between two hypotheses: (1) low performance of PD patients on executive function tests reflects deficits in the executive function and (2) low performance of PD patients on executive function tests is due to impairment in some other cognitive functions. To this end, Cognition Scale for Older Adults was administered to patients with PD (n=30) and matched controls (n=26). They were compared on six sets of paired tasks, in which one strongly demanded the executive function while the other did not. The major findings were as follows. First, relative to the matched controls, PD patients showed significantly greater impairment in word fluency than in information fluency, Rey copy than picture naming, delayed recall than delayed recognition, and Executive Function Index than Basic Function Index, indicating that low performance on word fluency, Rey copy, Delayed recall, and Executive Function Index is associated with impairment in executive function. Second, PD patients showed a large impairment in both the Stroop simple and interference trials, indicating prominent deficit in the psychomotor speed. Third, PD patients and controls were not significantly different with respect to Digit span forward and backward, indicating relative preservation of working memory capacity. Taken together, these results indicate that PD is associated with relatively greater cognitive impairment in the domains of the executive function and psychomotor speed.
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