갑상선장애 환자에서 나타나는 인지기능 장애의 특징 및 관련요인
Characteristics of Cognitive Function and Related Factors in Patient with Thyroid Disorder
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목적 : 본 연구의 목적은 갑상선장애 환자에서 인지기능의 특징 및 이에 영향을 미치는 요인을 알아보기 위함이다. 방법 : 고신대학교복음병원 내분비센터내 갑상선크리닉에 내원한 98명(남자 16명, 여자 82명)의 갑상선장애 환자를 대상으로 반구조적 면담과 MoCA-K(Korean Version of the Montreal Cognitive Assessment) 및 한국어판 HDRS-17(Hamilton Depression Rating Scale-17)을 시행하여 다음의 결과를 얻었다. 결과 : 1) 인지장애가 동반된 갑상선장애 환자는 24명(24.49%) 이었다. 인지장애가 동반된 갑상선장애 환자군의 MoCA-K 총점은 18.42±3.75점으로서, 인지장애가 동반되지 않은 갑상선 장애 환자군(26.43±2.01점) 보다 유의하게 낮았다(p<0.001). 인지장애가 동반된 갑상선장애 환자에서 MoCA-K 소검사 중 지남력을 제외한 시각공간기능/집행력, 언어력, 집중력, 문장력, 추상력, 지연회상력 등의 인지영역에서 인지장애가 동반되지 않은 갑상선 장애 환자군보다 유의하게 점수가 낮았다. 2) 인지장애가 동반된 갑상선장애 환자군은 인지장애가 동반되지 않은 갑상선 장애 환자군보다 통계적으로 유의하게 연령과 갑상선장애의 초발연령이 높았고(각각 p<0.001), 교육수준과 HDL-cholesterol은 낮았다(p<0.001). 3) 갑상선장애 환자의 인지기능에 연관되는 변인으로서는 연령(ρ=-0.462, p<0.01), 교육수준(ρ=0.583, p<0.01), 갑상선장애의 초발연령(ρ=-0.494, p<0.01)이 MoCA-K 총점과 통계적으로 유의한 상관성이 있었다. 이 외에 성별, triiodothyronine, HDL-cholesterol, triglyceride가 MoCA-K 소검사 일부와 통계적으로 유의한 상관성을 보였다. 결론 : 갑상선장애 환자의 1/4 정도에서 여러 인지영역을 망라하는 인지장애가 동반되며, 특히 연령과 갑상선장애의 초발연령이 중요하게 연관되는 것으로 유추하건데, 노화에 관계된 기전이 작용할 가능성을 시사한다.
Abstract
Objectives：The aims of this study were to examine changes of cognitive function and its characteristics, and to identify influencing factors on cognitive fuction in patients with thyroid disorders. Methods：Data of 98 patients with thyroid disorders(16 males and 82 females) recruited from thyroid clinic in the Endocine Center of Kosin University Gospel Hospital were obtained by semi-structred interviews and MoCA-K(Korean Version of the Montreal Cognitive Assessment) and Korean version of the HDRS-17(Hamilton Depression Rating Scale-17). Results：1) The cognitive dysfunction was seen in 24 patients with thyroid disorders(24.49%). The total scores of the MoCA-K tests in thyroid patients with cognitive dysfunction(18.42±3.75) were significantly(p＜0.001) lower than those of controls(26.43±2.01). Their subtest scores of the MoCA-K such as visuospatial/executive, naming, attention, language, abstraction, delayed recall were also lower than those of controls. 2) The thyroid patients with MoCA-K ≤22 showed higher age and onset age of thyroid disorders, and had lower education and HDL-cholesterol(p＜0.001 respectively). 3) Total scores of the MoCA-K tests in patients with thyroid disorders had positive correlation with education(ρ=0.583, p＜0.01), and had negative correlation with age(ρ=-0.462, p＜0.01) and onset age of thyroid disorders(ρ= -0.494, p＜0.01). Otherwise, triiodothyronine and HDL-cholesterol had positive correlation, and sex and triglyceride had negative correlation with some subtest scores of the MoCA-K. Conclusions：The cognitive dysfunction accompanied in about 1/4 of patients with thyroid disorders. The finding that the cognitive function in thyroid disorders seemed to be mainly associated with age and onset age of thyroid disorders, suggested a possibility of an important role of aging mechanism.
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