Parkinson-Krankheit – nicht-motorische Symptome für die Praxis

Nicht-motorische Symptome der Parkinson-Krankheit wie kognitive Einbußen, Depressionen, Schlafstörungen oder orthostatische Hypotonie treten oft bereits im Frühstadium auf und beeinflussen die Lebensqualität erheblich. Eine gezielte Diagnostik und individuell angepasste Therapie sind entscheidend, um diese Symptome zu erkennen und effektiv zu behandeln.

Kernaussagen

• Nicht-motorische Störungen treten bei fast allen Parkinson-Patienten auf, viele sogar schon vor den motorischen Symptomen.

• Kognitive Symptome treten ebenfalls häufig bei der Parkinson-Krankheit (PK) auf und können alle Schweregrade haben.

• Depressive Symptome sind bei der PK häufig und werden oft nicht erkannt. Der WHO-5-Test ist ein einfacher Screening-Test.

• REM-Schlaf-Verhaltensstörungen (RBD) sind ein wichtiges Frühsymptom bei der PK, niedrigdosiert Clonazepam zur Nacht gilt als Mittel der Wahl.

• Über die Hälfte der PK-Patienten entwickeln im Krankheitsverlauf Halluzinationen. Hierbei sollte zuerst auf auslösende Medikamente verzichtet werde, die man ersetzen kann.

• Impulskontrollstörungen treten im Verlauf immer häufiger auf, Dopaminagonisten gelten als die Medikamentengruppe mit der höchsten Wahrscheinlichkeit, diese auszulösen.

• Eine orthostatische Hypotonie tritt bei sehr vielen Parkinson-Patienten, häufig schon sehr früh auf.

• Parkinson-Patienten zeigen eine fehlende Nachtabsenkung des Blutdrucks, was bei einer eventuellen Blutdruckeinstellung berücksichtigt werden muss.

• Zur Therapie der orthostatischen Hypotonie haben sich u.a. Anpassung der Medikation, Stützstrümpfe und die Gabe von Midodrin bewährt.

Publication History

Article published online:
06 March 2025

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