Langzeitverlauf der Parkinson-Erkrankung

Zusammenfassung

Das idiopathische Parkinsonsyndrom (IPS) verläuft chronisch progredient und führt langfristig bei den meisten Betroffenen zu Behinderung, Demenz und verminderter Lebenserwartung. In neuen Langzeitstudien wurde gezeigt, dass doparesistente Symptome wie Gleichgewichtsstörungen, Dysarthrie und Dysphagie in den Spätstadien maßgeblich für die motorische Behinderung sind. Mortalität und Pflegebedürftigkeit sind eng mit dem Auftreten von Demenz und Halluzinationen assoziiert. Der wichtigste Risikofaktor für das Auftreten dieser Komplikationen ist das Alter bei Erkrankungsbeginn. Stürze, Demenz und Halluzinationen manifestieren sich bei Patienten mit frühem Krankheitsbeginn erst nach deutlich längerem Verlauf als bei spätem Beginn des IPS. Weitere verlaufsrelevante Faktoren sind kognitive Störungen, motorischer Subtyp des IPS, Pharmakoresponsivität und genetische Disposition. Ob initial eine Behandlung mit L-Dopa oder Dopaminagonisten erfolgte war in Studien mit mehr als zehnjähriger Beobachtungsdauer für die langfristige Prognose von untergeordneter Bedeutung.

Summary

Idiopathic Parkinson’s disease (IPD) has a chronic progressive course. Late stage IPD is associated with disability, dementia and increased mortality. Recent studies with longterm follow-up have shown that disability is strongly determined by levodopa-resistant symptoms such as imbalance, dysarthria and dysphagia. Mortality and residential care are associated with dementia and hallucinations. The most important risk-factor for late-stage complications is age at disease onset. Falls, dementia and hallucinations manifest after much longer disease-duration in patients with earlier onset of disease. Further factors, including cognitive disturbances, motor subtype, response to dopaminergic medication and genetic disposition have been found to influence the course of IPD. Initiating pharmacotherapy with levodopa or dopamine agonists had little impact on long-term outcome in studies with follow-up over more than ten years.

Schlüsselwörter

Parkinson - Verlauf - Langzeitkomplikationen

Keywords

Parkinson - disease course - long-term complications

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