특발성 파킨슨병과 파킨슨플러스 증후군 환자의 마비말장애 및 인지기능 특성 비교 (Characteristics of Dysarthria and Cognitive Functions in Patients with Parkinson’s Disease and Parkinson- plus Syndrome)

서지정보

· 발행기관 : 한국언어청각임상학회
· 수록지 정보 : Communication Sciences and Disorders / 19권 / 4호 / 551 ~ 557페이지
· 저자명 : 김자영, 정선주, 이재홍, 권미선

초록

배경 및 목적: 본 연구는 공통적 특징으로 감별진단이 어려운 특발성 파킨슨병(idiopathic Parkinson’ s disease, IPD)과 파킨슨플러스증후군 환자의 말/인지기능 특징을 살펴보고, 감별진단을 위한 유용한 요소인지 알아보고자 하였다. 방법: IPD 환자 11명과 파킨슨플러스 증후군 중 산발적 올리브교소뇌위축(sporadic olivopontocerebellar atrophy, MSA-c)환자 10명, 선조흑질변성(Striatonigral de-generation; Parkinsonian variant; MSA-p) 환자 10명, 진행성핵상마비(Progressive supranuclear palsy, PSP) 환자 10명(총 41명)을 대상으로 파킨슨병 등급척도(Unified Parkinson’ s Disease Rating Scale, UPDRS)의 세부항목 중 경축, 운동느림증, 실조증의 각 점수를 합친 것을 기준으로 네 집단의 운동기능장애 중증도를 통제한 후 마비말장애 유형 및 인지능력을 평가하였다. 결과: UPDRS 운동기능 능력을 세분화하여 분석한 결과, 경축은 IPD-MSA-p 집단과 MSA-c-MSA-p 집단 간, 실조증은 IPD-MSA-c 집단, MSA-c-MSA-p 집단,MSA-p-PSP 집단 간 유의미한 차이를 보였다(p<.05). 또한, 마비말장애 유형 중 과소운동형은 IPD-MSA-c 집단과 MSA-c-MSA-p 집단간 유의하였고, 실조형은 IPD-MSA-c 집단과 MSA-c-MSA-p 집단, MSA-c-PSP 집단 간 유의했다(p<.01). Korean version of Mon-treal Cognitive Assessment (MoCA-K) 점수에서 PSP 환자는 IPD, MSA-c 환자에 비해 유의미하게 낮은 인지기능을 보였다(p<.05). 논의 및 결론: 마비말장애 유형과 인지능력 특성이 네 집단을 감별진단 하는 데 유용할 수 있음을 시사하였는데 더 많은 수의 증례를 포함해 진단 세부 유형별 연구가 이루어지길 기대해본다

영어초록

Objectives: This study was to investigate the characteristics of dysarthria and cognitive ability of patients with Parkinson’s disease and Parkinson-plus syndrome to find the key components that can differentiate these diseases. Methods: Forty-one patients (11 patients with idiopathic Parkinson’s disease [IPD], 10 with multiple systems atrophy with predominant cerebellar ataxia [MSA-c], 10 with multiple systems atrophy with predominant Parkinsonism [MSA-p], and 10 with progressive supranuclear palsy [PSP]) participated. After controlling the motor ability in rigidity, bradykinesia, and ataxia in the Unified Parkinson’s Disease Rating Scale of 4 groups, dysarthria was assessed by performing tasks of prolonged phonation, diadochokinesis, and connected speech. In addition, cognitive function was measured by the Korean version of the Montreal Cognitive Assessment. Results: The age, education level, disease duration, and motor ability of patients were not significantly different. However, analysis of motor ability showed significant (p<.05) differences between IPD-MSA-p, and MSA-c-MSA-p group for rigidity, and between IPD-MSA-c, MSA-c-MSA-p, and MSA-p-PSP group for ataxia. There was no significant difference for bradykinesia. In addition, dysarthria evaluation showed that the hypokinetic component was more frequently observed in the IPD and MSA-p than the MSA-c group and the ataxic component was greater in the MSA-c than other groups. Moreover, cognitive ability was significantly (p< .05) more impaired in patients with PSP than the IPD & MSA-c groups. Conclusion: The characteristics of dysarthria and cognitive deficits may serve as useful factors in distinguishing IPD, MSA-c, MSA-p, and PSP. Further studies including large numbers of patients are warranted to confirm these results.

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