Journal of Digital Convergence (디지털융복합연구)

The Society of Digital Policy and Management (한국디지털정책학회)
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A Comparative Study of Changes in Cognitive Function, Depression and Activities of Daily Living in Patients with Dementia, Mild Cognitive Impairment and Ischemic Stroke

치매, 경도인지장애, 허혈성 뇌졸중 환자에서 인지기능, 우울 및 일상생활수행능력의 변화 비교

  • Jung, Mi-Sook (College of Nursing, Chungnam National University) ;
  • Oh, Eun-Young (Department of Nursing, Catholic kkottongnae University) ;
  • Cha, Kyeong-In (College of Nursing, Chungnam National University)
  • 정미숙 (충남대학교 간호대학) ;
  • 오은영 (가톨릭꽃동네대학교 간호학과) ;
  • 차경인 (충남대학교 간호대학)
  • Received : 2021.12.14
  • Accepted : 2022.03.20
  • Published : 2022.03.28
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Abstract

This study aimed to compare changes in cognitive function, depression and ability to perform activity of daily living (ADL) in patients with dementia, mild cognitive impairment (MCI), and ischemic stroke (IS) and to identify factors associated with changes in instrumental ADL. A total of 86 patients (dementia=30, MCI=32, and IS=24) were included to analyse cognitive function, depression, and basic and instrumental ADL obtained at the time of diagnosis and 1 year after baseline. Repeated measures analysis of variance and multiple linear regression were used. A significant group by time interaction was found in executive function (p=.037) and instrumental ADL (p=.023) across groups. The MCI group has little change in executive function and instrumental ADL from the baseline to 1 year after diagnosis while other two groups showed changes with the dementia group showing declines and the group of IS having improvement in these factors over time. Changes in executive function(p=.030) and basic ADL (p<.001) explained 26.9% in the variance of changes in instrumental ADL. These findings showed a different changing pattern in executive function during the first year after diagnosis of dementia, MCI, and IS which have cognitive changes as their main symptoms, probably leading to a different changing pattern in instrumental ADL. Healthcare professionals should routinely assess for executive function and instrumental ADL problems and intervene to maintain and improve these functional outcomes immediately after disease.

본 연구의 목적은 치매, 경도인지장애, 허혈성 뇌졸중 환자의 인지기능, 우울과 일상생활수행능력의 변화를 비교하고 도구적 일상생활수행능력의 변화를 설명하는 요인을 확인하기 위함이다. 총 86명(치매=30명, 경도인지장애=32명, 허혈성 뇌졸중=24명)으로부터 진단 시점과 1년 뒤에 인지기능, 우울, 기본적 및 도구적 일상생활수행능력 자료를 수집하여 분석하였다. 반복측정분산분석과 다중회귀분석을 이용하였다. 집행기능(p=.037)과 도구적 일상생활수행능력(p=.023)에서 측정 시점에 따른 집단 간 교호작용이 유의한 것으로 확인되었다. 경도인지장애 집단은 진단 후 1년 동안 집행기능과 도구적 일상생활수행능력의 변화가 거의 없었으나, 시간이 지남에 따라 치매 집단에서는 감소하는 양상이 나타났고 허혈성 뇌졸중 집단에서는 향상되는 양상을 나타냈다. 또한, 집행기능이 저하될수록(p=.030), 기본적 일상생활수행능력이 저하될수록(p<.001) 도구적 일상생활수행능력도 저하되는 것으로 확인되었으며 설명력은 26.9%였다. 이러한 결과는 인지변화를 주요 증상으로 가지는 치매, 경도인지장애, 허혈성 뇌졸중 환자에서 진단 후 1년까지 질병의 초기 단계에 각기 다른 집행기능 변화 양상이 나타났으며, 이로 인해 도구적 일상생활수행능력 변화 양상이 다른 것으로 보인다. 보건의료전문가는 진단 직후부터 집행기능과 도구적 일상생활수행능력 문제를 정기적으로 평가하고 이와 관련된 기능 상태를 유지 및 증진하기 위한 중재를 제공해야 할 것이다.

Keywords

References

  1. P. S. Sachdev et al. (2014). Classifying neurocognitive disorders: the DSM-5 approach. Nature Reviews Neurology, 10(11), 634-642. DOI : 10.1038/nrneurol.2014.181
  2. National Institute of Dementia. (2019). Korean Dementia observatory, 2019 [Internet] Seoul: National Institute of Dementia; 2019 [cited 2020 April 1]. Available from: https://www.nid.or.kr/info/dataroom_view.aspx?bid=209
  3. S. Ballesteros, J. Mayas, & J. M. Reales. (2013). Cognitive function in normal aging and in older adults with mild cognitive impairment. Psicothema, 25(1), 18-24. DOI : 10.7334/psicothema2012.181
  4. H S. Oh, W. S. Seo, H. Y. Cho, M. O. Kim, M. R. Kim, & J. A. Mo. (2008). Recovery state of hemorrhagic stroke patients: Exploratory comparison of recovery state between spontaneous intracerebral hemorrhage (s-ICH) and spontaneous subarachnoid hemorrhage (s-SAH). Korean Journal of Adult Nursing, 20(4), 600-612.
  5. Statistics Korea. (2021). Number of stroke patients (by sex, age, and month) [Internet] Seoul: Author; 2021 [cited 2021 January 29]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=411&tblId=DT_41104_222
  6. J. Y. Kim, H. J. Bae,& J. M. Park. (2018). Stroke statistics in Korea 2018. Public Health Weekly Report, 12(43), 1845-1860.
  7. J. J. Manly, M. X. Tang, N. Schupf, Y. Stern, J.P. G. Vonsattel, & R. Mayeux. (2008). Frequency and course of mild cognitive impairment in a multiethnic community. Annals of Neurology, 63(4), 494-506. DOI : 10.1002/ana.21326
  8. J. H. Sun, L. Tan, & J. T. Yu. (2014). Post-stroke cognitive impairment: Epidemiology, mechanisms and management. Annals of Translational Medicine, 2(8), 1-16. DOI : 10.3978/j.issn.2305-5839.2014.08.05
  9. K. H. Yu et al. (2013). Cognitive impairment evaluated with vascular cognitive impairment harmonization standards in a multicenter prospective stroke cohort in Korea. Stroke, 44(3), 786-788. DOI : 10.1161/STROKEAHA.112.668343
  10. J. C. Millan-Calenti et al. (2010). Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Archives of Gerontology and Geriatrics, 50(3), 306-310. https://doi.org/10.1016/j.archger.2009.04.017
  11. F. Poncet, B. Swaine, E. Dutil, M. Chevignard, & P. Pradat-Diehl. (2017). How do assessments of activities of daily living address executive functions: A scoping review. Neuropsychological Rehabilitation, 27(5), 618-666. DOI : 10.1080/09602011.2016.1268171
  12. P. H. Lee, T. T. Yeh, H. Y. Yen, W. L. Hsu, V. J. Y. Chiu, & S. C. Lee. (2021). Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging. Scientific Reports, 11(1), 1-9. DOI : 10.1038/s41598-021-91838-4
  13. C. Blomgren et al. (2017). Long-term performance of instrumental activities of daily living (IADL) in young and middle-aged stroke survivors: Results from SAHLSIS outcome. Scandinavian Journal of Occupational Therapy, 25(2), 119-126. DOI : 10.1080/11038128.2017.1329343
  14. A. Ghaffari, H. R. Rostami, & M. Akbarfahimi. (2021). Predictors of Instrumental Activities of Daily Living performance in patients with stroke. Occupational Therapy International, 1-7. DOI : 10.1155/2021/6675680
  15. T. Tabira et al. (2020). Age-related changes in instrumental and basic activities of daily living impairment in older adults with very mild Alzheimer's disease. Dementia and Geriatric Cognitive Disorders Extra, 10(1), 27-37. DOI : 10.1159/000506281
  16. P. J. Brown, X. Liu, J. R. Sneed, M. A. Pimontel, D. P. Devanand, & S. P. Roose. (2013). Speed of processing and depression affect function in older adults with mild cognitive impairment. The American Journal of Geriatric Psychiatry, 21(7), 675-684. DOI : 10.1016/j.jagp.2013.01.005
  17. J. J. de Paula et al. (2015). Specific cognitive functions and depressive symptoms as predictors of activities of daily living in older adults with heterogeneous cognitive backgrounds. Frontiers in Aging Neuroscience, 7, 139. DOI : 10.3389/fnagi.2015.00139
  18. D. A. Cahn-Weiner et al. (2007). Cognitive and neuroimaging predictors of instrumental activities of daily living. Journal of the International Neuropsychological Society, 13(5), 747-757. DOI : 10.1017/s1355617707070853
  19. L. Monaci, & R. G. Morris. (2011). Neuropsychological screening performance and the association with activities of daily living and instrumental activities of daily living in dementia: Baseline and 18- to 24-month follow-up. International Journal of Geriatric Psychiatry. 27(2), 197-204. DOI : 10.1002/gps.2709
  20. G. A. Marshall, D. M. Rentz, M. T. Frey, J. J. Locascio, K. A. Johnson, R. A. Sperling, & Alzheimer's Disease Neuroimaging Initiative. (2011). Executive function and instrumental activities of daily living in mild cognitive impairment and Alzheimer's disease. Alzheimer's & Dementia, 7(3), 300-308. DOI : 10.1016/j.jalz.2010.04.005
  21. A. J. Braaten, T. D. Parsons, R. McCue, A. Sellers, &W. J. Burns. (2006). Neurocognitive differential diagnosis of dementing diseases: Alzheimer's dementia, vascular dementia, frontotemporal dementia, and major depressive disorder. International Journal of Neuroscience. 116(11), 1271-1293. DOI : 10.1080/00207450600920928
  22. Y. S. Kim. (2021). A comparative study of cognitive function in the elderly with no cognitive impairment, mild cognitive impairment, and severe cognitive impairment. The Society for Cognitive Enhancement and Intervention, 12(1), 127-144. DOI : 10.21197/jcei.12.1.6
  23. Y. W. Kang, & D. L. Na. (2003). Seoul neuropsychological screening battery (SNSB). Incheon: Human Brain Research & Consulting Co.
  24. C. Collin, D. T. Wade, S. Davies, & V. Horne. (1998). The barthel ADL Index: A reliability study. International Disability Studies, 10(2), 61-63. DOI : 10.3109/09638288809164103
  25. S. J. Kang, S. H. Choi, B. H. Lee, J. C. Kwon, D. L. Na, & S. H. Han. (2002). The reliability and validity of the Korean Instrumental Activities of Daily Living (K-IADL). Journal of the Korean Neurological Association, 20(1), 8-14.
  26. I. K. Jung, D. I. Kwak, D. K. Shin, M. S. Lee, H. S. Lee, & J. Y. Kim. (1997). A reliability and validity study of geriatric depression scale, The Korean Journal of Neuropsychiatric Association, 36(1), 103-112.
  27. S. R. Chamberlain et al. (2011). Differential cognitive deterioration in dementia: A two year longitudinal study. Journal of Alzheimer's Disease, 24(1), 125-136. DOI : 10.3233/JAD-2010-100450
  28. K. W. Park et al. (2012). Cognitive profiles and subtypes of patients with mild cognitive impairment: data from a clinical follow-up study. International Journal of Clinical Medicine. 3(05), 352-360. DOI : 10.4236/ijcm.2012.35068
  29. V. K. Srikanth, S. J. Quinn, G. A. Donnan, M. M. Saling, & A. G. Thrift. (2006). Long-term cognitive transitions, rates of cognitive change, and predictors of incident dementia in a population-based first-ever stroke cohort. Stroke, 37(10), 2479-2483. DOI : 10.1161/01.str.0000239666.46828.d7
  30. J. Nathan, D. Wilkinson, S. Stammers, J. L. Low. (2001). The role of tests of frontal executive function in the detection of mild dementia. International Journal of Geriatric Psychiatry, 16, 18-26. DOI : 10.1002/1099-1166(200101)16:1<18::aid-gps265>3.0.co;2-w
  31. M. D. Lezak, D. B. Howieson, E. D. Bigler, & D. Tranel, (2012). Neuropsychological assessment (5th ed). New York: Oxford University Press.
  32. M. Abe et al. (2004). Normative data on tests for frontal lobe functions: Trail making test, verbal fluency, wisconsin card sorting test (Keio version). Brain and Nerve, 56(7), 567-574.
  33. J. D. Henry, & J. R. Crawford. (2004). A meta-analytic review of verbal fluency performance following focal cortical lesions. Neuropsychology, 18(2), 284-295. DOI : 10.1037/0894-4105.18.2.284
  34. M. S. Lee, & B. S. Kim. (2019). Characteristics of word fluency in healthy aging and Alzheimer's disease. Audiology and Speech Research, 15(2), 135-143. DOI : 10.21848/asr.2019.15.2.135
  35. B. Wollesen, A. Wildbredt, K. S. van Schooten, M. L. Lim, & K. Delbaere. (2020). The effects of cognitive-motor training interventions on executive functions in older people: A systematic review and meta-analysis. European Review of Aging and Physical Activity, 17(9), 1-22. DOI : 10.1186/s11556-020-00240-y
  36. J. K. Lee. (2015). Cognitive rehabilitation of dementia. Brain & Neuro Rehabilitation. 8(1), 29-33. DOI : 10.12786/bn.2015.8.1.29
  37. L. Monaci, & R. G. Morris. (2011). Neuropsychological screening performance and the association with activities of daily living and instrumental activities of daily living in dementia: Baseline and 18- to 24-month follow-up. International Journal of Geriatric Psychiatry, 27(2), 197-204. DOI : 10.1002/gps.2709
  38. K. Peres et al. (2008). Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: A prospective population-based study. Journal of the American Geriatrics Society, 56(1), 37-44. DOI : 10.1111/j.1532-5415.2007.01499.x
  39. S. J. Park, S. H. Park, Y. H. Park, J. I. Shin, J. H. Park, & Y. A. Yang. (2009). The perceived discomfort in the instrumental daily activities(IADL) of stroke. The Journal of Korean Aging Health Friendly Policy Association, 1(1), 21-29.
  40. A. Martyr, & L. Clare. (2012). Executive function and activities of daily living in Alzheimer's disease: A correlational meta-analysis. Dementia and Geriatric Cognitive Disorders, 33, 189-203. DOI : 10.1159/000338233
  41. E. Y. Oh. (2020). Effectiveness of early cognitive training and tailored telephone coaching program for ischemic stroke. Journal of Digital Convergence, 18(3), 195-205. DOI : 10.14400/JDC.2020.18.3.195
  42. K. A. Go, & Y. E. Kim. (2018). A study on the effectiveness of cognitive activity integration program designed for the aged with mild dementia. Journal of Digital Convergence, 16(2), 431-440. DOI : 10.14400/JDC.2018.16.2.431