본문 바로가기
KERD
논문KCI 등재

기억성 경도인지장애 환자에서 알츠하이머병 치매로의 진행과 신경정신행동 증상

Neuropsychiatric Symptoms and Increased Risks of Progression from Amnestic Mild Cognitive Impairment to Alzheimer’s Dementia

유승호|박두흠|유재학|하지현|신진
대한노인정신의학회 (Korean Association For Geriatric Psychiatry)|2017.04|노인정신의학 (Journal of Korean Geriatric Psychiatry)|제21권 제1호|pp. 29-34

1

조회

0

다운로드

3

인용

0

참고문헌

초록

Objective：Neuropsychiatric symptoms (NPS) are common in dementia and in mild cognitive impairment (MCI). They might be a predictor of progression to dementia. This study aimed to investigate the effects of NPS on the natural course in MCI. Methods：306 community-dwelling Korean elderly with MCI from local dementia center were assessed for NPS using Neuropsychiatric Inventory (NPI). Subjects were assessed again after more than a year from baseline. 52 subjects (17.0%) were progressed to dementia. We compared baseline NPI scores between stable and deteriorated groups. Results：Subjects progressing to dementia had a significantly higher prevalence of NPS (45.3% vs. 65.4%) than subjects who remained stable. Delusion (2.8% vs. 9.6%), agitation/aggression (14.6% vs. 26.9%), depression (21.7% vs. 40.4%) and disinhibition (4.3% vs. 19.2%) were more common in deteriorated group. After adjustment for other variables, on logistic regression analysis, only disinhibition at baseline was shown to be a risk factor for progression to dementia (OR=4.88, 95% CI=1.37-17.36, p=0.01, R2=302). Conclusion：These findings suggest that NPS in MCI may be a predictor of progression to dementia. NPS may be a useful item including delusion, agitation/aggression, depression, and disinhibition. To study course and nature of NPS may lead to better understanding of Alzheimer’s disease.

Abstract

Objective：Neuropsychiatric symptoms (NPS) are common in dementia and in mild cognitive impairment (MCI). They might be a predictor of progression to dementia. This study aimed to investigate the effects of NPS on the natural course in MCI. Methods：306 community-dwelling Korean elderly with MCI from local dementia center were assessed for NPS using Neuropsychiatric Inventory (NPI). Subjects were assessed again after more than a year from baseline. 52 subjects (17.0%) were progressed to dementia. We compared baseline NPI scores between stable and deteriorated groups. Results：Subjects progressing to dementia had a significantly higher prevalence of NPS (45.3% vs. 65.4%) than subjects who remained stable. Delusion (2.8% vs. 9.6%), agitation/aggression (14.6% vs. 26.9%), depression (21.7% vs. 40.4%) and disinhibition (4.3% vs. 19.2%) were more common in deteriorated group. After adjustment for other variables, on logistic regression analysis, only disinhibition at baseline was shown to be a risk factor for progression to dementia (OR=4.88, 95% CI=1.37-17.36, p=0.01, R2=302). Conclusion：These findings suggest that NPS in MCI may be a predictor of progression to dementia. NPS may be a useful item including delusion, agitation/aggression, depression, and disinhibition. To study course and nature of NPS may lead to better understanding of Alzheimer’s disease.

참고문헌 (46)

  1. Petersen RC, "Mild cognitive impairment as a diagnostic entity", J Intern Med, 256, pp.183~194 (2004)
  2. Petersen RC, "Mild cognitive impairment: clinical characterization and outcome", Arch Neurol, 56, pp.303~308 (1999)
  3. Grundman M, "Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials", Arch Neurol, 61, pp.59~66 (2004)
  4. Ritchie K, "Classification criteria for mild cognitive impairment: a population-based validation study", Neurology, 56, pp.37~42 (2001)
  5. Geslani DM, "Mild cognitive impairment: an operational definition and its conversion rate to Alzheimer’s disease", Dement Geriatr Cogn Disord, 19, pp.383~389 (2005)
  6. Petersen RC, "Vitamin E and donepezil for the treatment of mild cognitive impairment", N Engl J Med, 352, pp.2379~2388 (2005)
  7. Palmer K, "Differential evolution of cognitive impairment in nondemented older persons:results from the Kungsholmen Project", Am J Psychiatry, 159, pp.436~442 (2002)
  8. Lyketsos CG, "Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study", JAMA, 288, pp.1475~1483 (2002)
  9. Geda YE, "Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study", Arch Gen Psychiatry, 65, pp.1193~1198 (2008)
  10. Lee Y, "Effects of indoor gardening on sleep, agitation, and cognition in dementia patients--a pilot study", Int J Geriatr Psychiatry, 23, pp.485~489 (2008)
  11. Rozzini L, "Neuropsychiatric symptoms in amnestic and nonamnestic mild cognitive impairment", Dement Geriatr Cogn Disord, 25, pp.32~36 (2008)
  12. Monastero R, "A systematic review of neuropsychiatric symptoms in mild cognitive impairment", J Alzheimers Dis, 18, pp.11~30 (2009)
  13. Chan DC, "Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the memory and medical care study", Int J Geriatr Psychiatry, 18, pp.174~182 (2003)
  14. Feldman H, "Behavioral symptoms in mild cognitive impairment", Neurology, 62, pp.1199~1201 (2004)
  15. Robert PH, "Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer’s disease: a one-year follow-up study", Clin Neurol Neurosurg, 108, pp.733~736 (2006)
  16. Teng E, "Neuropsychiatric symptoms are associated with progression from mild cognitive impairment to Alzheimer’s disease", Dement Geriatr Cogn Disord, 24, pp.253~259 (2007)
  17. Edwards ER, "Neuropsychiatric symptoms in mild cognitive impairment: differences by subtype and progression to dementia", Int J Geriatr Psychiatry, 24, pp.716~722 (2009)
  18. Lee JH, "Development of the Korean version of the consortium to establish a registry for Alzheimer's disease assessment packet (CERAD-K):clinical and neuropsychological assessment batteries", J Gerontol B Psychol Sci Soc Sci, 57, pp.P47~P53 (2002)
  19. Jang Y, "Cross-cultural comparability of the geriatric depression scale: comparison between older Koreans and older Americans", Aging Ment Health, 5, pp.31~37 (2001)
  20. McKhann G, "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, pp.939~944 (1984)
  21. Cummings JL, "The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia", Neurology, 44, pp.2308~2314 (1994)
  22. Barcia D, "Risperidone in the treatment of psychotic, affective and behavioral symptoms associated to Alzheimer’s disease", Actas Esp Psiquiatr, 27, pp.185~190 (1999)
  23. Kaufer D, "Beyond the cholinergic hypothesis: the effect of metrifonate and other cholinesterase inhibitors on neuropsychiatric symptoms in Alzheimer’s disease", Dement Geriatr Cogn Disord, 9(Suppl 2), pp.8~14 (1998)
  24. Mahlberg R, "Effects of rivastigmine on actigraphically monitored motor activity in severe agitation related to Alzheimer’s disease: a placebo-controlled pilot study", Arch Gerontol Geriatr, 45, pp.19~26 (2007)
  25. Tariot PN, "A 5-month, randomized, placebo-controlled trial of galantamine in AD. The Galantamine USA-10 Study Group", Neurology, 54, pp.2269~2276 (2000)
  26. Cummings JL, "The Neuropsychiatric Inventory: assessing psychopathology in dementia patients", Neurology, 48(5 Suppl 6), pp.S10~S16 (1997)
  27. Chan WC, "Neuropsychiatric symptoms are associated with increased risks of progression to dementia: a 2-year prospective study of 321 Chinese older persons with mild cognitive impairment", Age Ageing, 40, pp.30~35 (2011)
  28. Amieva H, "Annual rate and predictors of conversion to dementia in subjects presenting mild cognitive impairment criteria defined according to a population-based study", Dement Geriatr Cogn Disord, 18, pp.87~93 (2004)
  29. Manly JJ, "Frequency and course of mild cognitive impairment in a multiethnic community", Ann Neurol, 63, pp.494~506 (2008)
  30. Tabert MH, "Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment", Arch Gen Psychiatry, 63, pp.916~924 (2006)
  31. Korf ES, "Medial temporal lobe atrophy on MRI predicts dementia in patients with mild cognitive impairment", Neurology, 63, pp.94~100 (2004)
  32. Hansson O, "Association between CSF biomarkers and incipient Alzheimer’s disease in patients with mild cognitive impairment: a follow-up study", Lancet Neurol, 5, pp.228~234 (2006)
  33. Devanand DP, "Combining early markers strongly predicts conversion from mild cognitive impairment to Alzheimer’s disease", Biol Psychiatry, 64, pp.871~879 (2008)
  34. Pike KE, "Beta-amyloid imaging and memory in non-demented individuals:evidence for preclinical Alzheimer’s disease", Brain, 130(Pt 11), pp.2837~2844 (2007)
  35. Klunk WE, "Imaging brain amyloid in Alzheimer’s disease with Pittsburgh compound-B", Ann Neurol, 55, pp.306~319 (2004)
  36. Fiandaca MS, "The critical need for defining preclinical biomarkers in Alzheimer’s disease", Alzheimers Dement, 10(3 Suppl), pp.S196~S212 (2014)
  37. Peters ME, "Neuropsychiatric symptoms as risk factors for progression from CIND to dementia: the cache county study", Am J Geriatr Psychiatry, 21, pp.1116~1124 (2013)
  38. Modrego PJ, "Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study", Arch Neurol, 61, pp.1290~1293 (2004)
  39. 곽용태, "알츠하이머병에서 망상", Dementia and Neurocognitive Disorders(대한치매학회지), 13(3), pp.63~73 (2014), 대한치매학회[DOI]
  40. Peters ME, "Neuropsychiatric symptoms as predictors of progression to severe Alzheimer’s dementia and death: the cache county dementia progression study", Am J Psychiatry, 172, pp.460~465 (2015)
  41. Palmer K, "Predictors of progression from mild cognitive impairment to Alzheimer disease", Neurology, 68, pp.1596~1602 (2007)
  42. 황보람, "경도인지장애 및 알쯔하이머형 치매 환자에서의 신경정신증상", 정신신체의학, 20(2), pp.105~111 (2012), 한국정신신체의학회
  43. Geda YE, "Mild cognitive impairment in older adults", Curr Psychiatry Rep, 14, pp.320~327 (2012)
  44. Laws KR, "Sex differences in cognitive impairment in Alzheimer’s disease", World J Psychiatry, 6, pp.54~65 (2016)
  45. Gabelli G, "Gender diff erences in cognitive decline and Alzheimer’s disease", Ital J Gender-Specific Med, 1, pp.21~28 (2015)
  46. 최선형, "알쯔하이머형 치매환자의 Optimized VBM: 뇌 회색질 감소와 임상척도와의 연관성", 대한영상의학회지, 53(5), pp.323~329 (2005), 대한영상의학회

관련 논문AI추천

기억상실성 경도인지장애 환자의 신경정신 증상김도관, 안인숙대한신경정신의학회 · 신경정신의학2009 · 제48권 제4호치매 진행 정도에 따른 조기발현과 지연발현 알츠하이머병 환자의 행동심리증상 비교김은주, 윤여주, 홍창희대한치매학회 · Dementia and Neurocognitive Disorders(대한치매학회지)2014 · 제13권 제4호Predictors of Change in Behavioral Psychological Symptoms of Dementia in Patients With Alzheimer’s Disease in Korea김민숙, 정재균대한노인정신의학회 · 노인정신의학2021 · 제25권 제2호알츠하이머 치매 환자에서의 병식과 신경정신행동과의 연관성 : A Clinical Research Center for Dementia of South Korea (CREDOS) Study강효신, 김도관, 김상윤, 김성윤, 나덕렬, 명우재, 송지혜, 윤혜연, 이재홍, 최성혜, 최준배, 한설희대한신경정신의학회 · 신경정신의학2013 · 제52권 제1호Clinical Characteristics of Behavioral and Psychological Symptoms in Patients with Drug-naïve Alzheimer’s Disease곽순구, 곽용태, 양영순대한치매학회 · Dementia and Neurocognitive Disorders(대한치매학회지)2012 · 제11권 제3호알츠하이머 치매와 경도인지장애에서 우울증상의 유병률과 특징김민혁, 김윤아, 노현진, 박기창대한노인정신의학회 · 노인정신의학2013 · 제17권 제2호

이 간행물의 다른 논문 (5건)

정신건강의학과에 내원한 노인들의 심리적 특성 : Minnesota Multiphasic Personality Inventory-2의 군집분석을 중심으로육설아, 백정미, 한상우pp. 1-7배우자 지지와 갈등이 노년기 우울에 미치는 영향과 그 성차김호영, 고명진pp. 8-16치매환자 조호자를 위한 교육지지프로그램의 효과성에 관한 비교연구조성진, 윤선경, 연병길, 윤혜진, 김병규, 강재명, 송흡pp. 17-27노인성 우울증 환자에서 지역사회 기반 ‘목표달성 프로그램’의 효용성 : 예비 연구강규하, 임기영, 노현웅, 장기중, 정영기, 노재성, 이은희, 손상준, 한진주, 홍창형, 임현국pp. 35-40급성 일산화탄소 중독 후 발생된 지연성 뇌병증의 치료 증례이선희, 주진형pp. 41-45
원문 보기