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1 Original Article Korean J Health Promot 2014;14(1):26-32 pissn: eissn: 주간 high-speed 탄력밴드운동이경도인지장애고령여성의인지능력, 신체수행능력과근력에미치는영향 강동헌, 김희재, 윤동현, 김진수, 송욱 서울대학교건강운동과학실 Effects of 12 Weeks High-Speed Elastic Band Training on Cognitive Function, Physical Performance and Muscle Strength in Older Women with Mild Cognitive Impairment: A Randomized Controlled Trial Dongheon Kang, Heejae Kim, Donghyun Yoon, Jinsoo Kim, Wook Song Health and Exercise Science Laboratory, Institute of Sports Science, Institute on Aging, Seoul National University, Seoul, Korea Background: Exercise has shown to slow down the progression from mild cognitive impairment (MCI) to dementia. In particular, not only resistance exercise has been verified to improve physical performance and muscle strength, leading to the prevention of fall-related injuries in the frail elderly, but also cognitive function. In this study, we investigated how high-speed elastic band training, applied using a high-speed power training protocol, affects cognition, physical performance and muscle strength of female elderly individuals with MCI. Methods: Thirty-nine subjects diagnosed with MCI from one senior college using a Korean version of mini-mental state examination (MMSE-K) and a Korean version of the Montreal Cognitive Assessment (MoCA-K) were randomly divided into exercise group (n=20) and control group (n=19). The exercise group completed a 12-week high-speed resistance elastic band exercise program and was encouraged to exercise at home as well during the intervention period. Results: The results showed significant increases in cognitive function, physical performance and muscle strength assessed by digit span forward test (P<0.001), digit span backward test (P=0.003), the Stroop test B (P=0.031), SPPB scores (P=0.010), right knee 60 extensor peak torque (P=0.004), 60 flexor peak torque (P=0.001), 180 extensor peak torque (P=0.020) and grip strength (P=0.025) Conclusions: Our study showed that participants with MCI who continued the high-speed elastic band training program for 12 weeks showed improvements in cognitive function, physical performance and muscle strength. Korean J Health Promot 2014;14(1):26-32 Keywords: Mild cognitive impairment, Resistance training, Cognition, Muscle strength, Aged Received:February 6, 2014 Accepted:March 14, 2014 Corresponding author:wook Song, PhD Health and Exercise Science Laboratory, Institute of Sports Science, Institute on Aging, Seoul National University, 599 Gwanak-ro, Seoul , Korea Tel: , Fax: songw3@snu.ac.kr This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by MEST 서론 경제수준의상승및의료기술의향상과복지분야의발전으로인해평균수명이연장되어노인인구가급격하게증가되고있다. 2000년, 전체인구의 7.2% 가 65세이상노인으로이미고령화사회에진입하였고, 2013년노인인구가 12.2%, 2030년에는 24.3% 에이를것으로전망되고있다. 1) 65-69세치매노인의수는약 3만 8천명

2 Dongheon Kang, et al. High-Speed Band Exercise Effect in Older Women with MCI 27 으로추정되며, 연령이증가함에따라치매발병률또한계속증가하고있다. 2) 이와같이치매인구가늘어나면서치매환자 1명을돌보는데연 564만원을지출하고있는것으로보고되었으며, 국가전체로는연간 2조 3천 8백억원정도가소요되는것으로추산되고있고, 앞으로경제활동인구가감당하는경제적부담이증가하고있다. 3) 이러한사회경제적부담에도불구하고치매로진단된이후저하된인지기능을정상수준으로회복시킬수있는치료법은아직알려져있지않으며, 치매의위험요인을최대한이른시점에서진단하고그에맞는적절한개입을통해사전에예방하여치매의경과속도를저하시키는방법만이현실적으로시행가능한대응책이라볼수있다. 4) 치매환자수가증가하면서경도인지장애 (mild cognitive impairment) 에대한사회적관심이증가하고있다. 5) 경도인지장애는인지기능이나이와교육수준에비해떨어져있으나전반적인일상생활에는지장이없는상태를의미하며, 정상적인인지기능을가진단계와치매초기단계의경계이다. 5) 경도인지장애의구체적진단기준은 (1) 주관적인기억력저하, (2) 정상적인일상생활수행, (3) 전반적인인지기능의보존, (4) 객관적인기억력손상그리고치매가아닌경우이다. 5) Petersen 등 6) 에따르면, 3 년이내에정상노인의 2-6% 가치매로진단받는반면경도인지장애를가진노인의 12-50% 가 3년이내에치매로진단받는다고보고하였다. 따라서경도인지장애의조기발견과적절한치료는치매예방에매우중요하다. 경도인지장애에서치매로의진행을늦추기위한다양한중재방법들이보고되고있으나, 7) 그중운동중재프로그램은치매위험인자를줄이고인지기능을자극하는데효과적이라고보고되었다. 8) 뿐만아니라 Gates 등 8) 의연구에의하면운동은인지기능을향상시킨다고보고하고있으며, 특히, 저항성운동은근력, 근지구력의향상을통한낙상방지, 신체수행능력향상뿐만아니라인지기능향상등의효과들이검증되면서점차저항성운동과경도인지장애를가진노인에관련한연구가활발히진행되고있다. 9) 최근경도인지장애를가진노인을대상으로한연구에서기존의연구들과달리유산소운동보다저항성운동이인지기능향상에더효과적이라는연구결과가보고되었으며, 10) Boyle 등 11) 에의하면경도인지장애또는치매로의발전가능성은근력과부적관계를나타난다고보고하였다. 기존방법의저항성운동은노인들의최대근력의 50-80% 범위의무게를권장하지만, 12) 최근에알려진근파워트레이닝은근력뿐만아니라근파워및기능적능력을향상시킨다고보고되어있다. 13) 근파워는일상생활에서계단을오르거나길을건너는등노인뿐만아니라일반인에게도영향을미치는요소로서근파워의저하는노인의삶의질에영향을미치며, 파워를증가시키기위해서는근육의빠른단축성수축을요하는운동을수행해야된다고보고되었다. 14,15) Pereira 등 16) 에따르면, 근파워를이용한 high-speed 파워트레이닝은빠른단축성수축에중점을둔트레이닝으로, muscle concentric 과 eccentric contraction의비율을모든운동범위에 2:1로설정하여단축성운동속도를증가시켜실시하는방법이며, 단축성수축 (concentric contraction) 단계에서최대한빨리수축을한뒤정점에서 1초간정지, 신장성수축 (eccentric contraction) 을 2초간실시하는프로토콜을사용하였다. Sayers 와 Gibson 13) 에의하면, 1 repetition maximum (RM) 40% 에서 1 RM 90% 까지무게의양이무거워질수록근수축속도는줄어드는기존저항성운동과는달리, 파워 ( 힘 속도 ) 를적용할경우, 1 RM 40% 에해당하는낮은무게를빠른속도로단축성수축을실시하는것과 1 RM 90% 에해당하는무거운무게를상대적으로낮은속도로단축성수축을실시하는것의근파워값이유의하게나타난다고보고하였다. 이러한결과로볼때, 낮은무게를빠른속도로단축성수축을실시하는 high-speed 파워트레이닝이높은저항성운동에비해노인에게적합한운동이라고보고하였다. 13) 하지만, 저항성운동시운동방법으로머신과덤벨등을이용한기구사용은부상을초래할수있으나탄력밴드는비용성, 편의성, 휴대성의장점을가지고있다. 17) 탄력밴드를이용한저항성운동은근력증가, 균형, 유연성, 보행의향상뿐만아니라근육을최대한활성화시키고다양한각도에서동작을실시하여도운동시주어지는충격이최소화되는것이장점이라고보고하였다. 18) 이를근거로본연구에서는 high-speed 파워트레이닝의프로토콜을적용한 high-speed 탄력밴드운동이경도인지장애를가진고령여성노인에게인지능력, 신체수행능력, 근력에미치는효과를검증하고자한다. 1. 연구대상 방 법 본연구의대상은서울시 Y구소재 Y노인대학에재학중인 65세이상으로의학적으로특별한질환이없고평소운동습관이없는피험자 50명을모집하였으며, 이중인지기능을평가한결과 Korean version of Mini-Mental State Examination (MMSE-K, 20 MMSE-K<24), 19) Korean version of the Montreal Cognitive Assessment (MoCA-K,

3 28 Korean J Health Promot Vol. 14, No. 1, 2014 <23) 20,21) 기준에부합되는총 39명의경도인지장애를가진피험자를선별하여무작위로운동군 (n=20) 과대조군 (n=19) 으로분류하여연구를진행하였다. 중도포기한피험자를제외한총 21명 ( 운동군 14명, 대조군 7명 ) 이연구에참여하였다. 본연구에참여한피험자들에게사전모임에서연구목적과내용을충분히설명하였고, 연구참여동의서에서명을한후실험에참여하도록하였다 (SNUIRB No.1305/ ). 를기록하였다. 2 스트룹검사 (Stroop test) 스트룹검사는 2개의과제로구성되어있다. 첫번째과제는집행기능을측정할수있으며, 1분동안표안의색을보고답안에표시하는과제이다. 23) 두번째과제는집중력을측정할수있으며, 1분동안글자가나타내는색이아닌실제글자의색을고르는과제이다. 23) 본연구에는피험자가검사를실시한 1분동안정반응수를기록하였다. 2. 실험절차 1) 신체조성측정피험자들의신체조성은생체전기저항측정법 (Inbody 370, Biospace, Seoul, Korea) 을이용하여키, 몸무게, 골격근량, 체지방율, 체질량지수를측정하였다. 2) 운동프로그램본운동프로그램은밴드운동시단축성수축 (concentric contraction) 단계에서최대한빨리, 중지 1초, 신장성수축 (eccentric contraction) 단계에서는 2초로하는프로토콜 13) 을이용하였으며, 점진성의원리를적용하여 1개월마다운동의강도를점진적으로증가시켜 high-speed 탄력밴드운동프로그램을진행하였다. 밴드색의강도는녹색 (Hygenic Corporation, USA), 주관적운동강도 (RPE) 는 12-13으로설정하였다. 운동군은미국스포츠의학회 (ACSM) 22) 의권고사항에따라준비운동 (10분), 본운동 (40분), 정리운동 (10분) 을포함하여 1회당 60분실시하였으며, 주 2회 high-speed 탄력밴드운동과주 3회 home- based 운동을총 12주간진행하였다. 대조군은 12주간주 1회스트레칭을실시하였다. 3) 인지능력검사 1 숫자외우기검사 (digit span test) 이검사는서울신경심리검사 (Seoul Neuropsychological Screening Battery에포함된숫자외우기검사를사용하였다. 23) 숫자외우기검사는바로따라외우기 (digit span forward) 와거꾸로따라외우기 (digit span backward) 로두가지유형이있다. 숫자바로따라외우기는주의집중능력을측정할수있으며, 숫자거꾸로따라외우기는작업기억 (working memory) 을측정할수있다. 24) 검사수행시, 피험자는검사자가 1초간격으로불러주는숫자들을바로따라또는거꾸로따라외워서말을하도록하였다. 제시되는숫자들은바로따라외우기에서 3자리부터 9 자리까지, 거꾸로따라외우기에서 2자리부터 8자리까지로구성되어있다. 본연구에는피험자가최대로외운수 4) 신체수행능력검사 1 Short physical performance battery (SPPB) SPPB는노인들의하지기능을평가하는신체수행능력검사이다. 25) 균형감각, 보행속도, 의자에서 5회반복일어나기 3가지항목으로구성되어있으며, 각과제마다수행불능 0점, 수행차이에따라 1점에서 4점까지점수를부여해각과제당 4점씩모두성공했을경우 12점만점으로기록하였다. 2 Timed up and go test (TUG) TUG는동적균형및이동능력을측정하는검사 26) 로팔걸이가있는의자에앉아시작신호와함께일어서서 3 m 전방목표물을돌아다시의자에앉는시간을측정하였다. 5) 근력검사 1 하지근력검사하지근력검사는등속성측정장비 (Humac Norm, USA) 를이용하여하지근력을측정하였다. 피험자를측정의자에앉게한후슬관절의중심점이등속성기기의회전축과일치하도록테이블과등받이를이용하여조정한뒤대퇴부위와가슴부위를고정하여근력을최대한발휘하도록하였으며, 각속도 60 /sec ( 근력 ), 180 /sec ( 근지구력 ) 을측정하였다. 2 상지근력검사악력검사는상지의근력을측정하는대표적인방법이다. 27) 피험자는차렷자세로선다음팔을곧게펴고악력계 (Takei, Japan) 을이용하여시작신호와함께좌, 우 2번씩측정을하여평균값을기록하였다. 3. 통계분석본연구를통해얻어진모든변인들의값은 SPSS 통계프로그램 (ver 18.0) 을이용하여평균과표준편차를구하였다. 피험자를대상으로운동전 후측정변인간의평균치변화에대한유의성검증을위해 Mann-Whitney U Test 를실시하였다. 분석시유의수준은 P<0.050으로설정하여검증하였다.

4 Dongheon Kang, et al. High-Speed Band Exercise Effect in Older Women with MCI 29 Table 1. General characteristics of subjects a Variables Control group (n=7) Exercise group (n=14) P b Age, y 78.0± ± Height, cm 149.5± ± Weight, kg 51.2± ± Skeletal muscle mass, kg 17.1± ± Body fat, % 33.4± ± BMI, kg/m ± ± Waist hip ratio, % 0.9± ± MMSE-K, score 22.3± ± MoCA-K, score 18.7± ± Abbreviations: BMI, body mass index; MMSE-K, Korean version of mini mental state examination.; MoCA-K, Korean version of Montreal Cognitive Assessment. b Calculated by Mann-Whitney U test. Table 2. Effects of high-speed elastic band training on cognitive function a Variables Control group (n=7) Exercise group (n=14) Before After Before After P b DST-F 4.71± ±0.58 c 4.86± ±0.88 d <0.001 DST-B 2.00± ± ± ±0.43 d ST A 11.43± ± ± ±6.17 NS ST B 6.43± ± ± ±3.22 e Abbreviations: DST-F, digit span forward test; DST-B, digit span backward test; ST A, stroop test A; ST B, stroop test B; NS, not significant. b Main effect calculated by Mann-Whitney U test. c Significantly different compared with Before Control group assessed by Wilcoxon signed rank test, P= d Significantly different compared with Before Exercise group assessed by Wilcoxon signed rank test, P= e Significantly different compared with Before Exercise group assessed by Wilcoxon signed rank test, P= Table 3. Effects of high-speed elastic band training on physical performance test a Variables Control group (n=7) Exercise group (n=14) Before After Before After P b SPPB (score) 7.14± ± ± ±1.59 c TUG (sec) 11.48± ± ± ±1.42 d NS Abbreviations: SPPB, short physical performance battery; TUG, timed up and go test; NS, not significant. b Main effect calculated by Mann-Whitney U test. c Significantly different compared with Before Exercise group assessed by Wilcoxon signed rank test, P= d Significantly different compared with Before Exercise group assessed by Wilcoxon signed rank test, P= 결 과 2. 인지능력의변화 1. 피험자의신체적특성본연구에참여한피험자 21명의신체적특성은사전검사에서연령, 신장, 체중, 골격근량, 체지방율, BMI, WHR, MMSE-K, MoCA-K를측정하였다 (Table 1). MMSE-K 는운동군 (n=14) 에서 21.00±1.04, 대조군 (n=7) 에서 ±1.11, MoCA-K는운동군 (n=14) 에서 18.29±2.81, 대조군 (n=7) 에서 18.71±2.63으로 21명의피험자들은경도인지장애기준에만족하였다. 12주간 high-speed 탄력밴드운동전 후인지능력의변화는 Table 2에제시한바와같다. 사전 사후의주효과는숫자바로따라외우기 (P<0.001), 숫자거꾸로따라외우기 (P=0.003), 스트룹검사 B (P=0.031) 에서나타나운동중재후유의한증가를나타내었다. 숫자바로따라외우기검사와숫자거꾸로외우기검사는운동군내에서유의하게증가하였고 (P=0.001), 대조군내에서는숫자바로따라외우기검사에서유의하게감소하였다 (P=0.014). 스트룹검사 B는운동군내에서유의하게증가하였다 (P=0.007).

5 30 Korean J Health Promot Vol. 14, No. 1, 2014 Table 4. Effects of high-speed elastic band training on muscle strength a Variables Control group (n=7) Exercise group (n=14) Before After Before After P b 60 /sec (Nm) Knee extensor Peak TQ (R)/BW ± ± ± ±31.92 c Knee flexor Peak TQ (R)/BW 74.86± ±18.00 d 66.21± ± /sec (Nm) Knee extensor Peak TQ (R)/BW 29.43± ±9.80 d 28.71± ±11.45 c Knee flexor Peak TQ (R)/BW 54.43± ±9.93 d 44.14± ±15.11 e NS Grip strength 17.69± ± ± ±4.14 c Abbreviations: Nm, newton meter; TQ, torque; R, right; BW, body weight; NS, not significant. b Main effect calculated by Mann-Whitney U test. c Significantly different compared with Before Exercise group assessed by Wilcoxon signed rank test, P= d Significantly different compared with Before Control group assessed by Wilcoxon signed rank test, P= e Significantly different compared with Before Exercise group assessed by Wilcoxon signed rank test, P= 따라서 12주간의운동중재는주의집중능력, 작업기억과집중력향상에효과가있음을관찰하였다. 3. 신체수행능력의변화 12주간 high-speed 탄력밴드운동전 후신체수행능력의변화는 Table 3에제시한바와같다. 사전 사후의주효과는 SPPB (P=0.010) 에서나타났으며, 운동군내에서유의하게증가하였다 (P=0.002). 또한 TUG 는사전 사후의주효과는나타나지않았지만, 운동군내에서유의하게감소하였다 (P=0.004). 따라서 12주간의운동중재는신체수행능력향상에효과가있음을관찰하였다. 4. 근력의변화 12주간 high-speed 탄력밴드운동전 후근력변화는 Table 4에제시한바와같다. 등속성검사의결과값은모든피험자의주축다리인오른쪽을나타내었으며, peak torque 값에체중 (body weight) 을보정하였다. 사전 사후의주효과는 knee extensor peak torque 60 /sec (P=0.004), knee flexor peak torque 60 /sec (P=0.001), knee extensor peak torque 180 /sec (P=0.020) 에서나타났으며, 악력검사또한사전 사후의유의한효과를나타내었다 (P=0.025). 따라서 12주간의운동중재는근력과근지구력향상에효과가있음을관찰하였다. 고찰 본연구는정상노화와치매초기전경계사이단계로알려진경도인지장애노인을대상으로 high-speed 탄력밴드운동이인지능력, 신체수행능력, 근력에어떠한영향을주는지확인하고자하였다. 인지능력을평가하는검사로작업기억과집행기능의정도를파악할수있는숫자외우기검사와스트룹검사에서운동군이대조군에비해효과가있는것으로나타났다. 이러한인지기능의향상은규칙적인저항성운동이대뇌피질의기능적가소성과신경세포의수상돌기연결의증가, 중추신경계기능의효율성을증가시켜뇌기능을향상시킨것이주원인이라고하였다. 28) 반면, 대조군에서의인지능력감소는노화로인한뇌기능의저하가경도인지장애노인들의학습, 기억, 주의집중능력, 작업기억, 집행기능과같은인지적기능의감퇴와운동참여의저하인것으로사료된다. 최근 Nagamatsu 등 10) 은경도인지장애를가진 70-80세노인을대상으로 6개월실시한저항성운동이인지기능을향상시킬수있다고보고하였는데이는본연구의운동군에서인지능력의유의한증가는 high-speed 밴드운동이경도인지장애를가진고령노인들에게미치는운동효과를입증하였다. 인지기능이저하된고령노인들의신체수행능력저하와근력감소는낙상의위험에노출되어있으며, 9) 낙상의위험을감소시키기위해서는운동을통해근 신경기능을향상시켜일상생활활동을무리없이할수있도록해야한다. 본연구에서는균형감각, 보행속도, 앉았다일어나기를실시하는신체수행능력검사와근력검사에서운동군이유의한증가를보여, 운동이신체수행능력과근력의변화에효과를미친것으로나타났다. 이러한결과는신체수행능력과근력이향상된선행연구결과 16) 와유사하며, 본연구에서는선행연구 13) 의프로토콜을적용하여실시한 high-speed 탄력밴드운동이효과가있는것으로보인다. 또한, 밴드운동의 squat, lunge, shoulder press, core training 등의동작수행이근력강화뿐만아니라신체수행능력향상으로앉거나일어서기, 물건들어올리기, 선반에서물건내리기등과같은전반적인신체활동능력을올려줄것이라고생각된다. 이러한효과는본연구에서실시한 high-speed 탄력밴드운동이노인들

6 Dongheon Kang, et al. High-Speed Band Exercise Effect in Older Women with MCI 31 의근육과신경기능을향상시킬뿐만아니라유연성과평형조절능력을향상시켜노화에따른기능저하와근력감소에따른낙상위험요인을감소시켜줄것이라사료된다. 더불어연구에참여한운동군피험자의경우운동참여율이 93.4% 로규칙적인운동참여가연구결과에긍정적인영향을가져다주었을뿐만아니라운동참여로인해피험자의삶의질도높아졌을것이라고판단된다. 본연구의제한점은다음과같다. 첫째, 피험자들의식이및운동프로그램이외의신체활동을엄격하게제한하지못하였다. 둘째, high-speed 탄력밴드운동군의독립적인효과를비교할수있는 slow-speed 탄력밴드운동군이없다. 이러한제한점에도불구하고본연구는경도인지장애를가진고령여성을대상으로 12주간의 high-speed 탄력밴드운동을실시한결과인지능력, 신체수행능력, 근력에서유의한변화를통해운동중재의효과를확인할수있었다. 더나아가본연구는경도인지장애를가진노인에게인지능력의향상뿐만아니라신체수행능력과근력을향상시켜주는연구결과를기반으로건강한노인및치매환자에게적용할수있는특화된운동중재프로그램을개발하여건강을증진하는데긍정적인영향을미칠것으로기대한다. 추후연구에서는경도인지장애단계에서치매단계로의이환속도를지연시킬수있는치매예방운동프로그램개발에대한연구가필요하다. 요약 배경 : 저항성운동은근력의향상을통한낙상방지, 신체수행능력의향상뿐만아니라인지기능향상등의효과들이검증되면서점차저항성운동과경도인지장애를가진노인에관련한연구가활발히진행되고있다. 본연구에서는 high-speed 파워트레이닝의프로토콜을적용한 high-speed 탄력밴드운동이경도인지장애를가진고령여성노인에게인지능력, 신체수행능력, 근력에미치는효과를검증하고자한다. 방법 : 본연구는무작위대조군연구로진행하였으며, 경도인지장애를가진노인을대상으로운동군 (n=20) 과대조군 (n=19) 으로분류하였다. 운동프로그램에서실시한밴드색의강도는녹색, 주관적운동강도 (RPE) 는 으로설정하였으며, 주 2회본운동프로그램과주 3회 home-based 운동을 12주실시하였다. 결과 : 인지능력검사는숫자바로따라외우기검사 (P<0.001), 숫자거꾸로따라외우기 (P=0.003), 스트룹검사 B (P=0.031) 에서유의한증가를나타내었다. 신체수행능력검사는 SPPB 점수에서유의한증가 (P=0.010) 를보였으며, 근력검사중등속성검사에서는오른쪽무릎 60 신 근 (P=0.004), 60 굴근 (P=0.001), 180 신근 (P=0.020), 악력검사에서는유의한증가 (P=0.025) 를나타내었다. 결론 : 12주간 high-speed 탄력밴드운동은경도인지장애를가진고령여성노인의인지능력과신체수행능력, 근력이향상되는데효과가있음을확인하였다. 따라서본연구는인지능력향상을통해치매단계로의이환속도를지연시킬뿐만아니라노화와더불어발생하는근력감소와낙상, 신체수행기능감소등노쇠한노인의독립적인생활을개선할수있는연구결과를제시함으로써향후경도인지장애를가진노인에게적용할수있는특화된운동중재프로그램이될수있음을제시한다. 중심단어 : 경도인지장애, 저항성운동, 인지, 근력, 노인 REFERENCES 1. Statistics Korea. Statistics of elderly people. Daejeon:Korea Statistical information Service; [Accessed Sep 30, 2013]. bmode=read&aseq=308689&ord=3.pdf. 2. National Health Insurance Service. Korea insurance Health insurance statistics analysis source book [Accessed Feb 8, 2011]. =VIEW&communityKey=B0070&boardId= Ministry of Health and Welfare. Nationwide Study on the prevalence of Dementia in Korean Elders [Accessed Apr 16, 2009]. PAR_MENU_ID=03&MENU_ID=030502&CONT_SEQ= &FILE_SEQ= pdf. 4. Cho MJ. The prevalence and risk factors of dementia in the Korean elderly. Health-welfare Policy Forum. 2009;156(156): Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56(3): Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol 2001;58(12): Bae HJ. Treatment of mild cognitive impairment. Dement Neurocognitive Disord 2003;2(2): Gates N, Fiatarone Singh MA, Sachdev PS, Valenzuela M. The effect of exercise training on cognitive function in older adults with mild cognitive impairment: a meta-analysis of randomized controlled trials. Am J Geriatr Psychiatry 2013;21(11): Kovacs E, Sztruhar Jonasne I, Karoczi CK, Korpos A, Gondos T. Effects of a multimodal exercise program on balance, functional mobility and fall risk in older adults with cognitive impairment: a randomized controlled single-blind study. European Journal of Physical and Rehabilitation Medicine 2013;49(5): Nagamatsu LS, Handy TC, Hsu CL, Voss M, Liu-Ambrose T. Resistance training promotes cognitive and functional brain plasticity in seniors with probable mild cognitive impairment. Arch Intern Med 2012;172(8): Boyle PA, Buchman AS, Wilson RS, Leurgans SE, Bennett DA.

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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 -