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์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์˜ ์–ธ์–ด์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ ์ˆ˜ํ–‰๋Šฅ๋ ฅ ์ฐจ์ด: ๋…ธ์ธ์„ฑ์น˜๋งค์ž„์ƒ์—ฐ๊ตฌ์„ผํ„ฐ ์—ฐ๊ตฌ

The Difference of Verbal Fluency Task Performance between Alzheimerโ€™s Disease and Subcortical Vascular Dementia: CREDOS (Clinical Research Center for Dementia of South Korea) Study

Yisuh Ahn, PhDa, Jong Hun Kim, MD, PhDa,b, Seong Hye Choi, MD, PhDc, Jee Hyang Jeong, MD, PhDd, Bon D. Ku, MD, PhDe, Yong S. Shim, MD, PhDf, Hae Ri Na, MD, PhDg, Jun Hong Lee, MD, PhDa,b

์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์˜ ์–ธ์–ด์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ ์ˆ˜ํ–‰๋Šฅ๋ ฅ ์ฐจ์ด: ๋…ธ์ธ์„ฑ์น˜๋งค์ž„์ƒ์—ฐ๊ตฌ์„ผํ„ฐ ์—ฐ๊ตฌ

์•ˆ์ด์„œa, ๊น€์ข…ํ—Œa,b, ์ตœ์„ฑํ˜œc, ์ •์ง€ํ–ฅd, ๊ตฌ๋ณธ๋Œ€e, ์‹ฌ์šฉ์ˆ˜f, ๋‚˜ํ•ด๋ฆฌg, ์ด์ค€ํ™a,b
Received April 27, 2015; ย  ย  ย  Revised June 1, 2015; ย  ย  ย  Accepted June 1, 2015;
ABSTRACT
Background:
The verbal fluency test consists of two separate tests of semantic fluency and phonemic fluency. The performance patterns of these tests differ with the type of dementia. We studied the patterns of verbal fluency between Alzheimerโ€™s disease (AD) and subcortical vascular dementia (SVaD), and assessed the clinical utility of these tests.
Methods:
The 1,475 selected participants comprised 73 normal control subjects, 673 patients with amnestic mild cognitive impairment (aMCI), 535 AD patients, 42 patients with subcortical vascular mild cognitive impairment (svMCI), and 152 SVaD patients. We analyzed the z-score for the total number of animal items as a semantic fluency index and the z-score of the phonemic total score as a phonemic fluency index.
Results:
The performance of semantic fluency was lower than that of phonemic fluency in all groups. The SVaD group showed the worst scores and abnormal performances on both tests, while the AD group presented abnormal performance only for semantic fluency. Dividing the patients with dementia according to severity revealed a different pattern between AD and SVaD for the clinical dementia rating (CDR) stage of 0.5. The performance of the AD group declined gradually with CDR. However, the SVaD group performed very poorly in both tests even for very mild dementia (CDR stage of 0.5). The aMCI and svMCI groups exhibited similar performance patterns.
Conclusions:
The pattern of semantic and phonemic fluency was not clinically useful at the MCI stage, but it could be helpful in differentiating AD and SVaD in the early stage of dementia.
์„œ ๋ก 
์„œ ๋ก 
์–ธ์–ด์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ๋Š” ์ œํ•œ๋œ ์‹œ๊ฐ„ ๋‚ด์— ์ž๋ฐœ์ ์œผ๋กœ ๋‹จ์–ด๋ฅผ ๋งŽ์ด ์ƒ์„ฑํ•ด๋‚ด๋Š” ๋Šฅ๋ ฅ์„ ์ธก์ •ํ•˜๋Š” ๊ฒ€์‚ฌ๋กœ, ํŠน์ • ๋ฒ”์ฃผ์— ์†ํ•œ ๋‹จ์–ด๋ฅผ ์ƒ์„ฑํ•˜๋Š” ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ์™€ ํŠน์ • ์ฒ ์ž๋กœ ์‹œ์ž‘ํ•˜๋Š” ๋‹จ์–ด๋ฅผ ์ƒ์„ฑํ•˜๋Š” ์Œ์†Œ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ๊ฐ€ ์žˆ๋‹ค. ์ด ๊ฒ€์‚ฌ๋“ค์€ ์ง‘ํ–‰๊ธฐ๋Šฅ์žฅ์• ๋ฅผ ์ธก์ •ํ•˜๊ธฐ ์œ„ํ•ด ์ฃผ๋กœ ์‚ฌ์šฉ๋˜๊ณ , ์ „๋‘์—ฝ์ด ์†์ƒ๋œ ํ™˜์ž๋“ค์€ ์–ธ์–ด์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ์— ์žฅ์• ๋ฅผ ๋ณด์ด๋Š” ๊ฒƒ์œผ๋กœ ์•Œ๋ ค์ ธ ์žˆ๋‹ค[1-5]. ๊ทธ๋Ÿฌ๋‚˜ ์ž„์ƒ์—์„œ ์ „๋‘์—ฝ ์†์ƒ์ด ์žˆ์Œ์—๋„ ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ ๊ฐ„์— ์žฅ์•  ์ •๋„๊ฐ€ ๋‹ค๋ฅด๊ฒŒ ๋‚˜ํƒ€๋‚  ์ˆ˜ ์žˆ๊ณ , ์ „๋‘์—ฝ ์™ธ์— ๋‹ค๋ฅธ ์˜์—ญ์— ์†์ƒ์ด ์žˆ์„ ๋•Œ์—๋„ ์žฅ์• ๋ฅผ ๋ณด์ด๋ฉฐ ์†์ƒ ์˜์—ญ์— ๋”ฐ๋ผ ์œ ์ฐฝ์„ฑ ์žฅ์•  ํŒจํ„ด์ด ๋‹ฌ๋ผ์ง€๊ธฐ๋„ ํ•œ๋‹ค[6,7]. ์ด๊ฒƒ์€ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ์„ ์ƒ์„ฑํ•˜๋Š” ์ธ์ง€์  ๊ธฐ์ œ๊ฐ€ ๊ธฐ๋ณธ์ ์œผ๋กœ ๋‹ค๋ฅด๊ธฐ ๋•Œ๋ฌธ์— ๋‚˜ํƒ€๋‚˜๋Š” ํ˜„์ƒ์ผ ์ˆ˜๋„ ์žˆ๊ณ , ์•„๋‹ˆ๋ฉด ์ง‘ํ–‰๊ธฐ๋Šฅ์ด๋ผ๋Š” ๋™์ผํ•œ ์ธ์ง€์  ๊ธฐ์ œ๋ฅผ ์‚ฌ์šฉํ•˜์ง€๋งŒ ์ง‘ํ–‰๊ธฐ๋Šฅ์ด ๊ด€์—ฌํ•˜๋Š” ์ •๋„์˜ ์ฐจ์ด ๋•Œ๋ฌธ์— ๋‹ค๋ฅธ ํŒจํ„ด์„ ๋ณด์ผ ์ˆ˜๋„ ์žˆ๋‹ค[8].
๋‹จ์–ด๋ฅผ ์œ ์ฐฝํ•˜๊ฒŒ ์ƒ์„ฑํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ๋จธ๋ฆฟ์†์— ์กฐ์งํ™”๋˜์–ด ์žˆ๋Š” ์ •๋ณด ์ค‘์—์„œ ์กฐ๊ฑด์— ๋งž๋Š” ์ •๋ณด๋ฅผ ํšจ์œจ์ ์œผ๋กœ ์ธ์ถœํ•  ์ˆ˜ ์žˆ๋Š” ์ „๋žต์ด ํ•„์ˆ˜์ ์ด๋‹ค. ์ด๋Ÿฐ ์ „๋žต์  ์ธ์ถœ์€ ์ง‘ํ–‰์ฒ˜๋ฆฌ์— ์˜ํ•ด ์ด๋ฃจ์–ด์ง€๋Š”๋ฐ ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ ๋ชจ๋‘์—์„œ ๊ณตํ†ต์ ์œผ๋กœ ์š”๊ตฌ๋˜๋Š” ๋Šฅ๋ ฅ์ด๋‹ค[9]. ๊ทธ์ค‘์—์„œ ์˜๋ฏธ์œ ์ฐฝ์„ฑ์€ ์˜๋ฏธ๊ธฐ์–ต๊ณผ ๋ฐ€์ ‘ํ•œ ๊ด€๋ จ์ด ์žˆ๋Š”๋ฐ, ์˜๋ฏธ๊ธฐ์–ต์€ ์žฅ๊ธฐ๊ธฐ์–ต ์ค‘์˜ ํ•˜๋‚˜๋กœ ์‚ฌ๋ฌผ, ์‚ฌ์‹ค, ๊ฐœ๋…, ๋‹จ์–ด, ์˜๋ฏธ์™€ ๊ฐ™์€ ์ง€์‹์— ๋Œ€ํ•œ ํ‘œ์ƒ์ด๋ผ๊ณ  ํ•  ์ˆ˜ ์žˆ๋‹ค[10]. ๊ธฐ๋ณธ์ ์œผ๋กœ ํŠน์ • ๋ฒ”์ฃผ(๋™๋ฌผ, ๊ฐ€๊ฒŒ ๋ฌผ๊ฑด)์— ์†ํ•˜๋Š” ๋‹จ์–ด๋ฅผ ์ ์ ˆํ•˜๊ฒŒ ์ธ์ถœํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ์˜๋ฏธ๊ธฐ์–ต์ด ์˜จ์ „ํ•ด์•ผ ํ•˜๋ฉฐ, ๋‹ค์Œ์œผ๋กœ ์˜๋ฏธ์ €์žฅ์†Œ์— ์žˆ๋Š” ๋‹จ์–ด ์ค‘ ํ•ด๋‹น ๋ฒ”์ฃผ์˜ ๋‹จ์–ด๋ฅผ ํšจ์œจ์ ์œผ๋กœ ์ธ์ถœํ•  ์ˆ˜ ์žˆ์–ด์•ผ ํ•œ๋‹ค. ๋‘˜ ์ค‘ ํ•˜๋‚˜์— ๋ฌธ์ œ๊ฐ€ ๋ฐœ์ƒํ•˜๋”๋ผ๋„ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ์—์„œ ์žฅ์• ๊ฐ€ ๋‚˜ํƒ€๋‚  ์ˆ˜ ์žˆ๋‹ค[11]. ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ๋‹ฌ๋ฆฌ ์˜๋ฏธ ๊ธฐ์–ต ์ฒ˜๋ฆฌ๊ฐ€ ์š”๊ตฌ๋˜์ง€ ์•Š๊ณ  ํŠน์ • ์Œ์†Œ(ใ„ฑ/ใ…‡/ใ……)๋กœ ์‹œ์ž‘ํ•˜๋Š” ๋‹จ์–ด๋ฅผ ํšจ์œจ์ ์œผ๋กœ ์ธ์ถœํ•˜๋Š” ๊ฒƒ์ด ํ•„์ˆ˜์ ์ด๋‹ค. ๋Œ€์‹ ์— ์˜๋ฏธ์ƒ์„ฑ๊ณผ ๊ฐ™์ด ์ต์ˆ™ํ•˜๊ณ  ์Šต๊ด€์ ์ธ ๋ฐ˜์‘์„ ์–ต์ œํ•˜๊ณ  ์นœ์ˆ™ํ•˜์ง€ ์•Š์€ ๋ฐฉ์‹์œผ๋กœ ์–ดํœ˜์  ํ‘œ์ƒ์— ์ ‘๊ทผํ•˜์—ฌ ๋‹จ์–ด๋ฅผ ์ƒ์„ฑํ•˜๊ธฐ ๋•Œ๋ฌธ์— ์ง‘ํ–‰๊ธฐ๋Šฅ์ด ๋” ์š”๊ตฌ๋˜๊ณ  ์ด๋ฅผ ํ‰๊ฐ€ํ•˜๋Š”๋ฐ ๋” ์ ํ•ฉํ•œ ๊ฒ€์‚ฌ๋กœ ๊ฐ„์ฃผ๋œ๋‹ค[2,12]. ๊ทธ๋ž˜์„œ ์Œ์†Œ์œ ์ฐฝ์„ฑ์—์„œ ์žฅ์• ๋ฅผ ๋ณด์ผ ๊ฒฝ์šฐ ์ง‘ํ–‰๊ธฐ๋Šฅ์žฅ์• ๋กœ ์ง์ ‘์ ์œผ๋กœ ํ•ด์„ํ•˜๋Š” ๊ฒƒ์ด ๊ฐ€๋Šฅํ•˜๋‹ค[8].
์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ํšจ์œจ์  ๋‹จ์–ด ์ธ์ถœ์ด๋ผ๋Š” ๊ณตํ†ต์ ์ธ ์ฒ˜๋ฆฌ๋ฅผ ๊ณต์œ ํ•˜๊ณ  ์žˆ์ง€๋งŒ ์ฒ˜๋ฆฌ๊ณผ์ •์—์„œ ์ฐจ์ด๊ฐ€ ์žˆ๊ธฐ ๋•Œ๋ฌธ์— ์น˜๋งค์˜ ์›์ธ์งˆํ™˜์— ๋”ฐ๋ผ ๋‹ค๋ฅธ ์œ ์ฐฝ์„ฑ ์žฅ์•  ํŒจํ„ด์„ ๋‚˜ํƒ€๋‚ผ ์ˆ˜ ์žˆ๋‹ค. ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž๋“ค์€ ์–ธ์–ด์œ ์ฐฝ์„ฑ์— ์†์ƒ์„ ๋ณด์ด๋Š” ๊ฒƒ์œผ๋กœ ์•Œ๋ ค์ ธ ์žˆ๊ณ [13-15], ์Œ์†Œ๋ณด๋‹ค๋Š” ์˜๋ฏธ์œ ์ฐฝ์„ฑ์—์„œ ๋” ์†์ƒ์„ ๋ณด์ด๋Š” ๊ฒƒ์œผ๋กœ ๋น„๊ต์  ์ผ๊ด€๋˜๊ฒŒ ๋ณด๊ณ ๋œ๋‹ค[9,13,15-17]. ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์˜ ์ดˆ๊ธฐ์—๋Š” ์ „๋‘์—ฝ ๊ธฐ๋Šฅ์ด ๋œ ์†์ƒ๋˜๊ณ  ์˜๋ฏธ๊ธฐ์–ต๊ณผ ๊ด€๋ จ๋œ ์ธก๋‘์—ฝ ์†์ƒ์ด ๋จผ์ € ์ผ์–ด๋‚˜๊ธฐ ๋•Œ๋ฌธ์— ์Œ์†Œ๋ณด๋‹ค๋Š” ์˜๋ฏธ์œ ์ฐฝ์„ฑ์ด ๋” ์˜ํ–ฅ์„ ๋ฐ›๋Š” ๊ฒƒ์œผ๋กœ ์ดํ•ด๋  ์ˆ˜ ์žˆ๋‹ค[18-21]. ์ด๊ฒƒ์€ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์„ ๋Œ€์ƒ์œผ๋กœ ํ•œ ๋ฉ”ํƒ€๋ถ„์„์—ฐ๊ตฌ์—์„œ ํ™•์ธ๋˜์—ˆ๊ณ [9-11,14,22], ์ „๋‹จ๊ณ„๋กœ ์•Œ๋ ค์ง„ ๊ฒฝ๋„์ธ์ง€์žฅ์•  ์—ฐ๊ตฌ์—์„œ๋„ ํ™•์ธ๋˜์—ˆ๋‹ค[23-25]. ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์—์„œ์˜ ์˜๋ฏธ์œ ์ฐฝ์„ฑ ์žฅ์• ๋Š” ์ธ์ถœ์˜ ๋ฌธ์ œ๋ผ๊ธฐ๋ณด๋‹ค ์˜๋ฏธ์ €์žฅ์†Œ์˜ ์†์ƒ ์ž์ฒด๊ฐ€ ์›์ธ์ž„์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์ด ์ง„ํ–‰๋จ์— ๋”ฐ๋ผ์„œ ๋‡Œ์˜ ์ „๋ฐ˜์ ์ธ ์˜์—ญ์œผ๋กœ ์†์ƒ์ด ํ™•์‚ฐ๋˜๋Š”๋ฐ ์ด๋Ÿฐ ๊ฒฝ๊ณผ์— ๋”ฐ๋ฅธ ์œ ์ฐฝ์„ฑ์žฅ์•  ํŒจํ„ด์˜ ๋ณ€ํ™”์— ๋Œ€ํ•ด์„œ๋Š” ๊ฑฐ์˜ ์•Œ๋ ค์ง„ ๋ฐ”๊ฐ€ ์—†๋‹ค.
ํ˜ˆ๊ด€์น˜๋งค๋Š” ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ๋‹ฌ๋ฆฌ ์˜๋ฏธ๋ณด๋‹ค๋Š” ์Œ์†Œ์œ ์ฐฝ์„ฑ์ด ๋” ์†์ƒ๋˜๋Š” ๊ฒƒ์œผ๋กœ ์•Œ๋ ค์ ธ ์žˆ๋Š”๋ฐ[26-29], ๋‘ ์งˆํ™˜ ๊ฐ„ ํŒจํ„ด์ฐจ์ด๊ฐ€ ์—†๋‹ค๋Š” ๋ณด๊ณ ๋„ ์žˆ๋‹ค[16,30-32]. ๋น„๊ต์  ์ผ๊ด€๋œ ์—ฐ๊ตฌ๊ฒฐ๊ณผ๋ฅผ ๋ณด์ด๋Š” ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ๋‹ฌ๋ฆฌ ํ˜ˆ๊ด€์น˜๋งค์—์„œ ์ด๋Ÿฐ ๋ถˆ์ผ์น˜๋ฅผ ๋ณด์ด๋Š” ๊ฒƒ์€ ์ธ์ง€์žฅ์• ๋ฅผ ์•ผ๊ธฐํ•˜๋Š” ์›์ธ์ด ๋‹ค๋ฅด๊ณ  ํ˜ˆ๊ด€์น˜๋งค ๋‚ด์—์„œ๋„ ์†์ƒ์œ„์น˜๋‚˜ ํŠน์ง•์— ๋”ฐ๋ผ์„œ ๋‹ค์–‘ํ•œ ํŒจํ„ด์˜ ์ธ์ง€์žฅ์• ๊ฐ€ ๋‚˜ํƒ€๋‚  ์ˆ˜ ์žˆ๊ณ  ๊ทธ๊ฒƒ์ด ์œ ์ฐฝ์„ฑ ํŒจํ„ด์˜ ๋ถˆ์ผ์น˜์— ์˜ํ–ฅ์„ ๋ฏธ์น  ์ˆ˜ ์žˆ๋‹ค[1,8]. ์—ฌ๋Ÿฌ ๊ฐ€์ง€ ์š”์†Œ๋“ค์„ ๋ฐฐ์ œํ•œ ๋ฉ”ํƒ€๋ถ„์„์—ฐ๊ตฌ์—์„œ๋Š” ์ธก๋‘์—ฝ ๋ณ‘๋ณ€์ด ์žˆ๋Š” ๊ฒฝ์šฐ ์Œ์†Œ๋ณด๋‹ค ์˜๋ฏธ์œ ์ฐฝ์„ฑ์ด ๋” ์ €ํ•˜๋˜์—ˆ๊ณ  ์ด๋Š” ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž๋“ค์˜ ํŒจํ„ด๊ณผ ์œ ์‚ฌํ•จ์„ ๋ณด๊ณ ํ•˜์˜€๋‹ค[8]. ๊ทธ๋Ÿฌ๋‚˜ ์ „๋‘์—ฝ ๋ณ‘๋ณ€์ด ์žˆ๋Š” ๊ฒฝ์šฐ์—๋Š” ๋ฐ˜๋Œ€ ํŒจํ„ด์˜ ๊ฒฐ๊ณผ๊ฐ€ ๋‚˜์˜ค๋Š” ๊ฒƒ์ด ์•„๋‹ˆ๋ผ ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ์ด ๋ชจ๋‘ ์˜ํ–ฅ์„ ๋ฐ›์•„ ์†์ƒ๋˜๋Š” ๊ฒƒ์„ ํ™•์ธํ•˜์˜€๋‹ค. ์ด๊ฒƒ์€ ์ง‘ํ–‰๊ธฐ๋Šฅ์†์ƒ์œผ๋กœ ์ธํ•ด ์ธ์ถœ ์ž์ฒด๊ฐ€ ๋ฐฉํ•ด๋ฅผ ๋ฐ›์•„ ์ƒ๊ธฐ๋Š” ๊ฒฐ๊ณผ๋ผ๊ณ  ํ•  ์ˆ˜ ์žˆ๋‹ค.
ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋Š” ํ”ผ์งˆํ•˜ ์˜์—ญ์— ๋‹ค๋ฐœ์„ฑ์—ด๊ณต๊ฒฝ์ƒ‰์ด๋‚˜ ๋ฐฑ์งˆ๋ณ€์„ฑ์ด ๋ฐœ์ƒํ•˜์—ฌ ์น˜๋งค๋กœ ์ง„ํ–‰๋˜๋Š” ์งˆํ™˜์ด๋‹ค. ๋ฐœ๋ณ‘๊ธฐ์ „ ์ƒ ๋‹ค๋ฅธ ํ˜ˆ๊ด€์น˜๋งค์— ๋น„ํ•ด ๋น„๊ต์  ๋™์งˆ์ ์ธ ํ™˜์ž์ง‘๋‹จ์ด๋ฉฐ ์ „๋‘์—ฝ/์ง‘ํ–‰๊ธฐ๋Šฅ์žฅ์• ๊ฐ€ ์œ ์˜๋ฏธํ•˜๊ฒŒ ๊ด€์ฐฐ๋˜๋Š” ์ž„์ƒํŠน์ง•์„ ๊ฐ€์ง„ ๊ฒƒ์œผ๋กœ ์•Œ๋ ค์ ธ ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ๋ชจ๋‘ ์„œ์„œํžˆ ๋ฐœ์ƒํ•˜์—ฌ ์ ์ง„์ ์œผ๋กœ ์ง„ํ–‰ํ•˜๋Š” ๋น„์Šทํ•œ ์ž„์ƒ์–‘์ƒ์„ ๊ฐ€์ง€๊ณ  ์žˆ์œผ๋ฉฐ ์ดˆ๊ธฐ ์น˜๋งค๋‹จ๊ณ„์—์„œ๋Š” ์ธ์ง€์žฅ์• ํŒจํ„ด์ด ๋น„์Šทํ•˜๊ธฐ ๋•Œ๋ฌธ์— ์‹ ๊ฒฝ์‹ฌ๋ฆฌ๊ฒ€์‚ฌ๋ฅผ ํ†ตํ•ด ์›์ธ์งˆํ™˜์„ ๊ตฌ๋ณ„ํ•˜๊ณ  ์˜ˆ์ธกํ•˜๋Š” ๊ฒƒ์ด ์‰ฝ์ง€ ์•Š๋‹ค[18,19,33]. ์‹ค์ œ๋กœ ์ด๋Ÿฐ ์œ ์‚ฌ์„ฑ์€ ์น˜๋งค๋กœ ์ง„ํ–‰๋˜๊ธฐ ์ „ ์•ฝ 3๋…„ ๋™์•ˆ ๋น„์Šทํ•œ ํŒจํ„ด์„ ๋ณด์ด๋Š” ๊ฒƒ์œผ๋กœ ๋ณด๊ณ ๋œ๋‹ค[20,21]. ์ด์ „ ์—ฐ๊ตฌ์—์„œ๋„ ํ˜ˆ๊ด€์น˜๋งค์™€ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์—์„œ ์–ธ์–ด์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰์˜ ์ฐจ์ด๋ฅผ ๋น„๊ตํ•˜์˜€์œผ๋‚˜, ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๊ตฐ์— ํ”ผ์งˆ๋ณ‘๋ณ€๊ณผ ํ”ผ์งˆํ•˜๋ณ‘๋ณ€ ํ™˜์ž๊ฐ€ ๊ตฌ๋ณ„๋˜์ง€ ์•Š๊ณ  ํฌํ•จ๋œ ๊ฒฝ์šฐ๊ฐ€ ๋งŽ์•˜์œผ๋ฉฐ, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž์™€ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž์˜ ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ์ฐจ์ด๋ฅผ ๋น„๊ตํ•œ ์—ฐ๊ตฌ๋„ ๋งŽ์ง€ ์•Š์œผ๋ฉฐ, ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ ํŒจํ„ด์„ ๋น„๊ตํ•œ ์—ฐ๊ตฌ๋Š” ๊ฑฐ์˜ ์—†์—ˆ๋‹ค[26,34]. ๋‘ ํ™˜์ž ์ง‘๋‹จ์˜ ์œ ์ฐฝ์„ฑ ํŒจํ„ด์„ ๋น„๊ตํ•œ ์ตœ๊ทผ ์—ฐ๊ตฌ์—์„œ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž๋“ค์€ ์Œ์†Œ๋ณด๋‹ค ์˜๋ฏธ์œ ์ฐฝ์„ฑ์ด ๋” ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋ณด์ด์ง€๋งŒ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๋“ค์€ 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ ๋ชจ๋‘ ๋‚ฎ์€ ํŒจํ„ด์„ ๋ณด๊ณ ํ•˜์˜€๋‹ค[35]. ๊ทธ๋Ÿฌ๋‚˜ ํŠน์„ฑ์ด ๋‹ค๋ฅธ ์œ ์ฐฝ์„ฑ ๊ฒ€์‚ฌ์˜ ์›์ ์ˆ˜๋ฅผ ์‚ฌ์šฉํ•ด ์ง์ ‘ ํŒจํ„ด์„ ๋น„๊ตํ•œ ๋ฌธ์ œ๊ฐ€ ์žˆ์–ด ๊ทธ ๊ฒฐ๊ณผ๋ฅผ ์ž„์ƒ์— ์ ์šฉํ•˜์—ฌ ํ•ด์„ํ•˜๋Š”๋ฐ ์ œํ•œ์ด ์žˆ์„ ์ˆ˜ ์žˆ๋‹ค. ๋˜ํ•œ ๊ฐ ํ™˜์ž๊ตฐ์˜ ์ดˆ๊ธฐ ๋‹จ๊ณ„๋ถ€ํ„ฐ ์ง„ํ–‰์— ๋”ฐ๋ฅธ ์œ ์ฐฝ์„ฑ ํŒจํ„ด์˜ ๋ณ€ํ™”์— ๋Œ€ํ•œ ์ž์„ธํ•œ ๋ถ„์„์ด ์—†์–ด ๋‘ ํ™˜์ž๊ตฐ์˜ ์œ ์ฐฝ์„ฑ ํŒจํ„ด ํŠน์„ฑ์„ ํ™•์ธํ•˜๊ฑฐ๋‚˜ ์ดˆ๊ธฐ ์ž„์ƒ ์–‘์ƒ์„ ๋ณ€๋ณ„ํ•˜๋Š”๋ฐ ์œ ์šฉํ•˜์ง€ ์•Š์„ ์ˆ˜ ์žˆ๋‹ค.
๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์˜ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ํŒจํ„ด ์ฐจ์ด๋ฅผ ์•Œ์•„๋ณด๊ณ , ๊ฒฝ๋„์ธ์ง€๋‹จ๊ณ„๋ฅผ ํฌํ•จํ•ด์„œ ์น˜๋งค ์ง„ํ–‰๋‹จ๊ณ„์— ๋”ฐ๋ผ ํŒจํ„ด์ด ์–ด๋–ป๊ฒŒ ๋‹ฌ๋ผ์ง€๋Š”์ง€ ๊ทœ๋ช…ํ•˜๊ณ ์ž ํ•œ๋‹ค.
๋Œ€์ƒ๊ณผ ๋ฐฉ๋ฒ•
๋Œ€์ƒ๊ณผ ๋ฐฉ๋ฒ•
์ด ์—ฐ๊ตฌ๋Š” 2005๋…„๋ถ€ํ„ฐ 2011๋…„๊นŒ์ง€ ๋…ธ์ธ์„ฑ์น˜๋งค์ž„์ƒ์—ฐ๊ตฌ์„ผํ„ฐ(Clinical Research Center for Dementia of South Korea, CREDOS)์— ๋“ฑ๋ก๋œ ๋ณ‘์› ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€๋‹ค. CREDOS์—์„œ ์ •ํ•œ ํ”„๋กœํ† ์ฝœ์— ๋”ฐ๋ผ์„œ ๋ชจ๋“  ํ™˜์ž์—๊ฒŒ ํฌ๊ด„์ ์ธ ์ž„์ƒ๋ฉด๋‹ด, ์‹ ๊ฒฝํ•™์ ๊ฒ€์‚ฌ, ๊ฒ€์‚ฌ์‹ค๊ฒ€์‚ฌ, ๋‡Œ์ž๊ธฐ๊ณต๋ช…์˜์ƒ๊ฒ€์‚ฌ์™€ ์„œ์šธ์‹ ๊ฒฝ์‹ฌ๋ฆฌ๊ฒ€์‚ฌ[36]๋ฅผ ํ•˜์˜€๋‹ค[37-39].
๋ชจ๋“  ํ™˜์ž๋“ค์€ ์ธ์ง€๊ธฐ๋Šฅ ์ธก๋ฉด์—์„œ ์‹ ๊ฒฝ์‹ฌ๋ฆฌ๊ฒ€์‚ฌ ๊ฒฐ๊ณผ๋ฅผ ๊ธฐ์ค€์œผ๋กœ CREDOS์—์„œ ์ •ํ•œ ๊ธฐ์ค€์— ๋”ฐ๋ผ ์ •์ƒ, ๊ฒฝ๋„์ธ์ง€์žฅ์• , ๊ฒฝ์ฆ์น˜๋งค, ์ค‘์ฆ์น˜๋งค๋กœ ์ธ์ง€๊ธฐ๋Šฅ์ˆ˜์ค€์„ ๊ตฌ๋ถ„ํ•˜์˜€๋‹ค. ์–ธ์–ด๊ธฐ๋Šฅ, ์‹œ๊ณต๊ฐ„๊ธฐ๋Šฅ, ๊ธฐ์–ต๋ ฅ, ์ „๋‘์—ฝ/์ง‘ํ–‰๊ธฐ๋Šฅ์˜ ๋ชจ๋“  ์ธ์ง€์˜์—ญ์—์„œ ๊ฐ๊ด€์ ์ธ ์ธ์ง€์žฅ์• ๊ฐ€ ์—†๋Š” ๊ฒฝ์šฐ๋Š” ์ •์ƒ ์ธ์ง€๊ธฐ๋Šฅ์ˆ˜์ค€์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์˜€๋‹ค. 1๊ฐœ ์ด์ƒ์˜ ์˜์—ญ์—์„œ ๊ฐ๊ด€์  ์ธ์ง€์žฅ์• ๊ฐ€ ๊ด€์ฐฐ๋˜๊ณ  ์ž„์ƒ์น˜๋งค์ฒ™๋„(Clinical Dementia Rating; CDR) [40]๊ฐ€ 0.5, ์„œ์šธ๋ณตํ•ฉ์ผ์ƒ์ƒํ™œ๊ธฐ๋Šฅ๊ฒ€์‚ฌ(Seoul-Instrumental Activities of Daily Living; S-IADL) [41] 8์ ์„ ๊ธฐ์ค€์œผ๋กœ ์ผ์ƒ์ƒํ™œ์ˆ˜ํ–‰๋Šฅ๋ ฅ์— ์ œํ•œ์ด ์—†๋Š” ๊ฒฝ์šฐ๋Š” ๊ฒฝ๋„์ธ์ง€์žฅ์• ๋กœ ๋ถ„๋ฅ˜ํ•˜์˜€๋‹ค. ์น˜๋งค๋Š” ๊ฐ๊ด€์  ์ธ์ง€์žฅ์• ๊ฐ€ ์žˆ์œผ๋ฉฐ, ์„œ์šธ๋ณตํ•ฉ์ผ์ƒ์ƒํ™œ๊ธฐ๋Šฅ๊ฒ€์‚ฌ 8์  ์ด์ƒ์ธ ํ™˜์ž๋กœ CDR์ด 0.5, 1, 2์ธ ๊ฒฝ์šฐ๋Š” ๊ฒฝ์ฆ์น˜๋งค, 3์€ ์ค‘์ฆ์น˜๋งค๋กœ ๊ตฌ๋ถ„ํ•˜์˜€๋‹ค.
CREDOS์—์„œ ๋ชจ๋“  ํ™˜์ž์˜ ๋ฐฑ์งˆ๋ณ€์„ฑ ์ •๋„๋Š” T2๊ฐ•์กฐ์˜์ƒ(T2-weighted imaging)์ด๋‚˜ ์•ก์ฒด๊ฐ์‡„์—ญ์ „ํšŒ๋ณต์˜์ƒ(fluid attenuated inversion recovery imaging)์—์„œ Fazekas ์ฒ™๋„[42]์— ๋”ฐ๋ผ ํ‰๊ฐ€ํ•˜์˜€๋‹ค. ์‹ฌ๋ถ€๋ฐฑ์งˆ๋ณ€์„ฑ(deep white matter, D)์€ 10 mm์™€ 25 mm๋ฅผ ๊ธฐ์ค€์œผ๋กœ D1: <10 mm, D2: D1๊ณผ D2 ์‚ฌ์ด, D3: โ‰ฅ25 mm์œผ๋กœ ์‹ฌํ•œ ์ •๋„๋ฅผ ๊ตฌ๋ถ„ํ•˜์˜€์œผ๋ฉฐ ๋‡Œ์‹ค์ฃผ๋ณ€๋ฐฑ์งˆ๋ณ€์„ฑ(periventricular white matter, P)์€ 5 mm์™€ 10 mm๋ฅผ ๊ธฐ์ค€์œผ๋กœ P1: <5 mm, P2: P1๊ณผ P3 ์‚ฌ์ด, P3: โ‰ฅ10 mm์œผ๋กœ ์‹ฌํ•œ ์ •๋„๋ฅผ ๊ตฌ๋ถ„ํ•˜์˜€๋‹ค. CREDOS์—์„œ๋Š” ์ด ๊ธฐ์ค€์„ ์ข…ํ•ฉํ•˜์—ฌ ๋ฐฑ์งˆ๋ณ€์„ฑ์ •๋„๋ฅผ D1P1, D1P2๋Š” ๊ฒฝํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ, D1P3, D2P1, D2P2, D2P3, D3P1, D3P2๋Š” ์ค‘๋“ฑ๋„ ๋ฐฑ์งˆ๋ณ€์„ฑ, D3P3๋Š” ์‹ฌํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ์œผ๋กœ ์ˆ˜์ค€์„ ๋ถ„๋ฅ˜ํ•˜์˜€๋‹ค. ๊ฒฝํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ์„ ๊ฐ€์ง„ ๊ฒฝ์šฐ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์™€ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž๋กœ ํฌํ•จ์‹œ์ผฐ๊ณ , ์‹ฌํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ์ด ์žˆ๋Š” ํ™˜์ž๋งŒ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ์™€ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋กœ ํฌํ•จํ•˜์˜€๋‹ค. ์ค‘๋“ฑ๋„ ๋ฐฑ์งˆ๋ณ€์„ฑ์„ ๊ฐ€์ง„ ํ™˜์ž๋“ค์€ ์–ด๋А ์ง„๋‹จ๊ทธ๋ฃน์—๋„ ํฌํ•จ์‹œํ‚ค์ง€ ์•Š์•˜๋‹ค.
์œ„์— ์–ธ๊ธ‰ํ•œ ์ธ์ง€๊ธฐ๋Šฅ์ˆ˜์ค€, ๋ฐฑ์งˆ๋ณ€์„ฑ์ˆ˜์ค€, ๊ตญ์†Œ์‹ ๊ฒฝํ•™์ ์ง•ํ›„์˜ ์„ธ๊ฐ€์ง€ ๊ธฐ์ค€์— ๋”ฐ๋ผ์„œ ํ™˜์ž๋“ค์„ ์ •์ƒํ†ต์ œ๊ตฐ, ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• , ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• , ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋กœ ํ™˜์ž๊ทธ๋ฃน์„ ๊ตฌ๋ถ„ํ•˜์˜€๋‹ค. ์ •์ƒํ†ต์ œ๊ตฐ์€ ์‹ ๊ฒฝ์‹ฌ๋ฆฌ๊ฒ€์‚ฌ ์ƒ ์ •์ƒ์ธ์ง€๊ธฐ๋Šฅ์ˆ˜์ค€, ๋‡Œ์ž๊ธฐ๊ณต๋ช…์˜์ƒ๊ฒ€์‚ฌ ์ƒ ๊ฒฝํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ๋งŒ ๊ด€์ฐฐ๋˜๋ฉฐ, ๊ตญ์†Œ์‹ ๊ฒฝํ•™์ ์ง•ํ›„๋Š” ์—†๋Š” ์ฃผ๊ด€์ ์ธ์ง€์žฅ์•  ํ™˜์ž๋กœ ๊ตฌ์„ฑ๋˜์—ˆ๋‹ค. ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์•  ํ™˜์ž๋Š” ๋ชจ๋‘ Petersen [43] ๊ธฐ์ค€, ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž๋Š” ๋ชจ๋‘ National Institute of Neurological and Communicative Disorders and Stroke and AD and Related Disorders Association (NINCDS-ADRDA) [44] ๊ธฐ์ค€์„ ๋งŒ์กฑํ•˜์˜€์œผ๋ฉฐ ๊ฒฝํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ๋งŒ ๊ด€์ฐฐ๋˜๋ฉฐ ๊ตญ์†Œ์‹ ๊ฒฝํ•™์ ์ง•ํ›„๊ฐ€ ์—†๋Š” ํ™˜์ž๋“ค๋กœ ๊ตฌ์„ฑ๋˜์—ˆ๋‹ค. ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ์™€ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๋Š” ์‹ฌํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ์„ ๊ฐ€์ง€๋ฉฐ ๊ตญ์†Œ์‹ ๊ฒฝํ•™์ ์ง•ํ›„๊ฐ€ ๊ฐ๊ด€์ ์œผ๋กœ ๊ด€์ฐฐ๋˜์—ˆ์œผ๋ฉฐ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๋Š” Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) [45] ๊ธฐ์ค€์„ ๋ชจ๋‘ ๋งŒ์กฑํ•˜์˜€๋‹ค.
์‹ ๊ฒฝ์‹ฌ๋ฆฌ๊ฒ€์‚ฌ ์ค‘ ์˜๋ฏธ์œ ์ฐฝ์„ฑ์€ 60์ดˆ ๋™์•ˆ ๋™๋ฌผ์ด๋ฆ„์„ ๊ฐ€๋Šฅํ•œ ๋งŽ์ด ๋งํ•˜๋„๋ก ํ•˜์—ฌ ํ‰๊ฐ€๋˜์—ˆ์œผ๋ฉฐ, ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ โ€˜ใ„ฑโ€™, โ€˜ใ…‡โ€™, โ€˜ใ……โ€™์œผ๋กœ ์‹œ์ž‘ํ•˜๋Š” ๋‹จ์–ด๋ฅผ ๊ฐ๊ฐ 60์ดˆ ๋™์•ˆ ๋งŽ์ด ๋งํ•˜๋„๋ก ํ•˜์—ฌ ์ด์ ์œผ๋กœ ํ‰๊ฐ€ํ•˜์˜€๋‹ค. ์›์ ์ˆ˜ ์ž์ฒด๋กœ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ์˜ ํŒจํ„ด์„ ์ง์ ‘ ๋น„๊ตํ•  ์ˆ˜ ์—†๊ธฐ ๋•Œ๋ฌธ์— ํ™˜์ž์˜ ๋‚˜์ด์™€ ๊ต์œก์ˆ˜์ค€์— ๋งž๋Š” z์ ์ˆ˜๋ฅผ ์‚ฌ์šฉํ•˜์˜€๋‹ค.
8,124๋ช…์˜ ์ž๋ฃŒ์—์„œ ์ถ”์ ์ž๋ฃŒ๋ฅผ ์ œ์™ธํ•˜๊ณ  6,136๋ช…์˜ 1์ฐจ ๊ฒ€์‚ฌ์ž๋ฃŒ๋ฅผ ์„ ๋ณ„ํ•˜์˜€๋‹ค. ์‚ฌ์šฉ๋œ ์„œ์šธ์‹ ๊ฒฝ์‹ฌ๋ฆฌ๊ฒ€์‚ฌ์˜ ๊ทœ์ค€์€ 55์„ธ๋ถ€ํ„ฐ 80์„ธ๊นŒ์ง€ ์ ์šฉ๋˜๋„๋ก ๋งŒ๋“ค์–ด์กŒ๊ธฐ ๋•Œ๋ฌธ์— z์ ์ˆ˜ ๋ถ„์„์„ ํ•˜๊ธฐ ์œ„ํ•ด์„œ ํ•ด๋‹น ๋‚˜์ด ๋ฒ”์œ„์— ์†ํ•˜๋Š” 5,076๋ช… ์„ ๋ณ„ํ•˜๊ณ , ๋ฌธ๋งน์˜ ๊ฒฝ์šฐ ์Œ์†Œ์œ ์ฐฝ์„ฑ ๊ทœ์น™์„ ์ดํ•ดํ•˜๋Š”๋ฐ ์–ด๋ ค์›€์ด ์žˆ์–ด ์—ฐ๊ตฌ์—์„œ ์ œ์™ธํ•˜๊ณ  2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ ์ค‘ ํ•˜๋‚˜๋ผ๋„ ํ‰๊ฐ€๋˜์ง€ ์•Š์€ ํ™˜์ž๋“ค๋„ ๋ชจ๋‘ ์ œ์™ธํ•˜์—ฌ 3,872๋ช…์˜ ํ™˜์ž ์ž๋ฃŒ๋ฅผ ์„ ๋ณ„ํ•˜์˜€๋‹ค. ๊ทธ ์ค‘์—์„œ ์ง„๋‹จ๊ทธ๋ฃน์— ๋”ฐ๋ฅธ ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ํŒจํ„ด ์ฐจ์ด๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•ด ์•ž์—์„œ ์ œ์‹œํ•œ ์ง„๋‹จ๊ธฐ์ค€์— ๋ถ€ํ•ฉํ•˜๋Š” ํ™˜์ž๋ฅผ ์ตœ์ข… ์„ ๋ณ„ํ•˜์˜€๋‹ค. ์ •์ƒํ†ต์ œ๊ตฐ์€ 73๋ช…, ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ๋Š” 673๋ช…, ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์€ 535๋ช…, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ๋Š” 42๋ช…, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋Š” 152๋ช…์ด ๋ถ„์„์— ํฌํ•จ๋˜์—ˆ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ๋ณ‘์˜ ์ง„ํ–‰๋‹จ๊ณ„์— ๋”ฐ๋ฅธ ํŒจํ„ด ๋ถ„์„์„ ์œ„ํ•ด ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์•  ๊ทธ๋ฃน์„ ๋‹จ์ผ์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• (n๏ผ240)๊ณผ ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• (n๏ผ433)๋กœ ๊ตฌ๋ถ„ํ•˜์˜€์œผ๋ฉฐ ์น˜๋งค ๊ทธ๋ฃน์€ CDR์— ๋”ฐ๋ผ์„œ 0.5, 1, 2๋กœ ๊ตฌ๋ถ„ํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€๋‹ค. ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž 1๋ช…, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž ์ค‘ 6๋ช…์€ CDR 3์— ํ•ด๋‹นํ•˜์˜€์œผ๋‚˜ ํ”ผํ—˜์ž์ˆ˜๊ฐ€ ๋„ˆ๋ฌด ์ ์–ด ๊ทธ๋ฃน ๋ถ„์„์—์„œ๋Š” ์ œ์™ธํ•˜์˜€๋‹ค. ๊ฐ ์ง„๋‹จ๊ทธ๋ฃน ๋‚ด์—์„œ ์œ ์ฐฝ์„ฑ ํŒจํ„ด์„ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ๋ชจ๋“  ํ™˜์ž๋ฅผ 4๊ฐ€์ง€ ์œ ํ˜•์œผ๋กœ ๊ตฌ๋ถ„ํ•˜์˜€๋‹ค. ํ•œ ๊ฐœ์ธ์˜ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰์„ 1 ํ‘œ์ค€ํŽธ์ฐจ๊ธฐ์ค€(z๏ผ-1)์— ๋”ฐ๋ผ์„œ ๋‘˜ ๋‹ค ์ •์ƒ์ธ ๊ฒฝ์šฐ(SPnl), ์˜๋ฏธ๋งŒ ๋น„์ •์ƒ์ธ ๊ฒฝ์šฐ(SabPnl), ์Œ์†Œ๋งŒ ๋น„์ •์ƒ์ธ ๊ฒฝ์šฐ(SnlPab), ๋ชจ๋‘ ๋น„์ •์ƒ์ธ ๊ฒฝ์šฐ(SPab)๋กœ ๋ชจ๋“  ํ™˜์ž๋ฅผ ๋ถ„๋ฅ˜ํ•œ ํ›„ ๊ฐ ์ง„๋‹จ๊ทธ๋ฃน๋ณ„๋กœ ํฌํ•จ๋œ ๋„ค ๊ฐ€์ง€ ์œ ํ˜•์˜ ํ™˜์ž ๋น„์œจ์„ ํ†ตํ•ด ์œ ์ฐฝ์„ฑ ํŒจํ„ด์„ ํ™•์ธํ•˜์˜€๋‹ค.
๊ฒฐ ๊ณผ
๊ฒฐ ๊ณผ
5๊ฐœ ์ง„๋‹จ๊ทธ๋ฃน์— ์†ํ•œ ํ™˜์ž๋“ค์˜ ์ธ๊ตฌํ†ต๊ณ„ํ•™์  ๋ณ€์ˆ˜์™€ ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰์˜ ์›์ ์ˆ˜๋ฅผ Table 1์— ์ œ์‹œํ•˜์˜€์œผ๋ฉฐ z์ ์ˆ˜๋Š” Fig. 1์— ์ œ์‹œํ•˜์˜€๋‹ค. 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ๋ฅผ ๋ฐ˜๋ณต ์ธก์ •ํ•˜์˜€์œผ๋ฏ€๋กœ 5 (์ง„๋‹จ๊ทธ๋ฃน) ร— 2 (์œ ์ฐฝ์„ฑ) 2์š”์ธ ํ˜ผํ•ฉ๋ณ€๋Ÿ‰๋ถ„์„์„ ์‹ค์‹œํ•˜์˜€๋‹ค. ์ƒํ˜ธ์ž‘์šฉ์€ ์œ ์˜ํ•˜์˜€์œผ๋ฉฐ(F(4, 1,470)๏ผ7.39, p<.001) ๊ทธ๋ฃน์— ์˜ํ•œ ์ฃผํšจ๊ณผ(F(4, 1,470)๏ผ155.56, p<.001), ์œ ์ฐฝ์„ฑ์— ์˜ํ•œ ์ฃผํšจ๊ณผ(F(1, 1,470)๏ผ49.98, p<.001) ๋ชจ๋‘ ์œ ์˜ํ•˜์˜€๋‹ค. ์ •์ƒํ†ต์ œ๊ตฐ๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ ์ฐจ์ด๋Š” ๋‚˜ํƒ€๋‚ด์ง€ ์•Š์•˜์œผ๋‚˜, ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• , ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์—์„œ๋Š” ์Œ์†Œ๋ณด๋‹ค ์˜๋ฏธ์œ ์ฐฝ์„ฑ์ด ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•˜๊ฒŒ ๋‚ฎ์•˜์œผ๋ฉฐ, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์—์„œ ์˜๋ฏธ, ์Œ์†Œ ๋ชจ๋‘ ๊ฐ€์žฅ ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋‚˜ํƒ€๋ƒˆ๋‹ค. ์œ ์ฐฝ์„ฑ์— ๋”ฐ๋ฅธ ๊ทธ๋ฃน๊ฐ„ ์ฐจ์ด๋ฅผ ๋ถ„์„ํ•˜๋ฉด, ์˜๋ฏธ์œ ์ฐฝ์„ฑ์ด ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ๋ณด๋‹ค ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ ๋” ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋ณด์ด๊ธฐ๋Š” ํ•˜์˜€์œผ๋‚˜ ํ†ต๊ณ„์  ์ฐจ์ด๋ฅผ ์—†์—ˆ์œผ๋ฉฐ, ๋‹ค๋ฅธ ๋ชจ๋“  ๊ทธ๋ฃน ๊ฐ„์—๋Š” ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์žˆ์—ˆ๋‹ค. ์ด์— ๋น„ํ•ด ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ๋ชจ๋“  ๊ทธ๋ฃน ๊ฐ„์— ์ฐจ์ด๋ฅผ ๋‚˜ํƒ€๋ƒˆ์œผ๋ฉฐ, ํŠนํžˆ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์•  ํ™˜์ž๋“ค์ด ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ๋ณด๋‹ค ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋ณด์ด๋Š” ํ†ต๊ณ„์  ์œ ์˜์„ฑ์ด ๋‚˜ํƒ€๋‚ฌ๋‹ค.
์น˜๋งค์˜ ์ง„ํ–‰์ •๋„์— ๋”ฐ๋ฅธ ์œ ์ฐฝ์„ฑ ํŒจํ„ด์„ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•ด ์น˜๋งค๊ตฐ์—์„œ๋Š” CDR์— ๋”ฐ๋ผ ๊ตฌ๋ถ„ํ•˜์˜€์œผ๋ฉฐ ๊ฒฝ๋„์ธ์ง€์žฅ์• ๋Š” ๋‹จ์ผ์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์™€ ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ๋กœ ๊ตฌ๋ถ„ํ•˜์˜€์œผ๋ฉฐ ๊ฐ ํ™˜์ž๋“ค์˜ ์ธ๊ตฌํ†ต๊ณ„ํ•™์  ๋ณ€์ˆ˜์™€ ์œ ์ฐฝ์„ฑ ์›์ ์ˆ˜๋ฅผ Table 2์— ๋‚˜ํƒ€๋ƒˆ๋‹ค. ๊ฐ ๊ทธ๋ฃน ๊ฐ„ ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰์˜ z ์ ์ˆ˜๋Š” Fig. 2์— ์ œ์‹œํ•˜์˜€๋‹ค. ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋ฅผ ๋…๋ฆฝ์ ์ธ ์งˆํ™˜์œผ๋กœ ๊ฐ€์ •ํ•˜์—ฌ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ์ง„ํ–‰์— ๋”ฐ๋ฅธ ์œ ์ฐฝ์„ฑ ์ฐจ์ด๋ฅผ ํ™•์ธํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ๋‹จ์ผ์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• , ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• , ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ CDR 0.5, ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ CDR 1, ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ CDR 2 ๊ทธ๋ฃน ๊ฐ„์— ์œ ์ฐฝ์„ฑ ์ฐจ์ด๋ฅผ ๋ถ„์„ํ•˜๊ณ , ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ์ง„ํ–‰์— ๋”ฐ๋ฅธ ์œ ์ฐฝ์„ฑ ์ฐจ์ด๋ฅผ ํ™•์ธํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• , ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค CDR 0.5, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค CDR 1, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค CDR 2 ๊ทธ๋ฃน ๊ฐ„์— ์œ ์ฐฝ์„ฑ ์ฐจ์ด๋ฅผ ๊ฐ๊ฐ ๋ถ„์„ํ•˜์˜€๋‹ค. ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ์ง„ํ–‰์— ๋”ฐ๋ฅธ 5 (์ง„๋‹จ๊ทธ๋ฃน) ร— 2 (์œ ์ฐฝ์„ฑ) 2์š”์ธ ํ˜ผํ•ฉ๋ณ€๋Ÿ‰๋ถ„์„์—์„œ ์ƒํ˜ธ์ž‘์šฉ์€ ์œ ์˜ํ•˜์˜€์œผ๋ฉฐ(F[4, 1,202]๏ผ4.77, P๏ผ0.001), ๊ทธ๋ฃน์— ์˜ํ•œ ์ฃผํšจ๊ณผ(F[4, 1,202]๏ผ167.30, p<0.001), ์œ ์ฐฝ์„ฑ์— ์˜ํ•œ ์ฃผํšจ๊ณผ(F[1, 1,202]๏ผ144.61, p<0.001)๋Š” ๋ชจ๋‘ ์œ ์˜ํ•˜์˜€๋‹ค. ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ๋ชจ๋“  ๊ทธ๋ฃน ๊ฐ„์— ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค. ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ๋ชจ๋‘ ๋‹จ์ผ์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ๋ณด๋‹ค ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ ์œ ์˜ํ•˜๊ฒŒ ๋” ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋ณด์˜€๋‹ค. ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ์ง„ํ–‰์— ๋”ฐ๋ฅธ 4 (์ง„๋‹จ๊ทธ๋ฃน) ร— 2 (์œ ์ฐฝ์„ฑ) 2์š”์ธ ํ˜ผํ•ฉ๋ณ€๋Ÿ‰๋ถ„์„์—์„œ ์ƒํ˜ธ์ž‘์šฉ์€ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•˜์ง€ ์•Š์•„ ์งˆ๋ณ‘์˜ ์ง„ํ–‰์— ๋”ฐ๋ผ์„œ ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ์˜ ํŒจํ„ด ์ฐจ์ด๋Š” ๋‚˜ํƒ€๋‚˜์ง€ ์•Š์•˜๋‹ค(F[3, 184]๏ผ2.03, P๏ผ0.112). ๊ทธ๋Ÿฌ๋‚˜ ๊ทธ๋ฃน์— ์˜ํ•œ ์ฃผํšจ๊ณผ(F[3, 184]๏ผ29.68, p<0.001), ์œ ์ฐฝ์„ฑ์— ์˜ํ•œ ์ฃผํšจ๊ณผ(F[1, 184]๏ผ43.54, p<0.001)๋Š” ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค. ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค CDR 0.5์™€ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค CDR 1 ๊ทธ๋ฃน ๊ฐ„์—๋Š” ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ ๋ชจ๋‘ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋‚˜ํƒ€๋‚ด์ง€ ์•Š์•˜์œผ๋‚˜ ๊ทธ ์™ธ์— ๋‹ค๋ฅธ ๊ทธ๋ฃน ๊ฐ„์—๋Š” 2๊ฐœ ์œ ์ฐฝ์„ฑ ๋ชจ๋‘ ํ†ต๊ณ„์ ์ธ ์ฐจ์ด๋ฅผ ๋‚˜ํƒ€๋ƒˆ๋‹ค.
์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์˜ ์ „๋‹จ๊ณ„๋กœ ์•Œ๋ ค์ง„ ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์™€ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์•  ๊ฐ„ 2 (์ง„๋‹จ๊ทธ๋ฃน) ร— 2 (์œ ์ฐฝ์„ฑ) 2์š”์ธ ํ˜ผํ•ฉ๋ณ€๋Ÿ‰๋ถ„์„์—๋Š” ์ƒํ˜ธ์ž‘์šฉํšจ๊ณผ๋Š” ์œ ์˜ํ•˜์ง€ ์•Š์•˜์œผ๋ฉฐ(F[1, 473]๏ผ0.09, P๏ผ0.77) ์ง„๋‹จ๊ทธ๋ฃน ๊ฐ„ ์ฃผํšจ๊ณผ๋„ ์œ ์˜ํ•˜์ง€ ์•Š์•˜๋‹ค(F[1, 473]๏ผ0.08, P๏ผ0.78). ์œ ์ฐฝ์„ฑ์˜ ์ฃผํšจ๊ณผ๋Š” ์œ ์˜ํ•˜์˜€์œผ๋ฉฐ(F[1, 473]๏ผ10.95, P๏ผ0.001), ์˜๋ฏธ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰์ด ์Œ์†Œ์œ ์ฐฝ์„ฑ๋ณด๋‹ค ๋” ๋‚ฎ์•˜๋‹ค. ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์™€ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ๊ฐ„์˜ ๋‹จ์ˆœ ์ฃผํšจ๊ณผ๋ฅผ ๊ฐ๊ฐ ๋ถ„์„ํ•˜๋ฉด, ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ๋Š” 2๊ฐœ ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ์ฐจ์ด๊ฐ€ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•˜์˜€์œผ๋ฉฐ(t[433]๏ผ-6.06, p<0.001), ์˜๋ฏธ์œ ์ฐฝ์„ฑ์ด ์Œ์†Œ์œ ์ฐฝ์„ฑ๋ณด๋‹ค ๋” ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋‚˜ํƒ€๋ƒˆ๋‹ค. ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ๋„ ์˜๋ฏธ์œ ์ฐฝ์„ฑ์ด ์Œ์†Œ์œ ์ฐฝ์„ฑ๋ณด๋‹ค ๋” ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋‚˜ํƒ€๋ƒˆ์ง€๋งŒ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•˜์ง€ ์•Š์•˜๋‹ค.
๊ฐ ๊ฐœ์ธ์—์„œ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰์„ ์ •์ƒ/๋น„์ •์ƒ์œผ๋กœ ๊ตฌ๋ถ„ํ•˜์˜€์œผ๋ฉฐ, ๊ฐ ํ™˜์ž๋Š” 4๊ฐœ ์ค‘ 1๊ฐœ์˜ ์œ ํ˜•์— ์†ํ•˜๊ฒŒ ๋œ๋‹ค: ์˜๋ฏธ-์ •์ƒ/์Œ์†Œ-์ •์ƒ(SPnl), ์˜๋ฏธ-๋น„์ •์ƒ/์Œ์†Œ-์ •์ƒ(SabPnl), ์˜๋ฏธ-์ •์ƒ/์Œ์†Œ-๋น„์ •์ƒ(SnlPab), ์˜๋ฏธ-๋น„์ •์ƒ/์Œ์†Œ-๋น„์ •์ƒ(SPab). ๊ฐ ์ง„๋‹จ๊ทธ๋ฃน๋ณ„, ์ง„ํ–‰์ •๋„์— ๋”ฐ๋ฅธ ๊ทธ๋ฃน๋ณ„๋กœ ์–ด๋–ค ์œ ํ˜•์˜ ํ™˜์ž๋“ค์ด ๋งŽ์€์ง€ ํŒจํ„ด์„ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•ด ํ™˜์ž์ˆ˜๋ฅผ %๋กœ ํ‘œ์‹œํ•˜์˜€๋‹ค(Fig. 3). ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ๋Š” 42.2% ํ™˜์ž๊ฐ€ 2๊ฐœ ์œ ์ฐฝ์„ฑ ๋ชจ๋‘ ์ •์ƒ์ด์—ˆ์œผ๋‚˜ 26.7%์˜ ํ™˜์ž๋Š” ์˜๋ฏธ ์œ ์ฐฝ์„ฑ๋งŒ ์ด์ƒ์„ ๋ณด์ด๋Š” ํŒจํ„ด์„ ๋‚˜ํƒ€๋ƒˆ๋‹ค. AD๋กœ ์ง„ํ–‰ํ•˜๊ฒŒ ๋˜๋ฉด 50.1%์˜ ํ™˜์ž๊ฐ€ 2๊ฐœ ์œ ์ฐฝ์„ฑ ๋ชจ๋‘ ์ด์ƒ์„ ๋‚˜ํƒ€๋‚ด๊ณ  CDR์ด ์ง„ํ–‰ํ• ์ˆ˜๋ก ๊ทธ ๋น„์œจ์€ ์ ์ง„์ ์œผ๋กœ ๋งŽ์•„์ง„๋‹ค. ๋‹จ์ผ์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ๋Š” ์ •์ƒ ๊ทธ๋ฃน๊ณผ ๋น„์Šทํ•œ ํŒจํ„ด์„ ๋‚˜ํƒ€๋‚ด๊ณ  ์žˆ์œผ๋ฉฐ ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ CDR 1๊นŒ์ง€ ์ง„ํ–‰ํ•˜๋”๋ผ๋„ ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ์ •์ƒ์ด๋ฉด์„œ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๋งŒ ์ด์ƒ์„ ๋ณด์ด๋Š” ํ™˜์ž๊ฐ€ ๊พธ์ค€ํžˆ 30%์ •๋„ ์ฐจ์ง€ํ•˜๋Š” ๊ฒƒ์„ ๋ณผ ์ˆ˜ ์žˆ๋‹ค. ์ด์— ๋น„ํ•ด์„œ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋กœ ์ง„ํ–‰ํ•˜๋Š” ์ดˆ๊ธฐ ๋‹จ๊ณ„์—์„œ๋ถ€ํ„ฐ 73.2%์˜ ํ™˜์ž๋“ค์ด 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ์—์„œ ๋ชจ๋‘ ์ด์ƒ์„ ๋‚˜ํƒ€๋‚ด๋Š” ํŽธํ–ฅ๋œ ํŒจํ„ด์„ ๋ณด์˜€์œผ๋ฉฐ ์ด๋Ÿฐ ํŒจํ„ด์€ CDR 1, 2๋กœ ์ง„ํ–‰๋ ์ˆ˜๋ก ๋” ํŽธ์ค‘ ๋ถ„ํฌ๋˜์–ด 97.7%์—์„œ 2๊ฐœ ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ ๋ชจ๋‘ ์ด์ƒ์ด ์žˆ๋Š” ํŒจํ„ด์„ ๋‚˜ํƒ€๋ƒˆ๋‹ค.
๊ณ  ์ฐฐ
๊ณ  ์ฐฐ
๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๋“ค์ด ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰์— ์žˆ์–ด์„œ ์–ด๋–ป๊ฒŒ ๋‹ค๋ฅธ ํŒจํ„ด์„ ๋ณด์ด๋Š”์ง€์™€ ์ง„ํ–‰๊ฒฝ๊ณผ์— ๋”ฐ๋ผ ํŒจํ„ด์ด ์–ด๋–ป๊ฒŒ ๋ณ€ํ™”ํ•˜๋Š”์ง€ ์•Œ์•„๋ณด์•˜์œผ๋ฉฐ, ๊ฒฝ๋„์ธ์ง€์žฅ์•  ๋‹จ๊ณ„์—์„œ ๋‘ ์งˆํ™˜์˜ ์ฐจ์ด๋„ ์ถ”๊ฐ€์ ์œผ๋กœ ํ™•์ธํ•˜์˜€๋‹ค.
์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž์™€ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž ๋ชจ๋‘ ์Œ์†Œ์œ ์ฐฝ์„ฑ๋ณด๋‹ค ์˜๋ฏธ์œ ์ฐฝ์„ฑ์—์„œ ๋” ๋‚ฎ์€ ์ˆ˜ํ–‰์„ ๋ณด์˜€๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๊ฐ ์ง‘๋‹จ์—์„œ ์ˆ˜ํ–‰์˜ ์–‘์  ์†์ƒ์ˆ˜์ค€์„ ๊ณ ๋ คํ•˜๋ฉด ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๋Š” 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ ๋ชจ๋‘ ํฌ๊ฒŒ ์†์ƒ๋œ ํŒจํ„ด์„ ๋ณด์ด๋Š”๋ฐ ๋ฐ˜ํ•ด ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž์˜ ๊ฒฝ์šฐ ์˜๋ฏธ์œ ์ฐฝ์„ฑ์€ ๋šœ๋ ทํ•œ ์†์ƒ์„ ๋ณด์ด์ง€๋งŒ 1ํ‘œ์ค€ํŽธ์ฐจ๋ฅผ ์ •์ƒ/๋น„์ •์ƒ ๊ธฐ์ค€์œผ๋กœ ์‚ผ์•˜์„ ๋•Œ ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ๊ฑฐ์˜ ์ •์ƒ ๋ฒ”์œ„ ์ˆ˜ํ–‰์ˆ˜์ค€(z๏ผ-1.2)์„ ๋ณด์—ฌ ์ง‘๋‹จ ๊ฐ„ ๋‹ค๋ฅธ ์–‘์ƒ์˜ ํŒจํ„ด์ด ๋‚˜ํƒ€๋‚จ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ด๋Ÿฌํ•œ ๊ฒฐ๊ณผ๋Š” ์ „๋‘์—ฝ ์†์ƒ์œผ๋กœ ์ง‘ํ–‰๊ธฐ๋Šฅ์˜ ์ฃผ๋œ ์žฅ์• ๊ฐ€ ์žˆ์„ ๋•Œ๋Š” ์ธ์ถœ ๊ณผ์ •์— ์˜ํ–ฅ์„ ๋ฏธ์ณ 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ ๋ชจ๋‘์—์„œ ํฐ ์–ด๋ ค์›€์„ ๋ณด์ด์ง€๋งŒ, ์˜๋ฏธ์ €์žฅ์†Œ์˜ ์ฃผ๋œ ์†์ƒ์ด ์žˆ์„ ๋•Œ๋Š” ์Œ์†Œ ์œ ์ฐฝ์„ฑ์—๋Š” ๋œ ์˜ํ–ฅ์„ ๋ฏธ์น˜๊ณ  ์˜๋ฏธ์œ ์ฐฝ์„ฑ์—๋งŒ ์˜ํ–ฅ์„ ์ฃผ๋Š” ๊ฒƒ์œผ๋กœ ํ•ด์„๋  ์ˆ˜ ์žˆ๊ณ  ์ด์ „ ์—ฐ๊ตฌ๊ฒฐ๊ณผ์™€๋„ ์ผ์น˜ํ•˜๋Š” ๊ฒƒ์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค[35].
๋ณธ ์—ฐ๊ตฌ์˜ ๊ฐ€์žฅ ํฅ๋ฏธ๋กœ์šด ์ ์€ ์ดˆ๊ธฐ์น˜๋งค๋‹จ๊ณ„์—์„œ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ๊ฐ„์— ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ์˜ ์ˆ˜ํ–‰ ์ฐจ์ด๊ฐ€ ๋šœ๋ ทํ•˜๊ฒŒ ๋‚˜ํƒ€๋‚œ๋‹ค๋Š” ๊ฒƒ์ด๋‹ค. ์ด์ „ ์—ฐ๊ตฌ๋“ค์€ ์น˜๋งค์ง‘๋‹จ์—์„œ ์œ ์ฐฝ์„ฑ ์ฐจ์ด๋งŒ ๋น„๊ตํ•˜์˜€์„ ๋ฟ ์น˜๋งค์˜ ์ง„ํ–‰์— ๋”ฐ๋ฅธ ์œ ์ฐฝ์„ฑ ์ฐจ์ด, ํŠนํžˆ ์น˜๋งค์ดˆ๊ธฐ๋‹จ๊ณ„์—์„œ ์œ ์ฐฝ์„ฑ ์ฐจ์ด๋‚˜ ํŠน์„ฑ์€ ๋ณด๊ณ ๋œ ๋ฐ”๊ฐ€ ์—†์—ˆ๋‹ค. ์น˜๋งค์ดˆ๊ธฐ๋‹จ๊ณ„์ธ CDR 0.5์—์„œ ๋‘ ์งˆํ™˜์˜ ์ธ์ง€๊ธฐ๋Šฅ์€ ๋น„์Šทํ•œ ์ˆ˜์ค€์ž„์—๋„, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž์˜ ์œ ์ฐฝ์„ฑ์€ ์˜๋ฏธ, ์Œ์†Œ ๋ชจ๋‘ ํฌ๊ฒŒ ์ €ํ•˜๋˜์–ด ์žˆ์œผ๋‚˜, ์ด์— ๋น„ํ•ด์„œ CDR 0.5์˜ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž๋“ค์€ ์˜๋ฏธ์œ ์ฐฝ์„ฑ์—์„œ๋งŒ ๋šœ๋ ทํ•œ ์ €ํ•˜๋ฅผ ๋ณด์ด๊ณ  ์Œ์†Œ์œ ์ฐฝ์„ฑ์€ ์ •์ƒ์ˆ˜ํ–‰(z๏ผ-1.0)์„ ๋ณด์ž„์„ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ฆ‰ ๊ฐ ์งˆํ™˜์˜ ์œ ์ฐฝ์„ฑ ํŒจํ„ด์ฐจ์ด๋Š” CDR 0.5์ธ ์ดˆ๊ธฐ ๋‹จ๊ณ„๋ถ€ํ„ฐ ํ™•์—ฐํžˆ ๊ตฌ๋ถ„๋จ์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค. ์‹ฌ์ง€์–ด๋Š” ์ด๋Ÿฐ ํŒจํ„ด์ฐจ์ด๊ฐ€ ์ง€์†๋˜์–ด ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘ ํ™˜์ž๋“ค์€ CDR 2 ๋‹จ๊ณ„์— ์ด๋ฅด๋Ÿฌ์„œ์•ผ CDR 0.5 ๋‹จ๊ณ„์˜ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž์™€ ์œ ์‚ฌํ•œ ์ˆ˜์ค€๊ณผ ํŒจํ„ด์„ ๋‚˜ํƒ€๋ƒˆ๋‹ค. ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๋“ค์€ ์ธ์ง€๊ธฐ๋Šฅ์ด ๊ฒฝ๋ฏธํ•˜๋”๋ผ๋„ ์‹ฌํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ์— ์˜ํ•ด ์ „๋‘์—ฝ์ˆ˜ํ–‰๊ธฐ๋Šฅ์žฅ์• ๊ฐ€ ๋ฐœ์ƒํ•˜์—ฌ ์ ์ ˆํ•œ ๋‹จ์–ด๋ฅผ ํšจ์œจ์ ์œผ๋กœ ์ธ์ถœํ•˜๋Š”๋ฐ ์˜ํ–ฅ์„ ๋ฏธ์น˜๊ธฐ ๋•Œ๋ฌธ์— ์˜๋ฏธ์ธ์ง€ ์Œ์†Œ์ธ์ง€์™€ ๋ฌด๊ด€ํ•˜๊ฒŒ 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ ๋ชจ๋‘๋ฅผ ์ €ํ•˜์‹œํ‚ค๊ฒŒ ๋œ๋‹ค. ์ฆ‰, ์ „๋‘์—ฝ์€ ์œ ์ฐฝ์„ฑ์˜ ์ดˆ๊ธฐ ์ฒ˜๋ฆฌ์— ์ค‘์š”ํ•œ ๊ด€๋ฌธ์˜ ์—ญํ• ์„ ํ•˜๋Š” ๊ฒƒ์œผ๋กœ ์ดํ•ด๋  ์ˆ˜ ์žˆ๊ฒ ๋‹ค. Henry์™€ Crawford์˜ ์—ฐ๊ตฌ[8]์—์„œ๋„ ์ „๋‘์—ฝ์— ๊ตญ์†Œ์ ์ธ ๋ณ‘๋ณ€์ด ์žˆ๋Š” ๊ฒฝ์šฐ ์Œ์†Œ์œ ์ฐฝ์„ฑ ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๋„ ๋น„์Šทํ•œ ์ •๋„์˜ ์ €ํ•˜๋ฅผ ๋ณด์ด๋Š” ๊ฒƒ์œผ๋กœ ๋ณด๊ณ ๋˜์—ˆ๋Š”๋ฐ ์šฐ๋ฆฌ์˜ ํ•ด์„๊ณผ ์ผ์น˜ํ•˜๋Š” ๊ฒƒ์œผ๋กœ ๋ณผ ์ˆ˜ ์žˆ๋‹ค.
์šฐ๋ฆฌ๋Š” ์ง„๋‹จ๊ทธ๋ฃน๋ณ„ ๋˜๋Š” ์ง„ํ–‰๋‹จ๊ณ„๋ณ„๋กœ ๊ฐœ๋ณ„ ํ™˜์ž์˜ ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ํŒจํ„ด์„ 4๊ฐœ๋กœ ๋ถ„๋ฅ˜ํ•˜์—ฌ ๋ถ„ํฌ๋ฅผ ์‚ดํŽด๋ณด์•˜๋Š”๋ฐ, ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ์™€ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์•  ๋‹จ๊ณ„์—์„œ๋Š” ์—ญ์‹œ ๋น„์Šทํ•œ ๋ถ„ํฌ ์–‘์ƒ์„ ๋ณด์˜€์œผ๋‚˜ ๋‹ค์ค‘์˜์—ญ ๊ธฐ์–ต์ƒ์‹คํ˜•๊ฒฝ๋„์ธ์ง€์žฅ์• ๋Š” ์˜๋ฏธ์œ ์ฐฝ์„ฑ ์žฅ์• ๋งŒ ์žˆ๋Š” ํ™˜์ž๊ฐ€ ์•ฝ๊ฐ„ ๋” ๋งŽ์•˜์œผ๋ฉฐ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ๋Š” ์œ ์ฐฝ์„ฑ์—์„œ ๋ชจ๋‘ ์žฅ์• ๊ฐ€ ์žˆ๋Š” ํ™˜์ž๊ฐ€ ์•ฝ๊ฐ„ ๋” ๋งŽ์€ ๊ฒฝํ–ฅ์„ ๋ณด์˜€๋‹ค. ์ด๋Ÿฐ ํŒจํ„ด์€ ์น˜๋งค ๋‹จ๊ณ„๋กœ ๋“ค์–ด๊ฐ€๋ฉด ์ฐจ์ด๊ฐ€ ๋” ๋ช…ํ™•ํ•ด์ง€๋ฉด์„œ ํ™•์—ฐํžˆ ๋‹ค๋ฅธ ๋ถ„ํฌ๋ฅผ ๋‚˜ํƒ€๋‚ด๋Š”๋ฐ ํŠนํžˆ CDR 0.5 ๋‹จ๊ณ„์—์„œ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž์—์„œ ๋ถ„ํฌ๊ฐ€ ๋งค์šฐ ํŠน์ดํ•˜์˜€๋‹ค. ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์€ ๋ณ‘์ด ์ง„ํ–‰ํ• ์ˆ˜๋ก 2๊ฐœ ์œ ์ฐฝ์„ฑ์—์„œ ๋ชจ๋‘ ์ด์ƒ์„ ๋ณด์ด๋Š” ํ™˜์ž๊ฐ€ ์ ์ง„์ ์œผ๋กœ ๋งŽ์•„์ง€์ง€๋งŒ ์•ฝ 30%์˜ ํ™˜์ž๋Š” CDR 1๊นŒ์ง€๋„ ์˜๋ฏธ์œ ์ฐฝ์„ฑ ์žฅ์• ๋งŒ ์žˆ๋Š” ์–‘์ƒ ํŠน์ง•์„ ๋ณด์ด๋Š”๋ฐ ๋ฐ˜ํ•ด, ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋Š” CDR 0.5 ๋‹จ๊ณ„์—์„œ ์ด๋ฏธ 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ์—์„œ ๋ชจ๋‘ ์žฅ์• ๋ฅผ ๋ณด์ด๋Š” ํ™˜์ž๊ฐ€ ๋‹ค์ˆ˜์ด๋ฉฐ ์ด๋Ÿฐ ํŒจํ„ด์€ ๋ณ‘์ด ์ง„ํ–‰ํ• ์ˆ˜๋ก ๊ฑฐ์˜ ๋น„์Šทํ•œ ์–‘์ƒ์œผ๋กœ ๋Œ€๋ถ€๋ถ„์˜ ํ™˜์ž๊ฐ€ 2๊ฐœ์˜ ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ์žฅ์• ๋ฅผ ๋ณด์ด๋Š” ๊ฒƒ์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค.
๊ธฐ์กด์˜ ์—ฐ๊ตฌ์—์„œ๋Š” ์œ ์ฐฝ์„ฑ์˜ ์–‘์  ๋น„๊ต๋ฅผ ํ†ตํ•ด์„œ๋งŒ ์น˜๋งค ํ™˜์ž์˜ ์ˆ˜ํ–‰์ฐจ์ด๋ฅผ ์—ฐ๊ตฌํ•˜์˜€์„ ๋ฟ ์œ ์ฐฝ์„ฑ ํŒจํ„ด์— ๋Œ€ํ•œ ์งˆ์  ์ฐจ์ด๋ฅผ ํ™•์ธํ•œ ์—ฐ๊ตฌ๋Š” ์ „ํ˜€ ์—†์—ˆ์œผ๋‚˜, ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์–‘์ , ์งˆ์  ์ฐจ์ด๋ฅผ ์ข…ํ•ฉํ•˜์—ฌ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์—์„œ ์ฐจ์ด๋ฅผ ๋” ๋ช…ํ™•ํ•˜๊ฒŒ ํ™•์ธํ•˜์˜€๋‹ค. ๊ฒฐ๊ณผ๋ฅผ ์ข…ํ•ฉํ•˜๋ฉด, ๊ฒฝ๋„์ธ์ง€์žฅ์•  ๋‹จ๊ณ„์—์„œ ์–‘์ ์ธ ์ธก๋ฉด์—์„œ๋Š” ์‹ฌํ•œ ๋ฐฑ์งˆ๋ณ€์„ฑ ์œ ๋ฌด์™€ ์ƒ๊ด€์—†์ด ์˜๋ฏธ์™€ ์Œ์†Œ์œ ์ฐฝ์„ฑ ํŒจํ„ด์˜ ๋šœ๋ ทํ•œ ์ฐจ์ด๊ฐ€ ๋‚˜ํƒ€๋‚˜์ง€ ์•Š์ง€๋งŒ ์งˆ์ ์ธ ์ธก๋ฉด์—์„œ๋Š” ๊ฐ ์น˜๋งค ๋‹จ๊ณ„์—์„œ ๋ณด์ด๋Š” ์œ ์ฐฝ์„ฑ ์ฐจ์ด ํŠน์„ฑ์„ ๋‚˜ํƒ€๋‚ด๊ธฐ ์‹œ์ž‘ํ•˜์˜€์œผ๋ฉฐ, ์น˜๋งค์ดˆ๊ธฐ๋‹จ๊ณ„์—์„œ๋Š” ์–‘์ , ์งˆ์  ์ฐจ์ด๊ฐ€ ๋ชจ๋‘ ๋‚˜ํƒ€๋‚˜๋Š” ๋šœ๋ ทํ•œ ํŒจํ„ด ์ฐจ์ด๋ฅผ ๋ณด์—ฌ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋ฅผ ๊ฐ๋ณ„ํ•˜๋Š”๋ฐ ์žˆ์–ด์„œ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ ์œ ์ฐฝ์„ฑ ํŒจํ„ด์ด ์œ ์šฉํ•œ ์ง€ํ‘œ๊ฐ€ ๋  ์ˆ˜ ์žˆ์Œ์„ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค.
๋ณธ ์—ฐ๊ตฌ๋Š” ๋‹ค๋ฅธ ์—ฐ๊ตฌ๋“ค๊ณผ ๋‹ฌ๋ฆฌ ๋Œ€๊ทœ๋ชจ ํ™˜์ž์ž๋ฃŒ๋ฅผ ๊ธฐ๋ฐ˜์œผ๋กœ ๋„์ถœ๋œ ๊ฒฐ๊ณผ์ด๊ธฐ ๋•Œ๋ฌธ์— ๋” ์‹ ๋ขฐํ•  ์ˆ˜ ์žˆ๋‹ค. ๋˜ํ•œ ๊ณผ์ œํŠน์„ฑ์ด ๋‹ค๋ฅธ ๊ฒ€์‚ฌ๋ฅผ ์–‘์ ์œผ๋กœ ๋น„๊ตํ•จ์— ์žˆ์–ด ์›์ ์ˆ˜๊ฐ€ ์•„๋‹ˆ๋ผ z์ ์ˆ˜๋ฅผ ์‚ฌ์šฉํ•˜์˜€๊ธฐ ๋•Œ๋ฌธ์— ๊ฒ€์‚ฌ ๊ฐ„์— ๋˜๋Š” ํ™˜์ž๊ตฐ ๊ฐ„์— ์ˆ˜ํ–‰์ˆ˜์ค€์„ ์ง์ ‘ ๋น„๊ตํ•˜๊ณ  ํ•ด์„ํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๋˜ ๊ธฐ์กด ์—ฐ๊ตฌ์—์„œ ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž๊ตฐ์˜ ๋™์งˆ์„ฑ ๋ฌธ์ œ๋กœ ๋ถˆ์ผ์น˜ํ•˜๋Š” ๊ฒฐ๊ณผ๋“ค์ด ๋„์ถœ๋˜์—ˆ๋Š”๋ฐ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค๋ผ๋Š” ๋™์งˆ์ ์ธ ํŠน์„ฑ์„ ๊ฐ€์ง„ ํ™˜์ž๋กœ ๊ตฌ์„ฑํ•˜์˜€๊ณ  ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž์˜ ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ํŠน์ง•์— ๋Œ€ํ•œ ํ•ด์„์˜ ์ •ํ™•์„ฑ์„ ๋†’์ผ ์ˆ˜ ์žˆ์—ˆ๋‹ค.
๊ทธ๋Ÿผ์—๋„ ๋ถˆ๊ตฌํ•˜๊ณ  ๋ณธ ์—ฐ๊ตฌ๋Š” ๋ช‡ ๊ฐ€์ง€ ์ œํ•œ์ ์ด ์žˆ๋‹ค. ํ›„ํ–ฅ์  ์—ฐ๊ตฌ์˜ ํŠน์„ฑ ์ƒ ๊ฐ ํ™˜์ž๊ตฐ์˜ ์ˆ˜๋ฅผ ์ž„์˜์ ์œผ๋กœ ์ œํ•œํ•  ์ˆ˜ ์—†์–ด ๊ฐ ํ™˜์ž๊ตฐ์— ํฌํ•จ๋œ ํ™˜์ž์ˆ˜์˜ ์ฐจ์ด๊ฐ€ ํฌ๋‹ค. ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์•  ํ™˜์ž๊ฐ€ ๋‹ค๋ฅธ ์ง‘๋‹จ์— ๋น„ํ•ด์„œ ์†Œ์ˆ˜๋กœ ๊ตฌ์„ฑ๋˜์–ด ์žˆ๊ณ  ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์— ๋น„ํ•ด ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž์˜ ์ˆ˜๊ฐ€ ์ ์–ด ๊ฒฐ๊ณผ์— ์˜ํ–ฅ์„ ๋ฏธ์ณค์„ ๊ฐ€๋Šฅ์„ฑ์„ ์™„์ „ํžˆ ๋ฐฐ์ œํ•  ์ˆ˜ ์—†๊ฒ ๋‹ค. ๋˜ํ•œ ๋‘ ์งˆํ™˜์ด ๊ณต์กดํ•˜๋Š” ํ˜ผํ•ฉ์น˜๋งค๋ฅผ ๋ฐฐ์ œํ•˜๊ธฐ ์œ„ํ•ด ์ค‘๋“ฑ๋„์˜ ๋ฐฑ์งˆ๋ณ€์„ฑ์„ ๊ฐ€์ง„ ํ™˜์ž๋ฅผ ์—ฐ๊ตฌ์—์„œ ์ œ์™ธํ•˜์˜€์Œ์—๋„ ํ”ผํŠธ๋ฒ„๊ทธํ™”ํ•ฉ๋ฌผB-์–‘์ „์ž๋ฐฉ์ถœ๋‹จ์ธต์ดฌ์˜(Pittsburgh Compound-B Positron Emission Tomography, PIB-PET), ๋‡Œ์ฒ™์ˆ˜์•ก์•„๋ฐ€๋กœ์ด๋“œ(CSF amyloid), ๋‡Œ์ฒ™์ˆ˜์•กํƒ€์šฐ(CSF tau) ๋“ฑ์˜ ์ƒ๋ฌผํ‘œ์ง€์ž๊ฒ€์‚ฌ๋‚˜ ๋ณ‘๋ฆฌ๊ฒ€์‚ฌ๋ฅผ ์‹œํ–‰ํ•˜์ง€ ์•Š์•˜์œผ๋ฏ€๋กœ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€๊ฒฝ๋„์ธ์ง€์žฅ์• ๋‚˜ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค ํ™˜์ž ์ค‘ ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘์˜ ๋ณ‘๋ฆฌ๋ฅผ ๊ฐ€์ง€๊ณ  ์žˆ์„ ๊ฐ€๋Šฅ์„ฑ๋„ ์™„์ „ํžˆ ๋ฐฐ์ œํ•  ์ˆ˜ ์—†๋Š” ์ œํ•œ์ ์ด ์žˆ๋‹ค.
๊ฒฐ๋ก ์ ์œผ๋กœ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์˜๋ฏธ์œ ์ฐฝ์„ฑ๊ณผ ์Œ์†Œ์œ ์ฐฝ์„ฑ ์ˆ˜ํ–‰ ํŒจํ„ด์ด 2๊ฐœ์˜ ๋‹ค๋ฅธ ์›์ธ์„ ๊ฐ€์ง€๋Š” ์•Œ์ธ ํ•˜์ด๋จธ๋ณ‘๊ณผ ํ”ผ์งˆํ•˜ํ˜ˆ๊ด€์น˜๋งค์˜ ์ „๋‹จ๊ณ„์ธ ๊ฒฝ๋„์ธ์ง€์žฅ์• ์—์„œ๋Š” ๋ณ€๋ณ„ํ•  ์ˆ˜ ์žˆ๋Š” ํ†ต๊ณ„์  ์œ ์˜์„ฑ์ด ์—†์ง€๋งŒ ์ž„์ƒ์  ๊ฒฝํ–ฅ์„ฑ์„ ๋ณด์ด๋ฉฐ ์ดˆ๊ธฐ ์น˜๋งค ๋‹จ๊ณ„์—์„œ 2๊ฐœ์˜ ์งˆํ™˜์„ ๊ฐ๋ณ„ํ•˜๋Š”๋ฐ ์žˆ์–ด ์‹ ๊ฒฝ์‹ฌ๋ฆฌํ•™์ ์œผ๋กœ ์ค‘์š”ํ•œ ์—ญํ• ์„ ํ•œ๋‹ค๋Š” ๊ฒƒ์„ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ถ”ํ›„์—๋Š” ๋‡Œ์˜์ƒ์ž๋ฃŒ๋ฅผ ์ด์šฉํ•˜์—ฌ ์ง์ ‘์ ์œผ๋กœ ๊ฐ ํ™˜์ž ์ง‘๋‹จ์—์„œ ์œ ์ฐฝ์„ฑ๊ฒ€์‚ฌ ์ˆ˜ํ–‰์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์š”์ธ์— ๋Œ€ํ•œ ๋ถ„์„์ด ์ด๋ฃจ์–ด์ง„๋‹ค๋ฉด ๋ณธ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋ฅผ ์ •ํ™•ํ•˜๊ฒŒ ํ•ด์„ํ•˜๋Š”๋ฐ ๋„์›€์ด ๋  ๊ฒƒ์ด๋‹ค.
Acknowledgments
Acknowledgments

๋ณธ ๋…ผ๋ฌธ์€ ๊ตญ๋ฏผ๊ฑด๊ฐ•๋ณดํ—˜ ์ผ์‚ฐ๋ณ‘์› ์—ฐ๊ตฌ๋น„ ์ง€์›์œผ๋กœ ์ด๋ฃจ์–ด์กŒ์œผ๋ฉฐ, ๋ณด๊ฑด๋ณต์ง€๋ถ€ ๋ณด๊ฑด์˜๋ฃŒ์—ฐ๊ตฌ๊ฐœ๋ฐœ์‚ฌ์—…์˜ ์ง€์›(HI10C2020)๊ณผ 2014๋…„๋„ ์ •๋ถ€(๋ฏธ๋ž˜๋ถ€)์˜ ์žฌ์›์œผ๋กœ ํ•œ๊ตญ์—ฐ๊ตฌ์žฌ๋‹จ ๋‡Œ๊ณผํ•™์›์ฒœ๊ธฐ์ˆ ๊ฐœ๋ฐœ์‚ฌ์—…์˜ ์ง€์›์„ ๋ฐ›์•„ ์ˆ˜ํ–‰๋œ ์—ฐ๊ตฌ์ž„(No. 2014M3C7A1064752).

Supplementary Material

Supplementary Material

Supplementaryย Table.
jkna-34-1-14-supple.pdf

Figureย 1.
Z-score for semantic and phonemic fluency in the patient groups. NC; normal control, aMCI; amnestic mild cognitive impairment, svMCI; subcortical vascular mild cognitive impairment, AD; Alzheimerโ€™s disease, SVaD; subcortical vascular dementia, *p<.05 **p<.01 ***p<.001, aThe mean differences from the other groups are all significant at the .05 level, bThe mean difference from NC group is significant at the .05 level, cThe mean difference from aMCI group is significant at the .05 level, dThe mean difference from svMCI group is significant at the .05 level, eThe mean difference from AD group is significant at the .05 level, fThe mean difference from SVaD group is significant at the .05 level.
jkna-34-1-14f1.tif
Figureย 2.
Z-score for semantic and phonemic fluency by disease severity in the groups. aMCI; amnestic mild cognitive impairment, saMCI; single-domain amnestic mild cognitive impairment, maMCI; multiple-domain amnestic mild cognitive impairment, AD; Alzheimerโ€™s disease, svMCI; subcortical vascular mild cognitive impairment, SVaD; subcortical vascular dementia, CDR; clinical dementia rating, *p<.05 **p<.01 ***p<.001, aThe mean differences from the other groups are all significant at the .05 level, bThe mean difference from saMCI group is significant at the .05 level, cThe mean difference from maMCI group is significant at the .05 level, dThe mean difference from svMCI group is significant at the .05 level, eThe mean difference from AD-CDR 0.5 group is significant at the .05 level, fThe mean difference from AD-CDR 1 group is significant at the .05 level, gThe mean difference from AD-CDR 2 group is significant at the .05 level, hThe mean difference from SVaD-CDR 0.5 group is significant at the .05 level, iThe mean difference from SVaD-CDR 1 group is significant at the .05 level, jThe mean difference from SVaD-CDR 2 group is significant at the .05 level, The significant level of mean difference is presented at the Supplementary Table.
jkna-34-1-14f2.tif
Figureย 3.
Pattern of verbal fluency abnormality in disease groups. (A) Percentage in disease groups (B) Percentage by severity in Alzheimerโ€™s disease (C) Percentage by severity in subcortical vascular dementia. SPnl; semantic-normal and phonemic-normal, SabPnl; semantic-abnormal and phonemic-normal, SnlPab; semantic-normal and phonemic-abnormal, SPab; semantic-abnormal and phonemic-abnormal, NC; normal control, aMCI; amnestic mild cognitive impairment, svMCI; subcortical vascular mild cognitive impairment, AD; Alzheimerโ€™s disease, SVaD; subcortical vascular dementia, saMCI; single-domain amnestic mild cognitive impairment, maMCI; multiple-domain amnestic mild cognitive impairment, CDR; clinical dementia rating.
jkna-34-1-14f3.tif
Tableย 1.
Demographics and raw scores of verbal fluency tasks
NC (n๏ผ73) aMCI (n๏ผ673) svMCI (n๏ผ42) AD (n๏ผ535) SVaD (n๏ผ152)
Age 66.6ยฑ6.1 68.3ยฑ6.3 70.9ยฑ5.4 70.4ยฑ6.6 73.2ยฑ5.6
Gender (Female %) 76.7 69.7 64.3 65.6 55.3
Education 7.5ยฑ4.7 9.0ยฑ4.7 9.4ยฑ4.6 8.5ยฑ4.9 7.8ยฑ5.0
K-MMSE 26.3ยฑ2.2 25.6ยฑ3.0 25.6ยฑ3.1 19.5ยฑ4.3 18.4ยฑ5.0
CDR-SB 1.2ยฑ0.6 1.3ยฑ0.8 1.3ยฑ0.8 5.1ยฑ2.4 7.0ยฑ3.8
Semantic fluency: raw 15.1ยฑ3.2 12.5ยฑ4.0 11.3ยฑ3.6 8.8ยฑ3.7 6.1ยฑ3.2
Phonemic fluency: raw 20.4ยฑ9.3 17.9ยฑ9.6 15.7ยฑ11.0 11.1ยฑ8.7 4.3ยฑ6.0

NC; normal control, aMCI; amnestic mild cognitive impairment, svMCI; subcortical vascular mild cognitive impairment, AD; Alzheimerโ€™s disease, SVaD; subcortical vascular dementia, K-MMSE; Korean mini-mental status examination, CDR-SB; clinical dementia rating-sum of boxes.

Tableย 2.
Demographics and raw scores of verbal fluency tasks
saMCI (n๏ผ240) maMCI (n๏ผ433) AD CDR 0.5 (n๏ผ234) AD CDR 1 (n๏ผ255) AD CDR 2 (n๏ผ45) svMCI (n๏ผ42) SVaD CDR 0.5 (n๏ผ41) SVaD CDR 1 (n๏ผ62) SVaD CDR 2 (n๏ผ43)
Age 67.4ยฑ6.5 68.8ยฑ6.2 70.3ยฑ6.3 70.4ยฑ6.8 70.9ยฑ6.9 70.9ยฑ5.4 73.7ยฑ6.5 73.6ยฑ5.0 71.8ยฑ5.3
Gender (Female %) 65.0 72.3 63.2 67.1 71.1 64.3 53.7 56.5 51.2
Education 9.7ยฑ5.5 8.5ยฑ4.5 8.7ยฑ5.1 8.5ยฑ4.8 7.8ยฑ4.9 9.4ยฑ4.6 8.0ยฑ4.7 7.4ยฑ4.8 8.4ยฑ5.3
K-MMSE 26.6ยฑ2.6 25.1ยฑ3.0 21.6ยฑ3.5 18.4ยฑ3.9 15.4ยฑ4.5 25.6ยฑ3.1 21.7ยฑ3.9 19.1ยฑ4.0 15.0ยฑ4.5
CDR-SB 1.1ยฑ0.6 1.5ยฑ3.8 3.2ยฑ0.9 5.9ยฑ1.2 10.6ยฑ1.5 1.3ยฑ0.8 3.3ยฑ1.0 11.2ยฑ1.9 11.2ยฑ1.9
Semantic fluency: raw 14.3ยฑ3.9 11.5ยฑ3.8 10.0ยฑ3.4 8.2ยฑ.7 6.6ยฑ3.5 11.3ยฑ3.6 7.4ยฑ3.1 4.5ยฑ2.5 4.5ยฑ2.5
Phonemic fluency: raw 22.4ยฑ9.2 15.4ยฑ8.8 12.9ยฑ8.9 10.2ยฑ8.4 7.0ยฑ6.9 15.7ยฑ11.0 6.1ยฑ6.8 2.2ยฑ3.9 2.2ยฑ1.1

saMCI; single-domain amnestic mild cognitive impairment, maMCI; multiple-domain amnestic mild cognitive impairment, AD; Alzheimerโ€™s disease, svMCI; subcortical vascular mild cognitive impairment, SVaD; subcortical vascular dementia, CDR; clinical dementia rating, K-MMSE; Korean mini-mental status examination, CDR-SB; clinical dementia rating-sum of boxes.

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