결론 중심단어 서론 연구방법 1. 연구대상및지역 1166

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1 KISEP Original Articles J Korean Neuropsychiatr Assoc Vol 41, No 6 광주광역시에서치매의유병률과위험인자의 도시 - 농촌지역비교 신일선 1) 김재민 2) 윤진상 1) 김석재 3) 양수진 1) 김웅장 1) 이승현 1) 강순아 2) 곽지영 1) 이형영 1) Prevalence Rate and Risk Factors of Dementia Compared between Urban and Rural Communities of the Metropolitan Kwangju Area 국문초록 Il-Seon Shin, M.D., 1) Jae-Min Kim, M.D., 2) Jin-Sang Yoon, M.D., 1) Suk-Jae Kim, M.D., 3) Su-Jin Yang, M.D., 1) Woong-Jang Kim, M.D., 1) Seung-Hyun Lee, M.D., 1) Soon-Ah Kang, M.A., 2) Ji-Young Kwak, M.A., 1) Hyung-Yung Lee, M.D. 1) 연구목적 방법 결과 Department of Psychiatry & Research Institute of Medical Science, Chonnam National University Medical School, Gwangju Department of Psychiatry, College of Medicine, Chosun University, Gwangju Saint John of God Mental Hospital, Gwangju Corresponding author 1165

2 결론 중심단어 서론 연구방법 1. 연구대상및지역 1166

3 2. 연구방법 1) 1차선별단계 - 2) 2차임상진단단계 자료분석 1167

4 Table 1. Characteristics of total participants and univariate associations with Alzheimer s disease Variables Levels No.% of total participants N=1,134 Age, years No.PR of AD N= OR95% CI p-value a b Gender Male Female Level of education 1+years Living area Urban Rural Marital status Spouse No spouse Previous occupation Non-manual Manual Current employment Yes No Housing Owned Rented 1, Religious activity Yes No PRPrevalence rate, OROdds ratio, CIConfidence interval a by chi-square tests, b by likelihood ratio test for trend 연구결과 1. 1차및 2차조사참가자의특성 1168

5 Table 2. Multiple logistic regression for associations with Alzheimer s disease Variables Total sample N=1,134 OR95% CI Urban sample N=485 Rural sample N=649 AreaUrbanRural Aging5 year increase Female gender No education No spouse Previous manual occupation a b a b OROdds ratio, CIConfidence interval Associations are shown in bold where p0.05. a Likelihood ratio test for interaction between living area and genderp0.001 b Likelihood ratio test for interaction between living area and educationp 치매의유병률 3. AD 의위험인자 4. 치매의유병률과위험인자의거주지역에따른차이 고 찰 1169

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7 참고문헌 1) Ferini-Strambi L, Marcone A, Garancini P, Danelon F, Zamboni M, Massussi P, Tedesi B, Smirne S(1997): Dementing disorders in north Italy:prevalence study in Vescovato, Cremona Province. Eur J Epidemiol 13: ) Boersma F, Eefsting JA, van den Brink W, Koeter M, van Tilburg W(1998):Prevalence of dementia in a rural Netherlands population and the influence of DSM- III-R and CAMDEX criteria for the prevalence of mild and more severe forms. J Clin Epidemiol 51: ) Andersen K, Lolk A, Nielsen H, Andersen J, Olsen C, Kragh-Sorensen P(1997):Prevalence of very mild to severe dementia in Denmark. Acta Neurol Scand 96: ) Graham JE, Rockwood K, Beattie BL, Eastwood R, Gauthier S, Tuokko H, McDowell I(1997) : Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 21: 349: ) Obadia Y, Rotily M, Degrand-Guillaud A, Guelain J, Ceccaldi M, Severo C, Poncet M, Alperovitch A(1997): The PREMAP Study:prevalence and risk factors of dementia and clinically diagnosed Alzheimer s disease in Provence, France:Prevalence of Alzheimer s Disease in Provence. Eur J Epidemiol 13: ) Bachman DL, Wolf PA, Linn R, Knoefel JE, Cobb J, Belanger A, D Agostino RB, White LR(1992):Prevalence of dementia and probable senile dementia of the Alzheimer s type in the Framingham study. Neurology 42: ) Folstein MF, Bassett SS, Anthony JC, Romanoski AJ, Nestadt GR(1991):Dementia:Case ascertainment in a community survey. J Gerontol 46: ) Lin RT, Lai CL, Tai CT, Liu CK, Yen YY, Howng SL (1998):Prevalence and subtypes of dementia in southern Taiwan:impact of age, sex, education, and urbanization. J Neurol Sci 18:160: ) Rajkumar S, Kumar S, Thara R(1997):Prevalence of dementia in a rural setting:a report from India. Int J Geriatr Psychiatry 12: ) Liu HC, Fuh JL, Wang SJ, Liu CY, Larson EB, Lin KN, Wang HC, Chou P, Wu ZA, Lin CH, Wang PN, Teng EL(1998):Prevalence and subtypes of dementia in a rural Chinese population. Alzheimer Dis Assoc Disord 12: ) Hasegawa K, Homma A, Imai Y(1986):An epidemiological study on age-related dementia in the community. Int J Geriatr Psychiatry 1: ) Rockwood K, Stadnyk K(1994):The prevalence of dementia in the elderly:a review. Can J Psychiatry 39: ) Suh GH, Shah A(2001):A review of the epidemiological transition in dementia-cross-national comparisons of the indicies related to Alzheimer s disease and vascular dementia. Acta Psychiatr Scand 104: ) Park JH, Ko HJ, Park YN, Jung CH(1994) : Dementia among the elderly in a rural Korean community. Br J Psychiatry 164: ) 우종인, 이정희, 유근영, 홍진표, 김창엽, 김용익, 이강욱 (1997): 한국의한농촌지역에거주하는노인에서의치매의유병률. 신경정신의학 36: ) 조맹제, 함봉진, 주진형, 배재남, 권준수 (1998): 일도시지역사회노인들의인지기능장애와우울증상의유병율. 신경정신의학 37: ) 서국희, 김장규, 연병길, 박수경, 유근영, 양병국, 김용식, 조맹제 (2000) : 노년기치매와우울증의유병률및위험인자. 신경정신의학 39: ) Jorm AF, Jolley D(1998):The incidence of dementia: a meta-analysis. Neurology 51: ) Gao S, Hendrie HC, Hall KS, Hui S(1998):The re- 1171

8 lationships between age, sex, and the incidence of dementia and Alzheimer s disease. Arch Gen Psychiatry 55: ) Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R(1994):Influence of education and occupation on the incidence of Alzheimer s disease. JAMA 271: ) Farmer ME, Kittner SJ, Rae DS, Bartko JJ, Reiger DA(1995):Education and change in cognitive function. The epidemiologic catchment area study. Ann Epidemiol 5:1-7 22) Sulkava R, Wikstrom J, Aromaa A, Raitasalo R, Lehtinen V, Lahtela K, Palo J(1985):Prevalence of severe dementia in Finland. Neurology 35: ) Shibayama H, Kasahara Y, Kobayashi H(1986):Prevalence of dementia in a Japanese elderly population. Acta Psychiatr Scand 74: ) Jorm AF, Korten AE, Henderson AS(1987):The prevalence of dementia:a quantitative integration of the literature. Acta Psychiatr Scand 76: ) Rocca WA, Bonaiuto S, Lippi A, Luciani P, Turtu F, Cavarzeran F, Amaducci L(1990):Prevalence of clinically diagnosed Alzheimer s disease and other dementing disorders:a door-to-door survey in Appignano, Macerata Province, Italy. Neurology 40: ) Baker FM, Jordan B, Barclay L, Schoenberg BS(1993): Risk factors for clinically diagnosed Alzheimer s disease. Int J Geriatr Psychiatry 8: ) Prince M, Cullen M, Mann A(1994):Risk factors for Alzheimer s disease and dementia:a case-control study based on the MRC Elderly Hypertension Trial. Neurology 44: ) Park JH, Park YN, Ko HJ(1991):Modification of the Mini-Mental State Examination for use in the elderly in a non-western society:part II. Cutoff points and their diagnostic validities. Int J Geriatr Psychiatry 6: ) American Psychiatric Association(1994) :Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Washington DC, APA Press 30) 최진영 (1998): 한국판치매평가검사, 서울학지사 31) Hughes CP, Berg L, Danzier WL, Coben LA, Martin RL(1982):A new clinical scale for the staging of dementia. Br J Psychiatry 140: ) 박종한, 조성완, 손형석 (1995): 노인기능상태평가의신뢰도. 신경정신의학 34: ) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM(1984):Clinical diagnosis of Alzheimer s disease:report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Service task force on Alzheimer s disease. Neurology 34: ) For the 31 Workshop Pannels, Roman GC, Tatemichi TK, Erkinjuntii T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hoffman A (1993):Vascular dementia:diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43: ) 광주광역시 (2000): 주민등록인구통계, 광주광역시청 36) Yamada M, Sasaki H, Mimori Y, Kasagi F, Sudoh S, Ikeda J, Hosoda Y, Nakamura S, Kodama K(1999): Prevalence and risks of dementia in the Japanese population:rerf s adult health study Hiroshima subjects. Radiation Effects Research Foundation. J Am Geriatr Soc 47: ) Shiba M, Shimogaito J, Kose A, Fujiuchi S, Nishiyama H, Yoshimasu F, Asai T, Rocca WA(1999):Prevalence of dementia in the rural village of Hanazono-mura, Japan. Neuroepidemiology 18: ) Jorm A(2000):Risk factors for Alzheimer s disease. In:Dementia. 2nd ed, Ed by O Brien J, Ames D, Burns A, London, Arnold, pp ) Azzimondi G, D Alessandro R, Pandolfo G, Feruglio FS(1998):Comparative study of the prevalence of dementia in two Sicilian communities with different psychosocial backgrounds. Neuroepidemiology 17: ) Mortimer JA(1988):Do psychosocial risk factors contribute to Alzheimer s disease? In:Etiology of Dementia of Alzheimer type. Ed by Henderson AS, Henderson JH, New York, John Wiley and Sons, pp

9 ABSTRACT J Korean Neuropsychiatr Assoc Vol 41, No 6, November, 2002 Prevalence Rate and Risk Factors of Dementia Compared between Urban and Rural Communities of the Metropolitan Kwangju Area Il-Seon Shin, M.D., Jae-Min Kim, M.D., Jin-Sang Yoon, M.D., Suk-Jae Kim, M.D., Su-Jin Yang, M.D., Woong-Jang Kim, M.D., Seung-Hyun Lee, M.D., Soon-Ah Kang, M.A., Ji-Young Kwak, M.A., Hyung-Yung Lee, M.D. Department of Psychiatry & Research Institute of Medical Science, Chonnam National University Medical School, Gwangju Objectives:The purpose of this study was to investigate the prevalence rate and risk factors of dementia in an urban and a rural sample of older persons in the metropolitan Kwangju area, Republic of Korea. In addition, the prevalence rate and risk factors of dementia between the two samples were compared. Methods:A two-phase epidemiological study of residents aged 65 or over(n=1,598) was conducted in a highly developed, urban and a non-contiguous, poorly developed, rural area of metropolitan Kwangju. In the first(screening) phase, 38 trained research assistants collectively performed in-home interviews for all participants. Detailed sociodemographic characteristics were gathered and the Korean version of Mini-Mental State Examination(MMSE-K) was administered. In the second(diagnosing) phase, diagnosis of dementia was established for those scoring 24 or less on the MMSE-K in the screening phase(n=431), and etiological types of dementia were classified to Alzheimer s disease (AD), vascular dementia(vad) or miscellanous type by two teams of experts. Prevalence rate of dementia was determined in the participants, and age-standardized prevalence rate adjusted by age distribution in metropolitan Kwangju was estimated. For AD, the risk factors were investigated in all participants, and analyses were repeated for the urban and rural samples separately. Results:The participating rates in the first and second phases were 71.0%(N=1,134) and 83.2% (N=410), respectively. In the participants, the prevalence rates of dementia(all types), AD and VaD were 9.7%, 5.2% and 1.8%, respectively. The age-standardized prevalence rates were 10.7%, 5.7% and 1.9%, respectively. Aging, female gender and no education(complete lack of formal education) were identified as independent risk factors for AD. No difference between the urban and rural samples was observed in the prevalence rates of dementia(all types), AD and VaD. However, risk factors for AD differed between these areas. In the urban sample, no education was the only significant factor; whereas, aging and female gender were identified as risk factors in the rural sample. Conclusion:A high prevalence rate of dementia was observed among old persons in metropolitan Kwangju, consistent with previous studies conducted in other Korean areas. The risk factor profiles for AD differed between urban and rural settings. The results of this study reflect the current status of dementia in Korea and suggests that appropriate management and prevention strategies for dementia should be tailored toward the geographic settings. KEY WORDS:Dementia Prevalence rate Risk factor. 1173

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -