한국어판 알쯔하이머병 평가 척도의 임상적 유용성
The Cognitive Subscale of Alzheimer’s Disease Assessment Scale (ADAS-Cog) for Patients with Alzheimer's Disease in Korea
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연구배경: 알쯔하이머병 평가척도(ADAS)는 치매 환자의 조기 진단과 질병 진행 단계를 민감하게 평가해 주는 종합적 인지기능 평가도구이다. 이 연구에서는 한국어판 알쯔하이머병 평가척도-인지영역 평가 도구의 타당도와 치매 진행 단계에 따른 변화를 분석하고 교육정도, 성별, 발병연령 등 관련된 요인들에 대해 알아보고자 한다. 방법: 70명의 알쯔하이머병 환자를 대상으로 ADAS-K-cog, MMSE-K, GDS, NPI-Q, SIADL을 측정하여 이들 평가 도구간 관련성 및 GDS 군별 ADASK-K-cog 총점 및 세부 항목별 점수를 비교하였다. 그리고 ADAS-K-cog 점수와 발병연령, 성별, 교육수준, 치매진행단계 사이의 관련성을 알아보았다. 결과: Pearson 상관 분석에서 ADAS-K-cog 총점은 MMSE-K 점수와 강한 음의 상관관계(r=-0.755, P<0.001)를 보였고 GDS (r=0.732, P＜0.001) 및 SIADL(r=0.700, P＜0.001) 점수와 강한 양의 상관관계를 보였다. ADAS-K-cog와 GDSS, NPI-Q, 교육수준 사이에는 유의한 관련성이 없었다. 다중회귀분석 결과에서 교육정도(P=0.150)나 성별(P=0.077), 발병연령(P=0.349)이 ADAS-K-cog 점수에 영향을 주지 않았다. ADAS-K-cog 총점은 GDS stage가 증가할수록 유의하게 증가하였고 ADAS-K-cog 검사 항목 중 언어 표현력과 단어선택장애, 언어이해력, 지남력 항목은 모든 GDS stage 사이에 통계적으로 유의한 차이를 보였다. 결론: ADAS-K-cog는 교육정도와 성별 및 발병연령에 영향을 받지 않으며 알쯔하이머병의 진행단계를 평가하는 데 유용한 도구이다. ADAS-K-cog 세부 항목 중에서는 지남력 척도, 언어 표현력, 단어선택장애, 언어이해력 항목이 알쯔하이머병 진행 정도를 민감하게 감별해 주는 것으로 생각한다.
Abstract
The Cognitive Subscale of Alzheimer’s Disease Assessment Scale (ADAS-Cog) for Patients with Alzheimer's Disease in KoreaSe Hong Kim, M.D., Hyun Kook Lim, M.D.*, Kyung Soo Kim, M.D., Ph.D, Ju Hye Chung, M.D.**† Background: This study was designed to examine the utility of the ADAS-Cog, Korean version (ADAS-K-cog) for staging of dementia in Alzheimer disease (AD). We also studied the possible influence of age, sex, and education on a ADAS-K-cog. Methods: A total of 70 patients with AD meeting the NINCDS-ADRDA criteria of probable AD were recruited. The ADAS-K-cog was administered to all AD subjects. Each patient was also rated on the Global Deterioration Scale (GDS). The probable AD patients were divided into three groups based on their GDS stage to evaluate the sensitivity of ADAS-K-cog to disease severity and their mean scores on ADAS-K-cog were compared. Results: The subjects' age range was 65∼93 years and their education range was 0∼16 years. The total score of ADAS-K-cog and each item score differed significantly between each groups. The item score of orientation, expressive language, word finding difficulty, comprehension of spoken language and the ADAS-K-cog total score could classify severity of early AD patients efficiently. ADAS-K-cog had high correlations with scores on the GDS (Pearson's r=0.732) and the Mini-Mental State Examination (Pearson's r=－0.755). Multiple regression analysis revealed that performance on the Korean ADAS- Cog was uninfluenced by age or gender, and neither by education level. It's language items were best for monitoring the progression of dementia. Conclusion: Our results indicated that the ADAS-K-cog is useful for staging of AD and uninfluenced by education level, sex and age. (J Korean Acad Fam Med 2007;28:853-859)
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