노인들 외출시 한 알 만 복용하면 낙상을 예방 해 주는 약 > 임상 응용 정보

노인들 외출시 한 알 만 복용하면 낙상을 예방 해 주는 약

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노인들 외출시 한 알 만 복용하면 
 
낙상을 예방 해 주는 약</TD></TR>
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노인들이 외출할 때 마다
주의력 증강제 Methylphenidate 20mg 한 알만 복용해도 
낙상 위험을 예방해 줄 수 있음이 입증되었다
 
이는 하버드 의대와 이스라엘 연구팀의 협동 연구결과이며
미국 노인병 학회지를 통해 발표된 내용이다 </TD></TR>
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걸음 거리의 생리학</TD></TR>
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걸어간다는 것은 자동적 연속 동작이 아니다
 
 감각과 지각과 뇌의 운동 신경이 총동원되어 
 순간 순간 주위의 상황을 판단하면서 
 안전한 Step을 내딛게 되는 계획적 동작인 것이다</TD></TR>
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상황 판단력 (EF)의 감퇴</TD></TR>
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노인들의 걸음마가 더디고 속도가 느려지는 것은
상황 판단력 Executive Function(EF)이 감퇴했기 때문이다
 
오래전부터 EF 측정치가 낮아진 노인들에게서
낙상률이 높다는 사실이 발표 되어 왔었다
 
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주의력 집중 증강제 Methylphenidate</TD></TR>
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건강한 정상 노인들을 대상으로 하여 
주의력을 집중시켜 주고 과민 행동을 조정해주는
 
 Methylphenidate 을 한 알 (20mg)만 복용시키면
 복용 후 2시간 째 부터 걸음 거리가 빨라지고 
확실하게 step을 밟는다
 
낙상 두려움도 사라지고 낙상률이 감소한다
 
Methylphenidate은 기억력은 증가 시키지 않으나
상황 판단력을 증가 시켜 막상 위험률을 감소시킨다
 
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약물 복용후 2시간 째 측정한 상항 판단 력 증가 현항
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75세 노인 </TD>
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Placebo</TD>
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Methylphenidate
1회20mg </TD></TR>
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투약 전</TD>
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투약후</TD>
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투약후</TD></TR>
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장기기억력 정확도</TD>
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50.7</TD>
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49.6</TD>
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53.5</TD></TR>
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상할판단력 지수 </TD>
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88.8</TD>
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90.0</TD>
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94.5</TD></TR>
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상항판단 소요시간</TD>
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601.9</TD>
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492.6</TD>
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489.3</TD></TR>
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낙물 잡는 소요시간</TD>
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901.8</TD>
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902.4</TD>
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750.4</TD></TR></TBODY></TABLE></TD></TR>
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걸음동작 개선효과</TD></TR>
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의자로부터 일어나서 3 meter 를 걷고 되돌아와 다시 앉을 때까지의 
 
걸음동작을 측정한 결과 
 Methylphenidate는 동작 시간을 단축시키고 걸음 속도를 증가시키므로
 
 Step을 안정화 시키고 낙상률을 감소 시키게 된다
 
이러한 효과는 파킨슨 환자에 대한 임상에서도 발표된 바 있다
 
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약물 복용후 2시간 째 측정한 상항 판단 력 증가 현항</TD></TR>
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75세 노인 </TD>
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Placebo</TD>
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Methylphenidate
1회20mg </TD></TR>
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투약 전</TD>
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투약후</TD>
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투약후</TD></TR>
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걸음 동작 시간</TD>
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10.3</TD>
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9,9</TD>
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9.4</TD></TR>
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걸음속도 </TD>
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1.12</TD>
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1.19</TD>
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1.20</TD></TR></TBODY></TABLE></TD></TR>
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순환기계 부작용이 발견되지 않았다</TD></TR>
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정상 노인에게 Methylphenidate를 투약해도 
 혈압과 맥박은 위약군과 동일하다
 
이 약물은 파킨슨 환자에게나 우울증 노인에게도
안전하게 투약할 수 있음이 발표된 바 있다
 
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75세 노인 </TD>
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Methylphenidate
1회20mg</TD>
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 Placebo</TD></TR>
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 </TD>
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투약 전</TD>
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투약후</TD>
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투약 전</TD>
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투약후</TD></TR>
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수축기 혈압</TD>
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123.9</TD>
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129.2</TD>
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126.5</TD>
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131.9</TD></TR>
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확장기 혈압</TD>
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71.1</TD>
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71.9</TD>
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73.1</TD>
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73.5</TD></TR>
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맥박수</TD>
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76.9</TD>
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76.7</TD>
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74.5 </TD>
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70.8</TD></TR></TBODY></TABLE></TD></TR>
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낙상 위험률 저하 이유</TD></TR>
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Methylphenidate은 대뇌 피질을 자극하여 감각 신경계와 지각신경계와 운동 신경계 연결 회로를 활발하게 촉진한다
 
따라서 걸어가는 주위 상황을 정확하게 인식시켜 
발디딤의 위치를 민첩하게 파악케하고 그 강도를 안정적으로 작동시킨다
 
Dopamine을 증가시켜 미세 운동 동작을 유연하게 유지시킨다
 
노인 골절은 골다공증 보다는 낙상 때문이다
 또한 낙상으로 입원한 노인의 50%는 1년 이내 사망한다
 Methylphenidate 은 정상노인뿐 아니라 
 파킨슨 환자에게도 안전하게 사용 할 수 있다
 
 <IMG src="/_dimg/2%20falls.bmp">
 
본 임상은 26명에 대한 소규모 임상이지만
 외출 전 단 한 알 복용으로 낙상을 예방할 수 있다는 것은
 
대단한 발견이 아닐 수 없다 
 
적응증 허가를 추가하기 위해서는 
 
하루 속히 대단위 임상을 서둘러야 할 것이다</TD></TR>
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근거</TD>
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Journal of the American Geriatrics Society April 2008 Vol 56 Issue 4 Pages 695-700, 
Can Methylphenidate Reduce Fall Risk in Community-Living Older Adults? A Double-Blind, Single-Dose Cross-Over Study; Ron Ben-Itzhak MD, Nir Giladi MD, Leor Gruendlinger MS, Jeffrey M. Hausdorff PhD :<A href="javascript:popRef(┖a1┖)">**Movement Disorders Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; and </A>, Department of Geriatrics, Reuth Medical Center, Tel Aviv, Israel; ‡Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; §Department of Physical Therapy, Harvard Medical School, Boston, Massachusetts, and <?xml:namespace prefix = v /><v:shape style="WIDTH: 6.75pt; HEIGHT: 11.25pt; VISIBILITY: visible; mso-wrap-style: square; mso-left-percent: -10001; mso-top-percent: -10001; mso-position-horizontal: absolute; mso-position-horizontal-relative: char; mso-position-vertical: absolute; mso-position-vertical-relative: line" id=그림_x0020_15 o:spid="_x0000_s1026" type="#_x0000_t75" alt="설명: ||"><?xml:namespace prefix = w ns = "urn:schemas-microsoft-com:office:word" /><w:wrap type="none"></w:wrap><w:anchorlock></w:anchorlock></v:shape>Division on Aging, Harvard Medical School, Boston, Massachusetts
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