뇌자기공명영상의 노화에 따른 변화
A Review of Brain Magnetic Resonance Imaging Correlates of Successful Cognitive Aging
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참고문헌
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초록
급격한 의료 기술과 생명과학의 발달로 인한 수명의 증가 및 출생률의 감소의 영향으로, 우리나라 사회는 급격히 고령화 사회로 진행하고 있다. 우리나라의 고령화 사회 진행 속도는 매우 빠르며, 이미 2010년에 65세 이상 고령 인구가 11.0%에 이르렀고 2030년에는 24.3%, 2060년에는 40.1%에 이를 것으로 추정하고 있다. 특히, 2020년까지는 65세의 고령 인구수의 증가가 연평균 4%대 이상을 상회할 것으로 추정하고 있다. 이러한 급속한 고령화 사회로의 진입은 필연적으로 노인질환의 증가를 유발하며, 특히 퇴행성 뇌질환인 치매 등에 대한 연구 및 치료 방법 개발에 많은 집중적인 투자가 필요한 것이 현실이다. 알츠하이머(Alzheimer) 치매 등의 퇴행성 뇌질환은 조기 발견 및 조기 치료가 효과적이며, 일차적으로 예방을 하는 것이 매우 중요하기 때문에, 노화에 따른 질환을 동반하지 않으며 기능적, 신체적, 정신사회적 측면에서 건강한 상태를 일컫는 성공적인 노화(successful brain aging)와 퇴행성 뇌질환의 뇌 변화를 초기에 구분할 필요성이 높아지고 있다. 성공적인 노화, 즉 건강한 노화에 따른 뇌의 변화는 기능적, 구조적, 인지적 측면에서 다양하게 보고되고 있는데, 구조적 관점에서 건강한 뇌의 노화에 대한 변화를 관찰하는 것이 실제 임상 현장이나 연구 분야에서 보다 용이하게 뇌의노화를 관찰할 수 있으며, 지속적으로 노화 현상을 추적할수 있는 장점이 있다. 이러한 퇴행성 뇌질환의 뇌 구조의 변화뿐만 아니라, 신약의 개발과 치료 기술의 발전으로 인하여,임상적으로 퇴행성 질환이 아닌, 신경발달학적 질환으로 여기고 있는 조현병, 조울병 등의 환자들이 정상적인 사회 생활을 하면서 퇴행성 노화 과정을 겪는 경우가 빈번해지고 있다. 이러한 연구와 평가를 위한 정상적인 뇌 노화의 변화를관찰하는 것이 중요해지고 있다. 이러한 구조적인 뇌의 변화를 관찰할 수 있는 뇌영상 도구중에서 자기공명영상(magnetic resonance imaging, 이하 MRI)이 가장 대표적인 뇌영상 도구이며, 임상 및 연구에서 쉽게 이용할 있는 도구이다. 뇌자기공명영상(brain MRI)은 촬영 기술 및 분석 방법에 있어서 계속적으로 발전하고 있으며, 노화에 따른 뇌의 구조적 변화뿐만 아니라, 이전까지 알기 어려웠던 미세한 뇌의 백질과 회백질 등의 미세한 변화를 관찰할수 있도록 해주어, 임상가들에게 많은 정보를 제공하고 있다. 본 논문에서는 뇌자기공명영상에서 관찰할 수 있는 백질과회백질의 구조적 변화, 양성자 분광법(proton spectroscopy),현성확산계수(apparent diffusion coefficient, 이하 ADC),확산텐서영상(diffusion tensor imaging, 이하 DTI), 기능적자기공명영상(function MRI, 이하 fMRI)에서 관찰되는 정상적인 노화에 따른 뇌의 변화 및 남녀 성별에 따른 차이 등에대하여 최근까지 보고된 연구결과들을 정리하여, 정상 뇌 노화의 MRI 소견을 논의하고자 한다.
Abstract
Normal aging causes changes in the brain volume, connection, function and cognition. The brain changes with increases in age and difference of gender varies at all levels. Studies about normal brain aging using various brain magnetic resonance imaging (MRI) variables such as gray and white matter structural imaging, proton spectroscopy, apparent diffusion coefficient, diffusion tensor imaging and functional MRI are reviewed. Total volume of brain increases after birth but decreases after 9 years old. During adulthood, total volume of brain is relatively stable. After 35 years old, brain shrinks gradually. The changes of gray and white matters by aging show different features. N-acetylaspartate decreases or remains unchanged but choline, creatine and myo-inositol increase with aging. Apparent diffusion coefficient decreases till 20 years old and then becomes stable during adulthood and increase after 60 years old. Diffusion tensor properties in white matter tissue are variable during aging. Resting-state functional connectivity decreases after middle age. Structural and functional brain changes with normal aging are important for studying various psychiatric diseases such as dementia, schizophrenia and bipolar disorder. Our review may be helpful for studying longitudinal changes of these diseases and successful aging.
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