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1 Journal of Movement Disorders ORIGINAL ARTICLE Journal of Movement Disorders Vol. 1, No. 1, April 2008 Received November 13, 2007 Accepted April 3, 2008 파킨슨병환자에서보이는인지기능저하의양상과설문지를통한병식에관한연구 고려대학교의과대학신경과학교실, 성균관대학교의과대학신경과학교실 a 신희영 a 이원용 a 박건우 The Characteristics of Cognitive Impairment in Parkinson s Disease and Recognition of Cognitive Symptom by Questionnaire Hee Young Shin, MD a, Won Yong Lee, MD, PhD a, Kun-Woo Park, MD Department of Neurology, Korea University College of Medicine, Seoul, Korea a Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea Objective: Parkinson s disease (PD) is characterized by m otor and non-m otor sym ptoms including cognitive, autonomic, sleep, and sensory disturbances. Cognitive impairment may occur in up to 80% of PD patients, and dementia in approximately 30%. The purpose of this study is to evaluate the frequency of cognitive impairment and the characteristics of cognitive deficits and to know the possibility of early detection of cognitive deficits in outpatient clinics with the questionnaire for patients and caregivers. Methods: A total of 129 consecutive patients with idiopathic Parkinson s disease were visited movement clinic from March 2006 to August Eighty-five patients performed cognitive test and questionnaires. All patients had motor sym ptoms with Hoehn and Yahr stage 0.5 to 3 (mean: 1.98±0.617), and evaluated with cognition by K-MMSE (Korean version of Mini-mental status examination), (7-minutes screen test), and demographic features. Results: The frequency of cognitive impairment in PD patients was 44.7% (38/85), among them thirty (78.9%) patients complained memory disturbance. The characteristics of cognitive test were retrieval defect in memory, visuospatial dysfunction and categorical word fluency. W ith questionnaire, the complaint of m em ory decline and difficulties in activity of daily living (ADL) were important points of cognitive deficit in PD patients. However questionnaire did not showed significant correlation between complain of memory decline and cognitive deficit, only regular check with cognitive function test revealed the patient s early cognitive im pairm ent. Conclusions: The cognitive im pairm ent was frequent in PD patients. The characteristics of cognitive testing were retrieval defect in memory function and frontal executive dysfunction. Journal of Movement Disorders 1(1):38-46, 2008 Key Words: Parkinson s disease, Cognitive im pairm ent, K-M M SE, 7-M S, Questionnaire 서론 파킨슨병은명확한발병원인이없이천천히진행되는퇴행성질환으로서, 안정떨림, 경축, 운동완만등의운동장애 가대표적인주증상으로알려져있으나, 자율신경계이상과감각신경계장애, 그리고치매를포함한다양한정도의인지기능장애도관찰된다. 1,2 파킨슨병환자에서보이는인지장애의증상은운동증상 Address for correspondence: Kun-W oo Park, MD Department of Neurology, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, , Korea Tel: , Fax: , kunu@korea.ac.kr 38

2 The Characteristics of Cognitive Impairment in Parkinson s Disease and Recognition of Cognitive Symptom by Questionnaire Hee Young Shin, et al. 이나타난후수년의시간이지난후에나타나며, 이는파킨슨병의병태생리에관여하는도파민과아세틸콜린의부족에의한것으로생각되고있다. 3,4 이러한인지장애는약 80% 정도의파킨슨환자에서나타나며, 대략 30% 에서치매로진행하는것으로알려져있다. 5,6 파킨슨병환자에서 3년혹은 5 년이내에치매가발생할확률이정상노인에비하여 5-6배정도높은것으로보고되었고, 파킨슨병의진행에따라높은빈도로치매증상을나타내는것으로알려져있다. 6,7 파킨슨병치매의전형적인양상은피질하치매양상과집행장애증후군이다. 즉, 주의집중력장애, 사고과정의완만, 정신운동지체, 경한기억력장애, 그리고시공간능력장애등이특징적으로나타난다. 8 또한치매증상을보이지않는파킨슨병환자의경우에도신경심리검사상언어유창성의저하와시공간능력, 집행기능저하등의소견이관찰된다는연구가있다. 9 이러한치매증상의발현은발병당시의연령, 운동증상의심한정도, 언어증상, 우울증, 환시증상등여러가지요인에영향을받는것으로알려져있다. 11,12 현재외래에서사용하는인지기능검사인 K-MMSE (Korean version of Mini-mental status examination) 와 (7-minutes screen test) 검사는이전의연구를통하여그유용성과검사상의용이성이이미입증되어있으며, 치매증상을보이는알츠하이머병을비롯한여러퇴행성질환에서사용되고있다. 13,14 본연구에서는이러한파킨슨병의진행에따른인지장애의빈도와외래에서사용하는간편한인지기능검사 (K-MMSE, ) 를이용하여알츠하이머치매에서사용하는 K-MMSE 24점이하의기준이파킨슨병치매에서도동일하게적용할수있는지알아보고, 검사상나타나는특성과위험요인에대하여알아보고자한다. 또한환자와보호자에게설문지를통하여인지장애에대한병식유무에따른다른증상과의연관성에대하여조사해보고자하였다. 대상과방법 1. 연구대상 본연구는 2006년 3월에서 2006년 8월까지고려대학교안암병원과안산병원신경과외래를내원하여특발성파킨슨병 (idiopathic Parkinson s disease) 으로진단받고경과관찰중인환자를대상으로하였다. 특발성파킨슨병은 NINDS diagnostic criteria of Parkinson disease에의해진단기준 에적합한환자로선정하였다. 15 비정형파킨슨증후군 ( 혈관성파킨슨병, 다기관위축증, 진행성핵상마비, 루이체병등 ), 이차적원인 ( 약물, 독성물질, 내과적질환등 ) 에의한파킨슨병, modified Hoehn and Yahr staging 4 이상에해당하는환자, 다른심각한정신질환이나주요우울증, 기타심각한신경과적질환 ( 간질, 뇌졸중등 ) 또는과거뇌손상의병력이있는환자는제외하였다. 특발성파킨슨병환자중에서 Hoehn and Yahr stage 정도의운동증상을보이고, 신경심리검사에협조가가능한환자를대상으로하였다. 이기간동안특발성파킨슨병으로외래를방문한환자는모두 129명이었고, 이중연구에참여한환자는모두 85명이었다. 환자의평균나이는 67.71±8.39( 범위 45~84) 세이고, 남자 33명과여자 52명이연구에참여하였다. 대상환자의 Hoehn and Yahr stage 0.5~3에해당하였고평균 1.98± 0.617이며, 유병기간은평균 5.32±2.84( 범위 : 2~15) 년이며, 파킨슨병의운동증상이발생한연령은평균 62.38±9.39 ( 범위 : 37~80) 세이었다. 환자의교육연수는평균 6.65±4.7 ( 범위 : 0~16) 년이었다. 2. 연구방법환자에게설문지를이용하여인지기능저하의인식여부, 기억장애, 이름대기장애, 시공간장애, 일상생활수행, 우울증, 불안장애의 7가지항목에대하여조사하였고, 환자와 1달이상함께생활한보호자를통하여환자의인지기능저하여부에대하여기억장애, 이름대기장애, 시공간장애, 성격변화, 일상생활수행장애의 5가지항목에대하여조사하였다. 연구에참여한보호자는모두 42명이었으며, 설문지시행전에환자와보호자에게연구의목적과방법에대하여설명하였다. 모든환자를대상으로기본적인인구통계학적인정보 ( 성별, 연령, 교육정도등 ), 특발성파킨슨병의증상발생시기와발병기간, Hoehn and Yahr stage와사용하고있는 L-dopa 용량에관하여조사하였으며, 인지기능의정도를알기위하여 K-MMSE 와 를시행하여인지장애특성을조사하였다. K-MMSE는 Folstein 등이 1975년에제안한것 10 을 1997년강연욱등이한국어판으로개정하였고, 후향적연구에서점수가 24점이하인경우알츠하이머치매에대한선별검사로그유용성이입증되어사용되고있다. 13 또한본연구에서는환자의 K-MMSE 점수에대한나이와학력에대한영향을보정하기위하여, 최근한국에서조사된정상인의 K-MMSE 39

3 Journal of Movement Disorders Vol. 1, No. 1, 2008 점수와비교하여 10% 미만의환자들을인지기능저하로정의하여양군으로나누어비교하였다 통계적분석인지기능저하를보인군과그렇지않은군간의인구통계학적요소, 인지검사와설문지에서나타난이상소견에대하여 Mann-Whitney U test 또는 student t-test를적용하여집단간차이를비교하였다. 연구결과의분석은통계처리프로그램인 SPSS version 10.0을이용하였으며, 통계학적유의수준의부여는 p-value<0.05 인경우로하였다. 결과 1. K-MMSE 점수에의한군간의비교 모든환자를대상으로 K-MMSE 검사를시행하였으며, 그 평균은 24.65±4.67( 범위 : 5~30, 총점 30점 ) 이었고, 24점이하인군은 38명이었고, 25점이상인군은 47명이었다. K- MMSE 24점이하와 25점이상의두군을나누어비교하였을때 K-MMSE 24점이하인군에서운동증상의발병연령이더높았고, 유병기간은더짧은것으로나타났다 (Table 1). Hoehn and Yahr stage에서도유의한차이를보여 K-MMSE 점수가낮은군에서운동증상이더심한소견을보였다. L-dopa 치료는 K-MMSE 25점이상인군에서 40명 (88.9%), 24점이하인군에서 36명 (90.0%) 에서시행되었고, L-dopa 용량은양군간에유의한차이를보이지않았다. 검사의세부항목에서는 K-MMSE 24점이하인군에서무조건회상에서낮은점수를보였으나조건을준후에호전되는형태를보였고, 시공간능력인시계그리기와언어유창성검사에서양군간에유의한차이를보여, 전두엽기능저하소견이관찰되었다. 환자에게시행한설문지에서인지기능저하에대한인식여부는양군에서유의한차이를보여, K-MMSE 24점이하인군에서환자스스로증상을더많이 Table 1. The comparisons between higher K-MMSE group and lower K-MMSE group about demographic characteristics, cognitive test (K-MMSE, subscale), insight and complaints of symptom for patients and caregiver by questionnaire Number of patients K-MMSE 27.8± ±4.54 Age 65.53± ± a Gender (male/female) 23/22 9/ a Onset age of motor sx 59.47± ± a Symptom duration 6.04± ± a Hoehn & Yahr stage 1.86± ± a Educational level (years) 8.43± ±4.25 <0.01 a Dosage of L-dopa (mg/day) 462.5± ± Free recall 6.64± ± a Enhanced cued recall 9.02± ± Clock drawing 6.47± ±2.43 <0.01 a Word fluency 13.56± ±3.98 <0.01 a Questionnaire by patients Insight of cognitive deficit 31 (66.7%) 28 (75%) a Memory deficit 0.36± ±1.21 <0.01 a Naming difficulty 36 (77.8%) 27 (72.5%) Visuospatial dysfunction 29 (62.2%) 25 (67.5%) Dependent ADL 1.33± ± a Depression Anxiety 37 (80%) 22 (46.7%) 33 (87.5%) 24 (65%) Questionnaire by caregiver Memory deficit 1.67± ± Naming difficulty 6 (40%) 14 (51.8%) Visuospatial dysfunction 2 (13.3%) 5 (18.5%) Personality change 9 (60%) 9 (33.3%) Dependent ADL 2.27± ± group A; higher K-MMSE group (MMSE 25), group B; lower K-MMSE group (MMSE 24), a p-value<

4 The Characteristics of Cognitive Impairment in Parkinson s Disease and Recognition of Cognitive Symptom by Questionnaire Hee Young Shin, et al. 호소하는것으로나타났고, 각세부항목을살펴보면기억장애에대한 5가지항목과일상생활수행장애에서유의한차이를보였다. 보호자설문의세부항목에따른유의한차이는 관찰되지않았다. 환자의 K-MMSE 점수에대한나이와학력에대한영향을보정하여최근한국에서조사된정상인의 K-MMSE 점수와 Table 2. The comparisons between cognitive impairment and non-impairment groups adjusted by age and the level of education (N=78) demographic characteristics, disease severity and cognitive test (K-MMSE, subscale) Number of patients K-MMSE 19.53± ±3.17 Age 71.71± ± a Gender (male/female) 5/12 25/ Onset age of motor sx 66.76± ± a Symptom duration 4.47± ± Hoehn & Yahr stage 2.32± ± Dosage of L-dopa (mg/day) ± ± Free recall 4.0± ± Enhanced cued recall 7.47± ± Clock drawing 3.65± ± Word fluency 7.94± ± group A; patients with cognitive impairment, group B; patients without impairment, a p-value<0.05. Table 3. The comparisons between with and without cognitive deficit complaint groups about demographic characteristics, cognitive test (K-MMSE, subscale), insight and complaints of symptom for patients and caregiver by questionnaire Number of patients K-MMSE (50%) 8 (32%) K-MMSE 24.0± ± a Age 69.48± ± a Gender (male/female) 22/38 11/ Onset age of motor sx 64.45± ± a Symptom duration 5.02± ± Hoehn & Yahr stage 2.06± ± Educational level (years) 6.55± ± Dosage of L-dopa (mg/day) ± ± Free recall 5.43± ± a Enhanced cued recall 8.48± ± Clock drawing 4.97± ± Word fluency 11.18± ± Questionnaire by patients Memory deficit 0.95± ± Naming difficulty 48 (80%) 16 (64%) Visuospatial dysfunction 43 (71.7%) 12 (48%) Dependent ADL 1.85± ± a Depression 54 (90%) 17 (68%) a Anxiety 35 (58.3%) 12 (48%) Questionnaire by caregiver 36 6 Memory deficit 1.69± ± Naming difficulty 19 (52.8%) 1 (16.7%) Visuospatial dysfunction 6 (16.7%) 1 (16.7%) Personality change 16 (44.4%) 2 (33.3%) Dependent ADL 2.03± ± group A; patients with cognitive deficit complaint, group B; patients without complaint, a p-value<

5 Journal of Movement Disorders Vol. 1, No. 1, 2008 비교하여 10% 미만의환자들을인지기능저하로정의하여양군으로나누어비교하였다. 학력을알지못하는 7명의환자는제외하였고, 결과는표 2에나타나있으며, 이결과로미루어파킨슨병환자에서인지기능의저하는약 21.8% 에서나타난다고할수있다. 환자의나이와운동증상의발생연령이인지기능저하를보인환자에서높게나타났다. 2. 인지기능저하를호소한군과그렇지않은군간의비교환자에게실시한설문지의결과를토대로인지기능저하증상을호소한군과그렇지않은군으로나누어비교했을때 인지기능저하를호소한군은 60명이며이중실제 MMSE상 24점이하를보인환자는 30명 (50%) 이었고, 인지기능저하를호소하지않은군은 25명이며이중 MMSE상 24점이하를보인환자는 8명 (32%) 이었다 (Table 3). 양군에서평균나이와운동증상의발병연령이인지기능저하를호소하는군에서유의하게높았다. 검사의세부항목에서인지기능저하를호소한군에서무조건회상에서낮은점수가조건회상에서호전되는양상을보여피질하치매의소견이관찰되었다. 환자에서시행한설문에서일상생활수행능력과우울증상에서유의한차이를보였고, 보호자설문에서는양군간에유의한차이는없었다. 인지기능저하를호소한 60명의환자를 K-MMSE 24점 Table 4. The comparisons between higher K-MMSE and lower K-MMSE groups with cognitive deficit complaint patients (N=60) about demographic characteristics and cognitive test (K-MMSE, subscale) Number of patients K-MMSE 27.57± ±4.99 Age 67.4± ± Gender (male/female) 15/15 7/ a Onset age of motor sx 61.77± ± a symptom duration 5.6± ± Hoehn & Yahr stage 1.88± ± Educational level (years) 8.23± ± Dosage of L-dopa (mg/day) ± ± Free recall 6.57± ± Enhanced cued recall 8.8± ± Clock drawing 6.33± ±2.51 <0.01 a Word fluency 13.8± ±3.66 <0.01 a group A; higher K-MMSE group (MMSE 25), group B; lower K-MMSE group (MMSE 24), a p-value<0.05. Table 5. The comparisons between higher K-MMSE and lower K-MMSE groups without cognitive deficit complaint patients (N=25) about demographic characteristics and cognitive test (K-MMSE, subscale) Number of patients 17 8 K-MMSE 27.88± ± Age 61.65± ± Gender (male/female) 9/8 2/ Onset age of motor sx 54.82± ± Symptom duration 6.71± ± a Hoehn & Yahr stage 1.82± ± Educational level (years) 8.06± ± Dosage of L-dopa (mg/day) 420.6± ± Free recall 7.0± ± Enhanced cued recall 9.29± ± Clock drawing 6.76± ± Word fluency 13.06± ± group A; higher K-MMSE group (MMSE 25), group B; lower K-MMSE group (MMSE 24), a p-value<

6 The Characteristics of Cognitive Impairment in Parkinson s Disease and Recognition of Cognitive Symptom by Questionnaire Hee Young Shin, et al. 이하와 25점이상의군으로나누어서, 비교해본결과 K- MMSE 24점이하인군에서여성이많았고, 운동증상의발병연령이유의하게높았다 (Table 4). 검사세부항목중에서는시계그리기와언어유창성검사에서유의한차이를보였다. 인지기능저하를호소하지않은환자 25명을 K-MMSE 24점이하와 25점이상의두군을나누어특성을비교했을때증상을호소하지않았으나 24점이하로점수가낮은환자는 8명 (32%) 이었고, 증상을호소하지만 25점이상인군과비교했을때유병기간이오히려더짧은소견을보인것외에는유의한차이는보이지않았고, 검사상에서도양군간에차이는없었다 (Table 5). 고찰 본연구를통하여파킨슨병환자들에게나타나는인지기능저하는적지않은빈도 44.7% (38/85) 로나타나며, 환자스스로인지기능저하를호소하는경우와호소하지않는경우모두에서실제검사상나타나는이상소견은 50% (30/60) 와 32% (8/25) 로나타났다. 이는외래에서간단한질문이나설문지를통해서알아보는데는한계가있음을알수있었다. 이두군에서모두인지기능검사상파킨슨병치매에서보이는전두엽기능저하와인출기능이상의기억력장애등의일부특성을보였다. 인지기능의이상을호소한환자와하지않은환자군은 상무조건회상에서유의한차이가있었으나, 단순히 MMSE만을비교한수치에서는무조건회상에서유의한차이가없었다. 이는환자의주관적호소가단순한 MMSE 보다파킨슨치매를검사하는데더유용한단서가될수있다는소견이라할수있다. 이전의연구에서파킨슨병에서인지장애가나타날수있는위험인자로제시한여러가지요소에대하여알아보고자하였으며, 본연구에서는고령, 여성, 운동증상의발병연령이높은경우와낮은교육수준그리고 Hoehn and Yahr stage 등에서차이를보였고, 유병기간은오히려더짧게나타났다. 하지만 K-MMSE 점수를연령과학력에대한인자를보정하였을경우고령과운동증상의발병연령이높은경우에서만유의한차이를보였다 (Table 2). 이러한결과는이전의여러연구에서나타난결과와유사하다고할수있으며, 11,12 이외에도무동성경직증후군, 우울증동반여부, 흡연및레보도파와연관된혼돈이나정신병증상등을위험인자로제 시하였다. 유병기간에대하여는노령에서발생한경우외래경과관찰기간이짧을수있으므로이에대한고려가필요할것으로생각된다. 이러한파킨슨병에서나타나는인지기능의저하는일반적으로콜린성장애에의한것으로알려져있으며, 이는뇌피질, 특히전두엽의콜린성활성의저하와마이너트기저핵의신 19, 20 경세포소실과밀접한관련이있다는연구결과가있다. 이러한결과를토대로파킨슨병에서나타나는치매의치료제로아세틸콜리분해효소억제재를사용하는시도가시작되었고, 최근발표된연구에서아세틸콜린분해효소억제재를치료제로사용하여파킨슨병의인지장애와행동장애를호전시켰다고보고하였다. 19,20 따라서파킨슨병환자에서인지장애에대한보다적극적인조기탐색이중요하다고하겠다. 본연구의단점은연구에참여한환자의수가적었다는점과정상노인과의비교를통하여파킨슨병환자중초기에나타나는인지기능저하에서나타나는증상의호소와인지기능검사상의이상소견에대한비교가부족했던점이다. 또한자세한신경심리검사를통하여인지기능저하에대하여비교함으로본연구에서제시한 K-MMSE 와 의유용성에대한비교연구가필요하며, 또한기계적인인지검사에의지하기보다운동장애환자에게적극적으로인지기능의이상여부를묻는자세가치매를조기발견하는데도움이될것으로생각된다. REFERENCES 1. Morris RG, Downes JJ, Sahakian BJ, Evenden JL, Heald A, Robbins TW. Planning and spatial working memory in parkinson s disease. J Neurol Neurosurg Psychiatry 1988;51: Robbins TW, James M, Owen AM, Lange KW, Lees AJ, Leigh PN, et al. Cognitive deficits in progressive supranuclear palsy, parkinson s disease, and multiple system atrophy in tests sensitive to frontal lobe dysfunction. J Neurol Neurosurg Psychiatry 1994;57: Hurtig HI, Trojanowski JQ, Galvin J, Ewbank D, Schmidt ML, Lee VM, et al. Alpha-synuclein cortical lewy bodies correlate with dementia in parkinson s disease. Neurology 2000;54: Apaydin H, Ahlskog JE, Parisi JE, Boeve BF, Dickson DW. Parkinson disease neuropathology: Later-developing dementia and loss of the levodopa response. Arch Neurol 2002;59: Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh- Sorensen P. Prevalence and characteristics of dementia in parkinson disease: An 8-year prospective study. Arch Neurol 2003;60:

7 Journal of Movement Disorders Vol. 1, No. 1, Emre M. Dementia associated with parkinson s disease. Lancet Neurol 2003;2: Aarsland D, Andersen K, Larsen JP, Lolk A, Nielsen H, Kragh-Sorensen P. Risk of dementia in parkinson s disease: A community-based, prospective study. Neurology 2001; 56: Green J, McDonald WM, Vitek JL, Evatt M, Freeman A, Haber M, et al. Cognitive impairments in advanced pd without dementia. Neurology 2002;59: Peran P, Rascol O, Demonet JF, Celsis P, Nespoulous JL, Dubois B, et al. Deficit of verb generation in nondemented patients with parkinson s disease. Mov Disord 2003;18: Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12: Mayeux R, Denaro J, Hemenegildo N, Marder K, Tang MX, Cote LJ, et al. A population-based investigation of parkinson s disease with and without dementia. Relationship to age and gender. Arch Neurol 1992;49: Aarsland D, Tandberg E, Larsen JP, Cummings JL. Frequency of dementia in parkinson disease. Arch Neurol 1996;53: Kang YW, Na DL, Hahn SH. The validity strudy on the Korean mini-mental state examination (K-MMSE) in dementia patients. J Korean Neurol Assoc 1997;15: Park MS, Lee JU, Yang JH, Cho BL, Yang DW, Kim SY. Standardization of korean version of 7-minute screen test. J Korean Neurol Assoc 2002;20: Gelb DJ, Oliver E, Gilman S. Diagnostic criteria for parkinson disease. Arch Neurol 1999;56: Han C, Jo SA, Jo I, Kim E, Park MH, Kang Y. An adaptation of the Korean mini-mental state examination (K-MMSE) in elderly Koreans: Demographic influence and population-based norms (the age study). Arch Gerontol Geriatr 2007 Oct Burn DJ, McKeith IG. Current treatment of dementia with lewy bodies and dementia associated with parkinson s disease. Mov Disord 2003;18:S Dubois B, Pilon B, Lhermitte F, Agid Y. Cholinergic deficiency and frontal dysfunction in parkinson s disease. Ann Neurol 1990;28: Aarsland D, Laake K, Larsen JP, Janvin C. Donepezil for cognitive impairment in parkinson s disease: A randomised controlled study. J Neurol Neurosurg Psychiatry 2002; 72: Reading PJ, Luce AK, McKeith IG. Rivastigmine in the treatment of parkinsonian psychosis and cognitive impairment: Preliminary findings from an open trial. Mov Disord 2001;16:

8 The Characteristics of Cognitive Impairment in Parkinson s Disease and Recognition of Cognitive Symptom by Questionnaire Hee Young Shin, et al. 부록 1 설문지 ( 환자대상 ) 질문예아니오 1. 기억력이떨어졌다고생각하십니까? 2. 오늘날짜를기억할수있습니까? 3. 지난 1 주일간있었던일을기억할수있습니까? 4. 지난 3 달간가족모임이나결혼식, 여행다녀오신사실을기억할수있습니까? 5. 고향이어디인지, 어느학교를나왔는지대답할수있습니까? 6. 집전화번호나직장전화번호를기억하십니까? 7. 다른사람과대화할때어려움을느낀다. 8. 물건이름이나사람이름이잘생각나지않을때가있다. 9. 혼자외출한후집에찾아갈수있다. 10. 물건을둔곳이잘기억나지않을때가있다. 11. 목욕하고, 옷입기를혼자서할수있습니까? 12. 이전에하던집안일이나취미생활을계속하고있습니까? 13. 이전에만나던친구들모임이나종교모임에계속참여하고있습니까? 14. 물건을사고돈계산하는것에어려움을느낀다. 15. 통장관리를직접하고있습니까? 16. 요즈음들어활동량이나의욕이많이떨어지셨습니까? 17. 생활이지루하게느껴질때가많습니까? 18. 자신에게불길한일이닥칠것같아불안하십니까? 19. 바깥에나가기가싫고집에만있고싶습니까? 20. 비슷한나이의다른노인들보다기억력이더나쁘다고느끼십니까? * Composition of questionnaire Insight of cognitive deficit (2) Memory deficit (5) Naming difficulty (2) Visuospatial dysfunction (2) Difficulty in activities of daily living (5) Depressive symptom (2) Anxiety symptom (2) 45

9 Journal of Movement Disorders Vol. 1, No. 1, 2008 부록 2 설문지 ( 보호자대상 ) 질문예아니오 1. 오늘이몇월이고, 무슨요일인지를잘모른다. 2. 자기가놔둔물건을찾지못한다. 3. 같은질문을반복해서한다. 4. 약속을하고서잊어버린다. 5. 물건을가지러갔다가잊어버리고그냥온다. 6. 물건이나, 사람의이름을대기가힘들어머뭇거린다. 7. 대화중내용이이해되지않아반복해서물어본다. 8. 길을잃거나헤맨적이있다. 9. 예전에비해서계산능력이떨어졌다. ( 예 : 물건값이나거스름돈계산을못한다.) 10. 예전에비해성격이변했다. 11. 이전에잘다루던기구의사용이서툴러졌다. ( 세탁기, 전기밥솥, 가스레인지 ) 12. 예전에비해방이나집안의정리정돈을하지못한다. 13. 상황에맞게스스로옷을선택하여입지못한다. 14. 혼자대중교통을이용하여목적지에가기힘들다. 15. 내복이나옷이더러워져도갈아입지않으려고한다. * Composition of questionnaire Memory deficit (5) Naming difficulty (2) Visuospatial dysfunction (1) Personality change (1) Difficulty in activities of daily living (6) 46

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