Erfassung motorisch-kognitiver Interaktionen bei Demenzerkrankungen im klinischen Alltag

Zusammenfassung

Hintergrund: Gangstörungen und kognitive Defizite treten bei hochbetagten Patienten häufig kombiniert auf. Für die Betreuung von Patienten mit motorischen und/oder kognitiven Defiziten ergeben sich für den klinischen Alltag folgende Konsequenzen: (1) Diagnostische Prozeduren sollten Untersuchungen beider Domänen abdecken. (2) Therapeutische Ansätze sollten mögliche Interaktionen und synergistische Effekte zwischen beiden Domänen berücksichtigen und gegebenenfalls nutzen.

Diskussion: In der klinischen Routine empfiehlt es sich, zur effektiven Abschätzung der motorisch-kognitiven Interaktionsfähigkeit eines Patienten die Gehfähigkeit unter Doppeltaufgaben (sog. Dual-Tasks) und alltagsnahen Bedingungen (z. B. im Timed-up-and-go-Test oder bei räumlicher Orientierung) zu prüfen. Bei kognitiven Störungen kommt es typischerweise zu einer Verlangsamung der selbstgewählten Ganggeschwindigkeit bei der Durchführung von Dual-Task Aufgaben. Die Veränderung der Ganggeschwindigkeit im Zeitverlauf ist ein guter Surrogatmarker für die kognitive Entwicklung von Patienten und die Funktionalität bei demenziellen Erkrankungen. Sie kann als reliabler Parameter bei therapeutischen Interventionen genutzt werden (z. B. im Rahmen eines Liquorablasses bei NPH).

In der Behandlung kombinierter Störungen von Gang und Kognition scheinen komplexe motorisch-kognitive Therapieformen, z. B. Thai Chi oder Dalcroze-Rhythmik synergistisch zu wirken und sollten bevorzugt angewendet werden. Dadurch können Sturzereignisse verhindert werden und exekutive Funktionen verbessert werden.

Abstract

Background: Difficulties of walking and deficits of cognitive functions appear to be associated in the elderly. Thus, clinical assessment in geriatry and neurology should focus on: (1) diagnostic approaches covering both domains of everyday functioning; (2) therapeutic interventions that take into account possible interactions and synergies of both domains.

Discussion: In order to assess the capability for motor-cognitive interactions in the elderly it is recommended to investigate walking patterns during dual-tasks (e.g. walking and counting backwards, walking and naming words) and to examine clinical tests of everyday mobility tasks, such as the Timed-up-and-go-Test and spatial navigation tasks. Patients with cognitive disorders often perform inferior with a reduction of walking speed and an increase of stepping variability. Dual-task performance appears to be a reliable parameter for long-term observations of the course of the disease. Moreover, it might improve the quality of the gait examination during diagnostic or therapeutic interventions (e.g. the spinal tap test in patients with NPH). Several studies further highlight gait deficits during dual-task walking as a marker for the everyday functioning and the quality of life in elderly persons and patients with cognitive disorders.

Therapeutic approaches in this context comprise complex motor-cognitive interventions, such as Thai Chi and Dalcroze rhythmic exercises. These interventions appear to act synergistically in motor and cognitive domains. First evidence for the efficacy for improving executive functions and reducing the fall risk of patients with cognitive impairments is given, thought randomized, controlled trials are rare.

Schlüsselwörter

Demenz - Mild cognitive impairment - Gangstörung - Stürze - Dual-task - Navigation

Key words

dementia - mild cognitive impairment - gait disorder - falls - dual-task - spatial navigation

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