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Aktuelle Neurologie 2011; 38(06): 303-308
DOI: 10.1055/s-0031-1285869
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Delir, Psychose und Demenz bei Morbus Parkinson

Delirium, Psychosis and Dementia in Patients with Parkinson’s Disease
L. Klingelhöfer
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus,, Technische Universität Dresden
,
H. Reichmann
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus,, Technische Universität Dresden
› Author Affiliations
Further Information

Publication History

Publication Date:
12 September 2011 (online)

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Zusammenfassung

Einleitung:

Die Entwicklung einer Demenzerkrankung ist ein häufiges Problem bei Patienten mit Idiopathischem Parkinsonsyndrom (IPS). Bis zu 80% dieser Patienten sind nach einer Erkrankungsdauer von 10 Jahren betroffen und bis zu 90% leiden zusätzlich unter mindestens einem neuropsychiatrischen Symptom.

Methodik:

Literatursuche über PubMed.

Ergebnisse:

Patienten mit Parkinson Demenz (PD) weisen eine andere Ausprägung der kognitiven Defizite auf als Patienten mit anderen Demenzformen. Primär sind bei der PD die exekutive Funktion und visuell-räumliche Erkennung, aber auch Aufmerksamkeit und Gedächtnis betroffen. Gerade auch bei Patienten mit PD manifestieren sich neuropsychiatrische Symptome wie Delir, optische Halluzinationen, Angst, Stimmungsschwankungen und Verkennungen. Symptomatische Ursachen wie eine Infektion, Dehydrierung, Elektrolytstörung oder Änderungen der eingenommenen Medikamente sollten als diagnostische Maßnahmen und zu therapeutischen Zwecken als erstes überprüft werden. Zur weiteren differenzialdiagnostischen Einordnung sollte eine körperliche Untersuchung, eine orientierende kognitive Testung und ein kranielles MRT erfolgen. Bei klinischer Unsicherheit können weitere diagnostische Maßnahmen wie eine Elektroencephalografie, Lumbalpunktion und nuklearmedizinische Untersuchungen für jeden Patienten individuell diskutiert werden.

Schlussfolgerung:

Patienten mit IPS sollten regelmäßig hinsichtlich kognitiver Beeinträchtigungen untersucht werden, um bei Zeichen einer möglichen Demenzerkrankung weitere diagnostische und therapeutische Maßnahmen frühzeitig einzuleiten. Weiterhin sollte bei diesen Patienten verstärkt auf neuropsychiatrische Symptome geachtet werden. Rivastigmin als Acetylcholinesterase-Hemmer, Neuroleptika wie Clozapin und Quetiapin sowie neuropsychologische Trainingsverfahren sind die im Vordergrund stehenden Therapieoptionen zur Behandlung der kognitiven Defizite, der Psychose und der Verhaltensauffälligkeiten.

Abstract

Introduction:

Dementia in patients with Parkinson’s disease (PDD) is a common problem and occurs in up to 80% of these patients after a disease duration of 10 years or longer. 90% of PDD patients suffer from at least one neuropsychiatric symptom. Often the dementia is diagnosed late or in cases of the occurrence of additional neuropsychiatric symptoms like psychosis and delirium.

Methods:

Selective literature review in PubMed was carried out.

Results:

Parkinson’s disease dementia presents a different profile of cognitive impairment in comparison to other types of dementia, e. g. Alzheimer’s disease, vascular dementia, dementia with Lewy bodies. Mainly cognitive deficits in PDD present in the executive and visual-constructive areas, but also concern attention and memory. The intensity of these deficits can fluctuate over the day. Neuropsychiatric symptoms such as delirium, visual hallucinations, anxiety, mood swings and delusions become manifest in patients with PDD mainly. For diagnostic and therapeutic processes symptomatic reasons like an infection, dehydration, blood electrolyte imbalance or a change of medication should be ruled out first. Subsequent further useful tests for differential diagnosis should be induced like physical examination, a bedside cognitive test and magnetic resonance imaging. In cases of clinical uncertainty further investigations like electroencephalography, cerebrospinal fluid analysis and nuclear medical procedures should be discussed on an individual base.

Conclusion:

Patients with Parkinson’s disease should be screened early and regularly for signs of dementia, so that further diagnostic and therapeutic strategies can be started. Furthermore, one should be aware of neuropsychiatric symptoms in patients with Parkinson’s disease. Rivastigmin as a cholinesterase inhibitor, neuroleptica like clozapine and quetiapine and neuropsychological training methods are the primary treatment options for cognitive deficits, psychosis and behavioural disturbances.

Schlüsselwörter

Idiopathisches Parkinsonsyndrom - Parkinson Demenz - Psychose bei Mb. Parkinson - Delir bei Mb. Parkinson - Psychose bei IPS

Keywords

idiopathic Parkinson’s disease - dementia in Parkinson’s disease - psychoses in Parkinson’s disease - delirium in Parkinson’s disease - psychoses in idiopathic Parkinson’s disease
 

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