Delir bei Demenz

Zusammenfassung

Delir und Demenz zeigen als organisch bedingte psychische Störungen Gemeinsamkeiten in klinischer und neurobiologischer Hinsicht und treten häufig gemeinsam auf. Das Vorliegen der einen scheint das Risiko zur Entwicklung der jeweils anderen Störung zu erhöhen. Obwohl das Delir gerade bei älteren Patienten eine häufige Störung ist, wird es oft übersehen. Zur Diagnostik des Delirs reichen aber nicht selten eine genaue Anamnese inklusive Medikamentenanamnese, klinische Untersuchung und Bestimmung von laborchemischen Routineparametern aus. Die kausale Behandlung des Delirs ist möglich und nicht unbedingt kompliziert. Zur symptomatischen Behandlung stehen nicht-medikamentöse und medikamentöse Maßnahmen zur Verfügung. Die nicht-medikamentösen Maßnahmen werden zu einem großen Teil vom pflegenden Personal ausgeführt und beinhalten u. a. Orientierungshilfen und Balance zwischen Reizüberflutung und -deprivation. Gute Kenntnis der Symptomatologie ist entscheidend auch im Hinblick auf die Prävention (Delirfachschwester). Zur symptomatischen medikamentösen Behandlung erscheinen Neuroleptika günstig. Im Hinblick auf extrapyramidale Nebenwirkungen sind Typika den Atypika unterlegen. Der Einsatz von Cholinesterase-Inhibitoren kann aus der Literatur nicht belastbar gestützt werden. Zu Benzodiazepinen wird außer zur Behandlung von Entzugsdelirien eher nicht geraten. Präparate mit kurzer Halbwertszeit und fehlenden aktiven Metaboliten können jedoch kurzzeitig flankierend eingesetzt werden. Besonders wichtig erscheint die Prävention, zu der gute Kenntnisse der Risikofaktoren und ihres Managements beim behandelnden Personal von zentraler Bedeutung sind. Als Sonderfall erscheint das Auftreten eines Delirs im Rahmen von alpha-Synukleinopathien. Internationale und deutsche Richtlinien zum Management des Delirs existieren.

Abstract

Delirium and dementia as organically caused mental disorders exhibit similarities in the clinical and neurological sense and often occur together. The existence of one appears to increase the risk for the development of the other. Although delirium is a very common disorder especially among the elderly, it is often not recognized. For the diagnosis of delirium, an exact family and case history including medication, clinical examination and determination of routine laboratory values are not infrequently necessary. Causal treatment of delirium is possible and not necessarily complicated. Both non-medicative and medicative measures are available for the symptomatic treatment. The non-medicative measures are to a large extent applied by nursing staff and comprise, among others, orientation guidance and attaining a balance between perceptual overload and deprivation. A good knowledge of symptomatology is decisive, also from the prevention point of view (nurses specialized in delirium). For symptomatic medicative treatment neuroleptic agents appear to be favorable. With regard to extrapyramidal side effects atypical neuroleptics are better than the typical ones. The use of cholinesterase inhibitors is not robustly supported by the literature. The use of benzodiazepines is rather discouraged except for the treatment of withdrawal delirium. Preparations with short half-lives and absence of active metabolites can be used as accompanying measures for a short time. Prevention appears to be extremely important for which the treating personnel require a good knowledge of risk factors and their management. The occurrence of delirium among cases of alpha-synucleinopathies represents a special case. Both international and German guidelines on the management of delirium are available.

Schlüsselwörter

Delirium - Dementia - Treatment

Key words

delirium - dementia - treatment

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