Demenz bei Parkinson-Syndromen

Zusammenfassung

Eine Demenz betrifft mehr als 10% der über 75-Jährigen. Kombinationen verschiedener Parkinson-Symptome wie Gangstörung, Bradykinese, Tremor und Rigor weisen mehr als 20% aller über 75-Jährigen auf. 75% der Patienten mit einem idiopathischem Parkinson-Syndrom (IPS) entwickeln 8 Jahre nach Diagnosestellung eine Demenz. Zu einer Demenz bei Parkinson-Syndromen kommt es früh im Verlauf bei der Lewy-Körper-Demenz (LKD) und spät beim IPS, bei der progressiven supranuklären Blickparese (PSP), bei der kortikobasalen Degeneration (CBD), seltener bei den frontotemporalen Demenzen. Bei der PSP, dem vaskulären Parkinson Syndrom/der vaskulären Demenz im Rahmen einer subkortikalen vaskulären Enzephalopathie (SVE) und dem Normaldruckhydrozephalus (NPH) dominiert als Parkinson-Symptom eine Gangund Standunsicherheit (Parkinson-Syndrom der unteren Körperhälfte). Das Erkennen einer Demenz bei einem Parkinson-Syndrom sollte es erlauben, das Auftreten von Verwirrtheit und Psychosen durch Antiparkinsonika zu reduzieren (Patienten mit Demenz reagieren besonders schnell mit Verwirrtheit und Halluzinose auf bestimmte Parkinson-Medikamente). Das Erkennen von Parkinson-Symptomen bei einer dementiellen Entwicklung sollte wiederum helfen, die Inzidenz von motorischer und kognitiver Verschlechterung durch Neuroleptika zu reduzieren (Patienten mit Parkinson-Syndromen reagieren besonders empfindlich nicht nur auf typische, sondern auch auf atypische Neuroleptika). Die vorliegende Übersicht erläutert im ersten Teil die Klinik dieser überlappenden Syndrome und diskutiert in einem zweiten Teil die Therapie.

Summary

Dementia can be diagnosed in at least 10% and parkinsonian signs in more than 20% of the general population over 75 years of age. The association of dementia and parkinsonism occurs in 75% of patients with classical Parkinson´s disease after an eight year course. Parkinsonism occurs in dementia with Lewy bodies (DLB), in progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) less so in other diseases associated with the Pick-complex (frontotemporal dementias). Gait and postural parkinsonian signs predominate in PSP, vascular parkinsonism/dementia and normal pressure hydrocephalus (NPH) (lower body parkinsonism). This review discusses in the first part the different disorders associated with parkinsonism and dementia and in a second part its management. Diagnostic differentiation of the dementia-parkinsonism disorders may help to avoid two common problems: 1. delirium and psychosis are often induced by antiparkinsonian drugs and 2. neuroleptics exacerbate parkinsonian signs and cognitve deficits.

Schlüsselwörter

Parkinson-Syndrom - Demenz - Cholinesterasehemmer - Dopaminergika

Keywords

Parkinson’s disease - dementia with Lewy bodies (DLB) - cholinesterase inhibitors - dopaminergics

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