노인의 인지기능과 우울증에 미치는 음악치료의 개선 효과

다국어 초록 (Multilingual Abstract)

Music therapy is a psychical therapy which can be used to improve cognitive functions and depression. The elderly are exposed to the environment easily leading them to dementia, and, as the disease progresses, decline of the cognitive functions makes them difficult in daily life. The present study has investigated if a songwriting and a concert-oriented music therapy (COMT) improve the depression and cognitive functions of the elderly. The study is divided into 3 parts, (a) a songwriting to improve the cognitive functions of the elderly with dementia, (b) a COMP for improving the depression of the elderly, and (c) correlation between brain waves and the questionnaire based tests used in the present study and specially designed for the elderly - MMSE-K (Mini Mental State Examination-Korea) for assessing cognitive functions and GDS-K (Geriatric Depression Scale in Korea) for scaling depression.
In order to explore the effects of songwriting on the cognitive functions of the elderly with dementia, the experiment was performed to 30 participants housed in a nursing home and capable of having group activities and communication. The subjects were divided into 2 groups, the control and experimental, each of which had 15 participants randomly allocated. The songwriting program consisted of topic discussion, fill-in-the-blanks, lyrics rewriting, singing, singing with instruments, singing with movements and making games with songs. One session of the songwriting program for 60 minutes was performed every week and the intervention continued for 16 weeks from 25 August to 8 December 2007. Fee time was given to the control group while the session was in progress. Cognitive functions was assessed by a questionnaire test MMSE-K consisting of 5 sub-items - orientation, memory, attention & calculation, language function, and comprehension & judgement. The experimental results show that the average MMSE-K score for the experimental group increased by 3.8 points (26.0%) from 14.6 to 18.4 (t=-17.076, p<0.001), while that of the control group decreased by 0.87 (5.8%) from 15.00 to 14.13 (t=4.026. p<0.01). In the sub-domains of language function, orientation, and memory, the scores were increased by 40.4%, 22.2%, and 15.8%, respectively. But no significant statistical differences were seen in the domains of attention & calculation and comprehension & judgement. It was verified that the songwriting intervention significantly improved MMSE-K scores of the elderly with dementia, namely, their cognitive functions.
The present study has newly introduced a concert oriented music therapy (COMT) which was an active type of music therapy contrasting to existing popular passive music therapy. Its effects on depression was tested to 67 elderly people being taken care of in a nursing home. The participants were divided into 2 groups, the control and experimental, to which 32 and 35 participants were respectively randomly allocated. The COMT program lasting for 60 minute was applied to the experimental group once a week and continued for 32 weeks from 22 March to 25 October 2006. Free time was give to the control group during the intervention session. The COMT was composed of singing, playing a instrument, and music and movement. The program was divided into Stage 1 (preparing and scrutinization) and Stage 2 (planing, performance and evaluation). The level of depression was assessed by a questionnaire test GDS-K designed for the elderly. The experimental results show that the average GDS-K score of the subjects participated in COMT program decreased by 5.18 points (25.5%) from 20.34 to 15.16 (t=32.759, p<0.001), while that of the control group increased by 0.60 points from 20.29 to 20.89 (t=-5.878, p<0.001). It was confirmed that the COMT program first conducted in this study as an active music therapy technique, significantly increase the GDS-K scores of the elderly.
In order to test the reliability of the questionnaire tests (MMSE-K and GDS-K) used in the study, correlation analysis was conducted between scores by the questionnaire tests and brain waves. Brain waves were measured for 28 elderly subjects by PolyG-I (Laxtha Inc, Daejeon, Korea). According to the international standards 10-20, electrodes were attached to FP1 & FP2(Prefrontal), F3 & F4(Frontal), T3 & T4(Temporal), and P3 & P4(Parietal), through which 8 channel brain waves were recorded for the reference electrode at the right ear. The results showed that MMSE-K was most closely related to PAF (peak alpha frequency) and relative theta. It was seen that MMSE-K score had a positive correlation with PAF and a negative correlation with relative theta. GDS-K had a statistically meaningful correlation with A1 and A2 asymmetry index calculated for the brain waves from Parietal (r=-0.49, p<0.05). These indicate that A1 and A2 asymmetry index of Parietal can be used for assessing depression of the elderly.
It is concluded that the songwriting intervention tested in the present study improved the cognitive functions of the elderly with dementia, and the COMT program newly developed in this study as an active type music therapy also significantly relieved the depression symptoms of the elderly. A statistical correlation was proven between brain waves and the questionnaire tests used in the study for assessing cognitive functions and depression.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1.1 치매와 노인의 우울증 1
• 1.1.1 노인의 특성과 건강 1
• 1.1.2 치매와 인지기능 1
• 1.1.3 노인의 우울증 3
• 1.2 노인상담과 심리치료 3
• 1.3 노인을 위한 음악치료 4
• 1.3.1 노인성 질환과 음악치료 4
• 1.3.2 치매노인을 위한 음악치료 6
• 1.3.3 인지기능 개선을 위한 노래 만들기 7
• 1.3.4 우울증 노인을 위한 음악치료 10
• 1.3.5 연주회 중심의 음악치료 10
• 1.4 고령자 뇌파 11
• 1.4.1 뇌파의 특성 11
• 1.4.2 고령자 뇌파 12
• 1.4.3 인지기능과 뇌파 13
• 1.4.4 우울증과 뇌파 14
• 1.5 연구 동기 15
• 1.6 연구 목적 16
• 1.7 논문의 구성 16
• Ⅱ. 노래 만들기 기법에 대한 치매노인의 인지기능 개선 효과 18
• 2.1 서론 18
• 2.2 방법 18
• 2.2.1 연구대상 18
• 2.2.2 노래 만들기 프로그램 18
• 2.2.3 인지기능 측정도구: MMSE-K 19
• 2.2.4 실험 절차 19
• 2.2.5 자료 분석 20
• 2.3 결과 25
• 2.3.1 실험 대상자의 MMSE-K 동질성 검증 25
• 2.3.2 노래 만들기 프로그램 사전-사후 MMSE-K 점수 25
• 2.3.3 노래 만들기 프로그램 사전-사후 MMSE-K 영역별 점수 25
• 2.3.4 피실험자 선호곡 26
• 2.3.5 주제 토의 내용 26
• 2.4 고찰 33
• 2.5 결론 37
• Ⅳ. 연주회 중심의 음악치료 기법에 대한 노인의 우울증 개선 효과 38
• 3.1 서론 38
• 3.2 방법 38
• 3.2.1 피실험자 38
• 3.2.2 COMT 프로그램 39
• 3.2.3 우울 수준 측정 도구: GDS-K 39
• 3.2.4 실험 절차 40
• 3.2.5 자료 분석 40
• 3.3 결과 47
• 3.3.1 피실험자의 GDS-K 동질성 검증 47
• 3.3.2 COMT 중재 전후 GDS-K 점수 차이 47
• 3.3.3 연주 유형별 우울 수준 변화 47
• 3.3.4 실험집단의 GDS-K 요인별 우울 수준 변화 48
• 3.4 고찰 64
• 3.5 결론 66
• Ⅳ. 인지기능 및 우울 평가 척도와 뇌파의 상관성 67
• 4.1 서론 67
• 4.2 방법 67
• 4.2.1 피실험자 67
• 4.2.2 측정도구 67
• 4.2.3 실험 절차 69
• 4.2.4 통계적 분석 70
• 4.3 결과 77
• 4.3.1 MMSE-K와 뇌파의 상관관계 77
• 4.3.2 GDS-K와 A1 & A2 비대칭 지표의 상관성 79
• 4.4 고찰 103
• 4.4.1 MMSE-K와 뇌파의 비교 103
• 4.4.2 GDS-K와 뇌파의 비교 104
• 4.5 결론 105
• Ⅴ. 토의 107
• 5.1 노래 만들기 기법에 대한 치매노인의 인지기능 개선 효과 107
• 5.2 우울증 개선을 위한 연주회 중심의 음악치료 109
• 5.3 설문 검사 척도 (MMSE-K 및 GDS-K)와 뇌파의 상관성 110
• Ⅵ. 결론 113
• 참고문헌 114
• 국문요약 129
• 부록 1 131
• 부록 2 132
• 감사의 글 133

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