Konzept der hypodopaminergen und hyperdopaminergen Verhaltensstörungen bei Parkinson-Patienten

Zusammenfassung

Sowohl eine hypo- als auch eine hyperdopaminerge Dysbalance können zu gravierenden Verhaltensstörungen bei Patienten mit Morbus Parkinson führen, die einen erheblichen Einfluss auf den Alltag der Patienten haben. Typische hypodopaminerge Zustände können im Rahmen des Dopamin-Entzugssyndroms, des Dopaminagonisten-Entzugssyndroms und der oft erheblichen Medikamentenreduktion nach der Tiefen Hirnstimulation des Nucleus subthalamicus auftreten. Die Symptome bestehen aus einer Apathie, Antriebsarmut, Aspontaneität, gelegentlich auch aus psychischen Störungen wie Depressionen, Anhedonie und autonomen Störungen wie einer orthostatischen Dysregulation. Eine hyperdopaminerge Dysbalance kann bei einer Behandlung mit Dopaminagonisten auftreten oder beim Dopamin-Dysregulationssyndrom. Impulskontrollstörungen wie Hypersexualität, Essattacken, Kaufzwang und das pathologische Glücksspiel sind neben dem Punding typische Symptome einer hyperdopaminergen Verhaltensstörung. Kontrollierte Therapiestudien zur Behandlung dieser Störungen sind rar und die Therapie muss auf den individuellen Fall abgestimmt sein. Beide Störungsbilder – die hypo- und die hyperdopaminerge Dysbalance – werden mit Veränderungen im mesolimbischen dopaminergen Belohnungssystem in Verbindung gebracht.

Abstract

A dysbalance within the dopaminergic system (hypodopaminergic and hyperdopaminergic dysregulation) can cause severe behavioral disorders in patients with Parkinson’s disease affecting patient’s daily life. Hypodopaminergic states are present in a dopamine withdrawal syndrome, a dopamine agonist withdrawal syndrome and after deep brain stimulation of the subthalamic nucleus, when medication can be reduced dramatically. These syndromes include signs and symptoms of apathy, a lack of energy, a lack of spontaneity, psychic signs and symptoms such as depression and anhedonia and vegetative symptoms like orthostatic dysregulation. A hyperdopaminergic dysbalance can be caused by a dopamine replacement therapy especially by dopamine agonists and the dopamine dysregulation syndrome. Impulse control disorders such as hypersexuality, binge eating, compulsive shopping and pathological gambling and punding are symptoms of a hyperdopaminergic behavioral disorder. Since controlled studies to treat these behavioral disorders are rare the treatment concept must focus the individual problems of a patient. Both, the hypodopaminergic and the hyperdopaminergic behavioral disorder seem to be caused by a dysfunction of the mesolimbic dopaminergic reward system.

Schlüsselwörter

Morbus Parkinson - Dopamin - Apathie - Dopamin-Dysregulationssyndrom - Impulskontrollstörung

Keywords

Parkinson’s disease - dopamine - apathy - dopamine dysregulation syndrome - impulse control disorder

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