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경도인지장애와 알츠하이머병 치매의 생물학적 표지자로서뇌파와 사건유발전위의 임상적 의미

Clinical Implications of EEG and ERP as Biological Markers for Alzheimer’s Disease and Mild Cognitive Impairment

이승환|김현택|김창규
대한생물정신의학회 (The Korean Society Of Biological Psychiatry)|2013.11|생물정신의학 (Journal of Korean Society of Biological Psychiatry)|제20권 제4호|pp. 119-128

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참고문헌

키워드

Mild cognitive impairment경도인지장애Alzheimer’s diseaseEEG알츠하이머병ERP뇌파사건유발전위조기발견Early detection.
주제분류정신과학

초록

알츠하이머병(Alzheimer’s Disease)은 65세 이상의 노인들에게 가장 흔한 신경퇴행성 질환이다.1) 현재 전 세계적으로 약 24만 명이 치매를 앓고 있으며 그 중 과반수 이상이(약 60%) 알츠하이머병으로 인한 치매이다.2) 우리나라의 65세 이상 노인 중 치매환자는 약 8.5%(약 42만 명 추정)으로 20년마다 치매 환자수가 2배씩 증가하고 있다. 또한 전체 치매 중 알츠하이머병 치매가 71%를 차지하고 있으며 2027년에는 치매 노인이 100만 명을 넘을 것으로 예상하고 있다. 알츠하이머병의 임상증상은 정신적 증상, 행동적 변화, 그리고 점진적인 인지적 저하와 일상생활 활동의 감소이다.3) 알츠하이머병 환자는 기억력을 비롯한 여러 인지기능들이 수년에 걸쳐 점진적으로 감퇴되며 이로 인한 일상생활능력의 저하를 수반한다. 알츠하이머병의 근본 원인은 아직 잘 밝혀지지 않았으나 유전적 요인들이 관련된다.4) 최근에는 알츠하이머병의 임상 증상들이 명확히 발현되기 이전부터 진행되고 있는 뇌의 생물학적 변화를 다양한 방법을 사용하여 측정하고 이 병을 조기 진단하는 방법을 찾기 위해 많은 연구들이 행해지고 있다. 경도인지장애(minimal cognitive impairment, 이하 MCI)는 어느 정도 인지기능장애가 있으나 치매로 진단하기에는 충분치 않은 상태를 의미하는 진단명이다. 경도인지장애는 1990년대 중반 이후 널리 알려졌으며5) 인지기능의 연속선상에서볼 때, 정상 노화 과정으로 나타나는 기억력 손상을 넘어, 장차 치매로 진단될 만한 기억력의 감퇴를 보이는 단계를 지칭한다. 또한 경도인지장애는 기억력을 비롯한 여러 인지기능의감퇴를 보이지만 일상생활능력은 어느 정도 유지되고 있는 상태를 일컫는다. 최근 연구들에 의하면 경도인지장애환자들중 일부는 수년 내에 알츠하이머병으로 발전할 위험성이 높은것으로 알려져 있다.5)6) 65세 이상의 정상노인 중 1~2%는 알츠하이머병으로 발병하나 경도인지장애환자 중 알츠하이머병치매로 발병하는 환자는 연간 10~15% 정도이다. 그러나 경도인지장애 환자 중 일부는 점진적인 퇴행을 보이지 않고 치매로발병하지도 않으며 심지어 시간이 경과함에 따라 인지기능의향상을 보이는 경우도 있다.7)Pertersen 등7)의 분류에 따르면, 경도인지 장애에는 크게 기억력의 장애를 보이는 기억성 경도인지장애 환자(amnestic MCI)와 기억력의 장애를 보이지 않지만 다른 인지 기능에는장애를 보이는 비 기억성 경도인지장애(non-amnestic MCI)로 나눌 수 있다. 한편, 알츠하이머병 치매 초기에 나타나는 주요 임상 증상은 내측 측두엽 영역(medial temporal area)과 해마(hippocampus) 및 주변부의 손상에 따른 일화성 기억(episodic memory)의 감퇴이며, 따라서 기억성 경도인지장애 환자가 알츠하이머병 치매로 진전될 확률이 상대적으로 높은것으로 알려져 왔다.8)9) 또한 비 기억성 경도인지 장애 환자의경우 알츠하이머병 치매가 아닌 다른 원인으로 유발된 치매의이전 단계일 가능성도 있다는 연구 결과들도 존재한다.10) 따라서 여러 경도 인지장애 환자 중에서 알츠하이머병으로 발병하는 환자들을 조기에 추적할 수 있는 민감한 표지자(marker)를 찾아내는 연구가 매우 필요하다.11) 이번 고찰에서는 뇌파(electroencephalograpgy, 이하 EEG)를 이용한 치매연구를리뷰하고 뇌파가 경도인지장애와 알츠하이머병 치매의 진단에 도움이 될 수 있는 지를 알아보고자 한다. 특히 안정 뇌파및 사건유발전위(event related potential, 이하 ERP)를 이용한 연구들을 중점적으로 살펴보고자 한다.

Abstract

Objectives: Memory impairment is a very important mental health issue for elderly and adults. Mild cognitive impairment (MCI) is a prodromal stage of Alzheimer’s disease (AD). Early detection of the prodromal stage of patients with AD is an important topic of interest for both mental health clinicians and policy makers. Methods: Electroencephalograpgy (EEG) has been used as a possible biological marker for patients with MCI, and AD. In this review, we will summarize the clinical implications of EEG and ERP as a biological marker for AD and MCI. Results: EEG power density, functional coupling, spectral coherence, synchronization, and connectivity were analyzed and proved their clinical efficacy in patients with the prodromal stage of AD. Serial studies on late event-related potentials (ERPs) were also conducted in MCI patients as well as healthy elders. Even though these EEG and ERP studies have some limitations for their design and method, their clinical implications are increasing rapidly. Conclusion: EEG and ERP can be used as biological markers of AD and MCI. Also they can be used as useful tools for early detection of AD and MCI patients. They are useful and sensitive research tools for AD and MCI patients. However, some problems remain to be solved until they can be practical measures in clinical setting.

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