실어증 환자의 인지능력 프로파일: 체계적 고찰 및 메타분석
The Cognitive Profile of Aphasia: A Systematic Review & Meta-Analysis
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초록
실어증 환자는 언어뿐 아니라 주의력, 시지각력, 기억력, 추론력, 집행기능 등 인지능력이 저하될 수 있다. 실어증에 대한 인지적 접근은 임상적으로 중요한 의미를 지님에도 불구하고 평가 및 치료 시 이에 대한 적용이 미흡한 실정이다. 또한, 임상적으로 활용될 수 있는 인지적 수행력에 대한 체계적 고찰이나 메타분석 연구가 매우 적은 편이다. 본 연구에서는 실어증 환자의 인지적 수행력을 체계적으로 고찰하고, 메타분석을 통해 인지능력 프로파일을 제시하고자 하였다. 이를 위해 2000년대 이후의 28개 국내외 문헌을 대상으로 연구의 방법 및 내용에 대해 고찰하였고, 메타분석을 통해 인지의 하위 영역별로 효과크기를 비교하였다. 그 결과, 분석에 포함된 연구의 대상군에는 40대 이상의 성인이 포함되었으며, 인지의 하위 영역 중 기억력과 주의력에 대한 연구가 많았다. 메타분석을 통해 실어증 환자의 인지능력이 ‘중간’ 정도의 평균 효과크기를 가지며, 하위 영역 중 집행기능이 가장 큰 효과크기를 보임을 입증하였다. 이밖에, 주의력 및 추론력, 기억력 등의 순으로 유의미한 효과를 나타내었다. 본 연구는 실어증 환자의 인지적 수행력에 대한 증거 기반적 자료를 제시함으로써 인지적 접근의 필요성을 다시 한번 확인할 수 있었다. 또한, 실어증 환자의 평가 및 중재 시 인지능력 프로파일을 적용함으로써 임상적 한계를 극복하는 계기를 마련하는 데 기여하였다.
Abstract
Patients with aphasia have difficulties in cognition including attention, visuoper ception, memory, reasoning, and executive function, as well as language. Despite the clinical importance of a cognitive approach to aphasia, most aphasic interventions are guided solely by the results of language assessment. Additionally, studies by systematic review or meta-analysis were hardly performed. The purpose of this study was to review literatures on the cognitive abilities of aphasia patients systema tically, and to propose the cognitive profile of aphasia using a meta-analysis method. Twenty-eight researches published since 2000, meeting the inclusion criteria, were entered into the analysis. They were analyzed in a methodological and content level, and the effect sizes were calculated by cognitive domains. As a result, the general target population for studies was adults over the age of 40, and most sources were related to memory or attention. An average effect size of cognition in aphasics was moderate. Executive function had the most signigicant effect size. Domains like attention, reasoning, and memory were also signigicant in effect sizes. Our results provide the evidence-based information to support the necessity of a cognitive approach to aphasia. Current study also can contribute to make good use of the cognitive profile in aphasic intervention.
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