Earticle

The purpose of this study is to examine the types and methods of virtual reality (VR) rehabilitation and their clinical effects, and to introduce recently developed VR rehabilitation methods. VR rehabilitation is largely divided into desktop type VR, third person type VR, and immersive type VR, and various companies have already introduced several such products. In addition, a VR rehabilitation method that surrounds the anterior, left, and right sides of a patient on three or all four sides have recently been introduced that has the advantage of providing a variety of sensory stimuli in an environment similar to real life. These devices vary in price, size, and sense of immersion. To date, VR rehabilitation has mainly been applied to adults with brain damage, including stroke, as well as to individuals with cerebral palsy, dementia, or mild cognitive impairment. VR rehabilitation positively contributes to improvements in their physical function, cognitive function, mental function, and daily living activities for two reasons. First, virtual reality-based rehabilitation provides continuous multisensory stimulation to the brain’s cognitive and motor areas through dynamic interaction with an environment similar to real life. This can positively contribute to the improvement of cognitive, physical, and mental functions through a direct effect on brain restructuring or plasticity. In addition, VR rehabilitation can induce active participation in rehabilitation by evoking fun and interest in patients, using a variety of contents. Thus, active rehabilitation can not only increase the time spent participating in rehabilitation but also improve compliance, which can aid in successful rehabilitation.

Unbalanced movements between the bilateral sides may lead to dyski-nesia and reduced motor function. The upper limbs are the most com-plex joints with different rate of usage between the limbs. The dominant side is repeatedly used more than the contralateral side for better dex-terity and musculoskeletal utility. Such imbalance between the two bi-lateral sides may lead to further difference in movement ability. This study aimed to observe the feasibility of the mirror feedback method in the upper limb movements in the old people with mild cognitive impair-ment. Twenty-seven-old people with history of stroke were selected. Motion sensors were used to assess the location and motion of two limbs in synchronized lateral raise that include the abduction and ad-duction motions during the mirror feedback and no feedback trials. The results of the mirror feedback showed comparatively similar motions between the left and right upper limbs. The results of the study may in-dicate possible recommendation of mirror feedback method for syn-chronizing exercise motion of the upper limbs for the old people with mild cognitive impairment.

목적: 본 연구에서는 우리나라 노인의 인지장애 경험과 낙상과의 관련성을 분석하여, 인지 기능 저하를 관리하고, 낙상 예방에 필요한 보건학적 중재 프로그램 개발에 기초자료로 활용 하고자 한다. 방법: 인지장애와 관련된 변수의 활용하기 위하여, 2019년 지역사회건강조사 원시자료를 이용하였다. 연구대상자는 총 13,879명이었다. 분석은 SAS 9.4(SAS Institute Inc. Cary. NC, USA)를 사용하였다. 결과: 성별에 따른 인지장애와 낙상 경험 간의 요인은 인지장애 경험이 있는 남성과 여성이 낙상 위험이 1.47배 높았고, 인지장애로 일상생활의 어려움이 있는 남성의 낙상 위험은 1.34 배, 여성은 1.33배 높았다. 인지장애로 인한 도움이 필요한 남성과 여성의 낙상 위험은 1.35 배, 인지장애로 인한 상담 경험은 남성의 낙상 위험이 1.45배, 여성은 1.47배 높았다. 결론: 인지기능 저하 노인을 위한 낙상 예방 정책은 단순한 신체적 중재를 넘어 인지기능 유지 프로그램, 사회적 고립 해소, 안전한 주거환경 조성, 일상생활 지원 등의 다차원적 접근 이 병행되어야 한다. 특히 여성 노인에 대한 포괄적이고 통합적인 건강 지원 체계 마련이 요구된다.

Objectives: This study analyzed the relationship between cognitive impairment (CI) and falls among the elderly in Korea. The findings aim to serve as foundational data for developing health intervention programs to manage cognitive decline and prevent falls. Method: To examine variables related to CI, raw data from the 2019 Community Health Survey were analyzed. The total number of study participants was 13,879. Statistical analyses were conducted using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Results: The risk of falling was 1.47 times higher among both men and women with CI. Among those with CI and difficulty in daily life, men had a 1.34 times higher risk of falling, and women had a 1.33 times higher risk. Men and women who required assistance due to CI had a 1.35 times higher risk. Those who had received counseling related to CI showed a 1.45 times higher fall risk in men and a 1.47 times higher risk in women. Conclusion: Fall prevention policies for elderly individuals with CI should go beyond simple physical interventions. A multidimensional approach including cognitive, emotional, and social support should be considered to effectively reduce fall risk.

본 연구의 목적은 인지기능저하 대상자를 돌보는 요양병원 간호사의 공감역량이 의사소통행위에 미치는 영향 을 파악하고 그 과정에서 회복탄력성의 매개효과를 검정하는데 있다. 자료수집 기간은 2021년 9월27일부터 10월 22일까지이며, P시에 재직 중인 요양병원 간호사 131명을 대상으로 하였다. 수집된 자료는 SPSS WIN 25.0을 이 용하여 기술통계, 상관관계, 단계별회귀분석으로 분석하였다. 연구결과 첫째, 공감역량과 의사소통(r=.625, p<.001), 회복탄력성과 의사소통행위(r=.535, p<.001)간 에는 유의한 정(+)적 상관관계가 있음을 확인하였다. 둘째, 공감역량은 의사소통행위(β=.725, p<.001)에 유의한 영향을 주며, 그 과정에서 회복탄력성이 부분매개효과 (Z=2.012, p=.042)가 있는 것으로 나타났다. 따라서 인지기능저하 대상자를 돌보는 요양병원 간호사의 의사소통행 위를 향상시키기 위해서는 공감역량과 회복탄력성를 증진시킬 수 있는 프로그램을 개발하고 적용할 것을 제안한다.

The purpose of this study was to identify the effect of compassion competence on communication behavior of long-term care hospital nurses caring for patients with cognitive impairment and the mediating effect of resilience in the process. The data collection period was from September 27, 2021 to October 22, 2021, and the subjects were 131 long-term care hospital nurses in P city. The collected data were analyzed using the SPSS WIN 25.0 program, and descriptive statistics, pearson correlation coefficient, and multiple regression were performed. As a result of the study, first, it was found that there was a significant positive correlation between compassion competence and communication behavior(r=.625, p<.001), resilience and communication behavior(r=.535, p<.001). Second, resilience was verified as a partial mediating in the relationship between compassion competence and communication behavior(Z=2.012, p=.042). Therefore, in order to improve the communication behavior of nurses, it is suggested to develop and apply a program that can enhance compassion competence and resilience.

목적 : 본 연구는 노인들의 인지기능과 삶의 만족도간의 관계에서 노인구강건강요인의 매개효과를 분석하 기 위해 수행되었다. 연구방법 : 8차 고령화연구패널조사(2020년)에 수집된 60세 이상의 중고령자 6,169명을 대상으로 분석하 였다. 노인구강건강 요인은 노인구강건강평가지수(Geriatric Oral Health Assessment Index; GOHAI)의 기능적 차원 요인, 심리사회적 차원 요인, 통증 및 불편함 요인으로 세분화하였고 각 요인의 매개효과를 Mplus 8.4를 활용하여 경로분석을 수행하였다. 결과 : 6,169명의 평균 연령은 70.77세였다. 인지기능과 삶의 만족도 사이에서 노인구강건강 요인 중 구강건 강관련 기능적 차원 요인(β = 0.207, 95% Confidence Interval; CI = 0.169, 0.207)이 23%로 가장 큰 부분매개효과를 나타났다. 심리사회적 차원 요인은 22%(β = 0.202, 95% CI = 0.171, 0.236), 통증 및 불편함 요인은 16%(β = 0.146, 95% CI = 0.119, 0.175)로 기술한 순으로 부분매개효과를 나타냈다. 결론 : 인지기능과 삶의 만족도 사이에 구강건강 관련 기능적 차원 요인, 심리사회적 차원 요인, 통증 및 불편함 요인이 미치는 영향력을 확인하였다. 따라서 노인의 인지수준을 고려하고, 삶의 만족도에 영향을 미치는 구강건강 요인을 세분화하여 파악한 결과를 통해 개개인의 맞춤형 재활치료 접근 전략을 세우고 노인의 삶의 만족도를 높일 필요성을 제시하고자 한다.

Objective: This study was conducted to analyze the mediating effect of oral health factors in the relationship between cognitive function and life satisfaction in the elderly. Methods: This study analyzed 6,169 elderly people aged 60 years or older described in the 8th Korean Longitudinal Study on Aging (2020). The oral health factors of the elderly were divided into "functional dimension factors," "psychosocial dimension factors," and "pain or discomfort factors" of the Geriatric Oral Health Assessment Index (GOHAI). To determine the mediating effect of each factor, a path analysis was conducted using Mplus 8.4. Results: Between cognitive function and life satisfaction, among the oral health factors in the elderly, the functional dimension factor showed the largest partial mediating effect at 23% (β = 0.207, 95% confidence interval; CI = 0.169, 0.207). The psychosocial dimension factor was 22% (β = 0.202, 95% CI = 0.171, 0.236), and the pain and discomfort factor was 16% (β = 0.146, 95% CI = 0.119, 0.175), showing a partial mediating effect. Conclusions: The influence of three oral health-related factors on cognitive function and life satisfaction was confirmed. Therefore, it is necessary to consider the cognitive level of the elderly and identify oral health factors in detail. Accordingly, it is necessary to establish a personalized rehabilitation treatment access strategy and increase the life satisfaction of the elderly.

Adolescence is a critical period for neurodevelopment, neuronal plas-ticity, and cognitive function. Experiences of adolescence can be exert-ed positive and negative effects on brain development. Physical exer-cise has a positive effect on brain function, which is characterized by improving memory function and increased neural plasticity. High fat diet (HFD)-induced obesity has a negative effect on brain function, which is characterized by insulin resistance and neuroinflammation and re-duced microvessel constructure. Although the positive effect of exer-cise and negative effect of obesity on cognitive function have been documented, it has not been well whether comparison of the effects of exercise and obesity on cognitive function in adolescent rats. In the present study, we evaluated the behavioral changes related to cogni-tive function induced by exercise and obesity in adolescent rats. Male Wistar rats were randomly divided into three groups: the control group (CON), the exercise group (Ex), the high fat diet group (HFD). The HFD containing fat 60% was freely provided. The present results showed that spatial learning ability and short-term memory did not show signifi-cant effect exercise as compared to the control group. The present re-sults showed that spatial learning ability and short-term memory was significantly decreased HFD-induced obesity group as compared to the control group. These results suggest that positive effect of physical ex-ercise in adolescence rats may be exerted no significant effect on cog-nitive function. But, negative effect of HFD-induced obesity might in-duce cognitive impairment. HFD-induced obesity in adolescent rats may be used as an animal model of neurodevelopmental disorders.

Objective : We investigated the efficacy of an artificial intelligence computerized cognitive training program using motion capture to identify changes in cognition, depression, and quality of life in older adults with mild cognitive impairment. Methods : A total of seven older adults (experimental group = 4, control group = 3) participated in this study. During the COVID-19 period from October to December 2021, we used a program, “MOOVE Brain”, that we had developed. The experimental group performed the program 30 minutes 3×/week for 1 month. We analyzed patients scores from the Korean version of the Mini-Mental State Examination-2, the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet for Daily Life Evaluation, the short form Geriatric Depression Scale, and Geriatric Quality of Life Scale. Results : We observed positive changes in the mean scores of the Stroop Color Test (attention), Stroop Color/Word Test (executive function), SGDS-K (depression), and GQOL (QoL). However, these changes did not reach statistical significance for each variable. Conclusion : The study results from "MOOVE Brain" can help address cognitive and psychosocial issues in isolated patients with MCI during the COVID-19 pandemic or those unable to access in-person medical services.

Objective: This study was to develop and verify the effects of the exercise-cognitive combined dual-task training program on cognitive function and depression of the elderly with mild cognitive impairment(MCI). Methods: The subjects were randomly assigned to the exercise-cognitive combined dual-task training group(n=32) or single-task training group(n=31). To identify the effects on cognitive function, general cognitive function, frontal lobe function, and attention/working memory were measured. Depression was evaluated using Korean version of Geriatric Depression Scale. The outcome measurements were performed before and after the 8 weeks of intervention(2 days per week). Results: After 8 weeks, general cognitive function, frontal cognitive function, attention/working memory function, depression of the dual-task training group were significantly increased than those of the single-task training group(p<0.05). Conclusion: The results indicated that an exercise-cognitive combined dual-task training for MCI was effective in improving general cognitive function, frontal /executive function, attention/working memory function and reducing depression.

Objective To analyze cognitive functions of post-stroke aphasia patients compared to patients having right hemispheric stroke and left hemispheric lesions without aphasia, and to look for a relationship between cognitive deficits and aphasia severity.Methods Thirty-six patients with right hemispheric stroke (group 1), 32 with left hemispheric lesion without aphasia (group 2), and 26 left hemispheric stroke patients with aphasia (group 3) completed a set of tests in the computerized neurocognitive function batteries for attention, executive function and intelligence and Korean version of Western Aphasia Battery. Data analyses explored cognitive characteristics among the three groups and the correlation between cognitive deficits and aphasia severity.Results Right hemispheric and left hemispheric stroke patients without aphasia showed similar findings except for digit span forward test. Cognitive tests for working memory and sustained attention were significantly impaired in the aphasic patients, but intelligence was shown to be similar in the three groups. Significant correlation between cognitive deficit and aphasia severity was only shown in some attention tests.Conclusion Cognitive deficits may be accompanied with post-stroke aphasia and there are possible associations between language and cognitive measures. Therefore, detection and treatment towards coexisting cognitive impairment may be necessary for efficient aphasia treatment.

Objective To determine the frequency and characteristics of vascular cognitive impairment (VCI) in patients with subacute stroke who underwent inpatient rehabilitation and to analyze whether cognitive function can predict functional assessments after rehabilitation.Methods We retrospectively reviewed the medical records of patients who were admitted to our rehabilitation center after experiencing a stroke between October 2014 and September 2015. We analyzed the data from 104 patients who completed neuropsychological assessments within 3 months after onset of a stroke.Results Cognitive impairment was present in 86 out of 104 patients (82.6%). The most common impairment was in visuospatial function (65, 62.5%) followed by executive function (63, 60.5%), memory (62, 59.6%), and language function (34, 32.6%). Patients with impairment in the visuospatial and executive domains had poor scores of functional assessments at both admission and discharge (p<0.05). A multivariate analysis revealed that age (b= -0.173) and the scores on the modified Rankin Scale (b=-0.178), Korean version of the Modified Barthel Index (K-MBI) (b=0.489) at admission, and Trail-Making Test A (TMT-A) (b=0.228) were related to the final K-MBI score at discharge (adjusted R2=0.646).Conclusion In our study, VCI was highly prevalent in patients with stroke. TMT-A scores were highly predictive of their final K-MBI score. Collectively, our results suggest that post-stroke executive dysfunction is a significant and independent predictor of functional outcome.

Purpose: Chemotherapy-related cognitive impairment (CRCI) is a prevalent and distressing issue amongolder adults with cancer, affecting quality of life and treatment adherence. While its mechanismsremain unclear, biomarkers have emerged as promising tools for understanding CRCI. This systematicreview aimed to explore the relationships between cognitive impairment following chemotherapy andbiomarkers in older patients with cancer. Methods: A comprehensive search was conducted through December 2024 across PubMed, CINAHL,Embase, PsycINFO, and the Cochrane Library. An additional hand search was performed through July2025. The focus was on patients over 60 years of age with CRCI and associated biomarkers. The reviewadhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines,and the methodological quality of included studies was assessed using the Joanna Briggs Institutechecklist to ensure rigor and reliability. Results: Six of the initial 6324 articles met the inclusion criteria, and seven additional studies wereidentified through manual searching. In total, 13 studies identified several biomarkers associated withCRCI in older patients with cancer. These included serum hemoglobin, brain-derived neurotrophic factor,percent cerebral oxyhemoglobin, functional network connectivity, and individual alpha peak frequency. Conclusions: This review highlights several biomarkers potentially associated with CRCI in older patientswith cancer, though consistent and definitive biomarkers remain elusive. Further research isneeded to clarify the biological mechanisms underlying CRCI and inform the development of interventionsaimed at preventing cognitive decline in this vulnerable population. The identification ofvalidated biomarkers will be critical for advancing personalized nursing and improving clinical outcomesin older adults with cancer.

Purpose: This study was done to better understand factors affecting care management of older adults with cognitive impairments (CI) in acute care settings and to provide a discussion of the literature focusing on educational issues for nurses caring for older adults with CI in acute care settings. Method: Analysis was done of 26 articles related to management of acute or chronic confusion in older adults in acute care settings, which were published between 2000 and 2012. Results: The theoretical literature outlines nurse-related and organizational-related factors that influence management of dementia or delirium in older adults in acute care settings. These themes offer grounding for further research and the development of education that address the needs of older adults with CI undergoing management for co-morbidity in acute care settings. Conclusion: In the current studies, the emphasis was on the need for education, which has the potential to lead to a significantly positive improvement in RNs’ knowledge and attitudes, and the appropriate management and empowerment of family members to participate through the early detection of dementia or delirium in hospitalized older adults with CI. Consequently, facilitating care improvement for older adults with CI, particularly those with dementia, needs to be given attention in Korean acute care settings.

Purpose: Adolescents who experienced the alcohol consumption have gradually increased. Adolescence is a critical period of the neural plasticity in the brain. Neural plasticity is mediated by neurotrophins and has an impact on cognitive function. Environmental enrichment ameliorates the cognitive function and increases neurotrophins. Thus, we investigated the neuroprotective effect of environmental enrichment on ethanol induced cognitive impairment in adolescent rats. Methods: The ethanol groups and the controls groups were injected with ethanol (0.5g/kg) and phosphate buffered saline, respectively, through intraperitoneal from 28th day of birth for 11 days. The environmental enrichment groups were provided larger cages containing toys than the standard cage . Passive avoidance test and Y-maze test were performed to evaluate the spatial memory. Results: Environmental enrichment+ethanol group showed higher alterations than the standard environment+ethanol group in Y-maze test (p<.05). In hippocampus, The environmental enrichment+ethanol group showed significantly higher level of the number of c-fos positive celsl and density of tropomyosin receptors kinase B receptor than the standard environment+ethanol group (p<.05). Conclusion: So, we suggested that the environmental enrichment played a role as a prophylaxis for prevention of memory impairment induced by ethanol exposure in adolescence.

Objective: To test the feasibility and usability of an artificial intelligence (AI)-guided mobile cognitive telerehabilitation program for patients with stroke or older adults with mild cognitive impairment (MCI).Methods: Thirteen participants with cognitive impairment (Mini-Mental State Examination [MMSE] score≤26; nine with stroke and four with MCI) were enrolled in the study. Each participant was provided with an AI-guided mobile cognitive rehabilitation program (Zenicog®). Participants were instructed to complete 24 sessions within 6 weeks, and those with sufficient adherence (≥70%, 17 sessions) were included in the analysis. Cognitive assessments included the MMSE, digit span, and Trail Making Tests A & B. The usability questionnaire investigated equitable use and flexibility in use, simple and intuitive use, perceptible information, tolerance for error, low physical effort, size and space for use, overall product quality, overall satisfaction.Results: Eleven participants completed the study, and 10 participants met adherence criteria. The MMSE score increased significantly from 24.00 [21.00, 25.75] at baseline to 27.50 [26.00, 28.75] after intervention. The overall product quality (Likert scale: 1?5) score was 4.00±0.87. The lowest score in the usability questionnaire was for tolerance for error. Female participants and participants with <12 years’ education gave lower scores for tolerance for error and equitable/ flexibility in use, respectively.Conclusion: The AI-guided mobile cognitive telerehabilitation program is feasible and potentially beneficial for improving cognitive function in patients with stroke or older adults with MCI. Individuals who are less familiar with electronic devices require special consideration to improve their usability.

Background: The chemotherapeutic and immunosuppressive agent cyclophosphamide (CYP), which is widely used in cancer treatment, can cause oxidative damage and inflammation in the brain, resulting in behavioral abnormalities, including cognitive impairment. Agastache rugosa (AR) has been traditionally used to treat digestive disorders and it has several physiological activities. Methods and Results: We investigated the neuroprotective effects of an AR ethanol extract against CYP-induced neurodegeneration and cognitive dysfunction. Free radical scavenging assays confirmed the antioxidant activity of the AR extract. C57BL/6 mice were orally administered an AR extract (100 or 200 mg/kg) for seven days, followed by an intraperitoneal injection of CYP (50 mg/kg). Mice exhibited memory impairment in a contextual fear conditioning test 24 h after CYP treatment. However, AR pretreatment notably improved behavioral deficits. Histological analysis demonstrated that CYP administration reduced the immunoreactivity of Ki67 (a proliferative cell marker) and doublecortin (an immature progenitor cell marker) in the dentate gyrus of the hippocampus, whereas AR pretreatment considerably normalized the levels of these markers. Subsequently, network pharmacology was used to investigate the potential genes involved in the ameliorative action of AR on CYP-induced neurodegeneration and memory impairment, which suggested BCL2, JUN, and MAPK3 as key candidates. Conclusions: These findings demonstrate that AR pretreatment protects against CYP-induced neurodegeneration and cognitive impairment. In addition, network pharmacology analysis suggests that AR compounds may provide neuroprotection against CYP-induced neuroinflammation by modulating key target genes such as BCL2, JUN, and MAPK3.

Objective: This study was to develop computerized screening test items for mild cognitive impairment. Methods: Through literature reviews, items from computerized tests for screening mild cognitive impairment were extracted. A panel of professional experts validated that the items were important and fit to screen for mild cognitive impairment. Results: A total 37 items were extracted from 12 computerized tests and 11 new items were added through the first panel review. After that, 18 items were removed via the second panel review. Finally, 16 items were selected by analyzing content validity ratio. 16 items consisted of memory, attention, and executive function areas. Conclusions: A total of 16 computerized test items were developed. It is urgent to validate them to screen mild cognitive impairment. Moreover, standardization studies for this test are required in the future.

Purpose: The present study was conducted to develop a mild vascular cognitive impairment (MVCI) assessment tool for patients with stroke and to examine its validity, reliability, and clinical adequacy. Methods: Items of this tool were developed based on previously verified cognitive assessment tools. Face, content, and criterion (concurrent) validities, optimal cut-off score for differentiation of MVCI and normal cognitive function, clinical adequacy, internal consistency, and inter-rater reliability of the assessment tool were determined in 60 stroke patients at a university hospital located in Incheon, South Korea. Results: The devised MVCI assessment tool contains 20 items which were designed to assess seven cognitive domains: orientation, memory, language, attention, reasoning/abstraction, visuospatial perception, and executive function/problem solving. Content, face, and construct validities were well supported. Clinical adequacy testing revealed that the overall probability of correctly discriminating MVCI using the MVCI assessment tool for stroke was 90.0%, which was statistically significant. Furthermore, a score of 23 was found to be the optimal cut-off score for MVCI. Internal consistency and inter-rater reliability were also well supported. Conclusions: The findings of this study indicate that the developed MVCI assessment tool for stroke could serve as a clinically useful tool for detecting MVCI and for properly assessing degree of cognitive impairment in stroke patients.

Purpose: The purpose of this study was to investigate if pain mediates or moderates the relationship between cognitive impairment and aggressive behaviors in nursing home residents with dementia based on the Need-driven Dementia-compromised Behavior model. Methods: This was a secondary analysis of the Minimum Data Set assessment data on long-term care from the state of Florida during calendar year 2009. The data used in this study was the first comprehensive assessment data from residents with dementia (N ¼ 56,577) in Medicare-certified or Medicaidcertified nursing homes. Path analysis using a series of hierarchical regression analyses and two-way analysis of variance was used to evaluate the mediating and moderating effect of pain on the relationship between the level of cognitive impairment and aggression. Results: Results indicated that pain did not mediate the relationship between cognition and aggressive behaviors, but there was evidence of a significant moderating effect of pain only for residents with severe cognitive impairment. Only among the residents with severe cognitive impairment, those with pain had significantly more frequent aggressive behaviors than those without pain. Conclusion: A change in the frequency of aggressive behaviors in severely cognitively impaired residents should signal the possibility that the person is experiencing pain. Accurate but simple pain assessment in this population including these behavioral changes should be developed further, and pain should be well controlled to reduce these problematic behaviors.