Delir, Psychose und Demenz bei Morbus Parkinson

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

• Literatur

• 1 Bower JH, Maraganore DM, McDonnell SK et al. Incidence and distribution of parkinsonism in Olmsted County, Minnesota, 1976–1990. Neurology 1999; 52: 1214-1220
• 2 Aarsland D, Zaccai J, Brayne C. A systematic review of prevalence studies of dementia in Parkinson’s disease. Mov Disord 2005; 20: 1255-1263
• 3 Aarsland D, Kurz MW. The epidemiology of dementia associated with Parkinson disease. J Neurol Sci 2010; 289: 18-22
• 4 National Collaborating Centre for Mental Health. Dementia. A NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. The British Psychological Society and Gaskell 2007; Number 42
• 5 Timmermann L, Maier F, Eggers C et al. Dementia in Morbus Parkinson: reasonable diagnostics and rational therapy. Fortschr Neurol Psychiatr 2010; 78: 513-518
• 6 Emre M. Dementia associated with Parkinson’s disease. Lancet Neurol 2003; 2: 229-237
• 7 Buter TC, van den Hout A, Matthews FE et al. Dementia and survival in Parkinson disease: a 12-year population study. Neurology 2008; 70: 1017-1022
• 8 Aarsland D, Beyer MK, Kurz MW. Dementia in Parkinson’s disease. Curr Opin Neurol 2008; 21: 676-682
• 9 Aarsland D, Bronnick K, Ehrt U et al. Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 2007; 78: 36-42
• 10 Holroyd S, Currie L, Wooten GF. Prospective study of hallucinations and delusions in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2001; 70: 734-738
• 11 Schwarz J, Storch A. Parkinson-Syndrome. Stuttgart: Kohlhammer; 2007
• 12 Perry E, Walker M, Grace J et al. Acetylcholine in mind: a neurotransmitter correlate of consciousness?. Trends Neurosci 1999; 22: 273-280
• 13 Braak H, Del Tredici K, Bratzke H et al. Staging of the intracerebral inclusion body pathology associated with idiopathic Parkinson’s disease (preclinical and clinical stages). J Neurol 2002; 249 (Suppl. 03) III/1-5
• 14 Hu WT, Chen-Plotkin A, Arnold SE et al. Biomarker discovery for Alzheimer’s disease, frontotemporal lobar degeneration, and Parkinson’s disease. Acta Neuropathol 2010; 120: 385-399
• 15 Braak H, Rub U, Del Tredici K. Cognitive decline correlates with neuropathological stage in Parkinson’s disease. J Neurol Sci 2006; 248: 255-258
• 16 Troster AI. Neuropsychological characteristics of dementia with Lewy bodies and Parkinson’s disease with dementia: differentiation, early detection, and implications for “mild cognitive impairment” and biomarkers. Neuropsychol Rev 2008; 18: 103-119
• 17 Sawamoto N, Honda M, Hanakawa T et al. Cognitive slowing in Parkinson’s disease: a behavioral evaluation independent of motor slowing. J Neurosci 2002; 22: 5198-5203
• 18 Owen AM. Cognitive dysfunction in Parkinson’s disease: the role of frontostriatal circuitry. Neuroscientist 2004; 10: 525-537
• 19 Brand M, Labudda K, Kalbe E et al. Decision-making impairments in patients with Parkinson’s disease. Behav Neurol 2004; 15: 77-85
• 20 Gleichgerrcht E, Ibanez A, Roca M et al. Decision-making cognition in neurodegenerative diseases. Nat Rev Neurol 6: 611-623
• 21 Deuschl G, Maier W, Reichmann H et al. Diagnose- und Behandlungsleitlinie Demenz Interdisziplinäre S3 Praxisleitlinien. Berlin, Heidelberg, New York: Springer; 2010
• 22 Scalzo P, Kummer A, Cardoso F et al. Depressive symptoms and perception of quality of life in Parkinson’s disease. Arq Neuropsiquiatr 2009; 67: 203-208
• 23 Rahman S, Griffin HJ, Quinn NP et al. Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord 2008; 23: 1428-1434
• 24 Hughes TA, Ross HF, Mindham RH et al. Mortality in Parkinson’s disease and its association with dementia and depression. Acta Neurol Scand 2004; 110: 118-123
• 25 McKeith IG, Dickson DW, Lowe J et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005; 65: 1863-1872
• 26 Kulisevsky J, Pagonabarraga J. Cognitive impairment in Parkinson’s disease: tools for diagnosis and assessment. Mov Disord 2009; 24: 1103-1110
• 27 Goetz CG, Emre M, Dubois B. Parkinson’s disease dementia: definitions, guidelines, and research perspectives in diagnosis. Ann Neurol 2008; 64 (Suppl. 02) S81-S92
• 28 Werhahn KJ. Epilepsy in the elderly. Dtsch Arztebl Int 2009; 106: 135-142
• 29 Bonanni L, Thomas A, Tiraboschi P et al. EEG comparisons in early Alzheimer’s disease, dementia with Lewy bodies and Parkinson’s disease with dementia patients with a 2-year follow-up. Brain 2008; 131: 690-705
• 30 McKeith I, O’Brien J, Walker Z et al. Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study. Lancet Neurol 2007; 6: 305-313
• 31 Walker Z, Jaros E, Walker RW et al. Dementia with Lewy bodies: a comparison of clinical diagnosis, FP-CIT single photon emission computed tomography imaging and autopsy. J Neurol Neurosurg Psychiatry 2007; 78: 1176-1181
• 32 Yoshita M, Taki J, Yokoyama K et al. Value of 123I-MIBG radioactivity in the differential diagnosis of DLB from AD. Neurology 2006; 66: 1850-1854
• 33 Gomez-Tortosa E, Gonzalo I, Fanjul S et al. Cerebrospinal fluid markers in dementia with lewy bodies compared with Alzheimer disease. Arch Neurol 2003; 60: 1218-1222
• 34 Mollenhauer B, Cepek L, Bibl M et al. Tau protein, Abeta42 and S-100B protein in cerebrospinal fluid of patients with dementia with Lewy bodies. Dement Geriatr Cogn Disord 2005; 19: 164-170
• 35 Shaw LM, Vanderstichele H, Knapik-Czajka M et al. Cerebrospinal fluid biomarker signature in Alzheimer’s disease neuroimaging initiative subjects. Ann Neurol 2009; 65: 403-413
• 36 Compta Y, Marti MJ, Ibarretxe-Bilbao N et al. Cerebrospinal tau, phospho-tau, and beta-amyloid and neuropsychological functions in Parkinson’s disease. Mov Disord 2009; 24: 2203-2210
• 37 Bibl M, Mollenhauer B, Esselmann H et al. CSF amyloid-beta-peptides in Alzheimer’s disease, dementia with Lewy bodies and Parkinson’s disease dementia. Brain 2006; 129: 1177-1187
• 38 Mollenhauer B, Cullen V, Kahn I et al. Direct quantification of CSF alpha-synuclein by ELISA and first cross-sectional study in patients with neurodegeneration. Exp Neurol 2008; 213: 315-325
• 39 Kasuga K, Tokutake T, Ishikawa A et al. Differential levels of alpha-synuclein, beta-amyloid42 and tau in CSF between patients with dementia with Lewy bodies and Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2010; 81: 608-610
• 40 Ohrfelt A, Grognet P, Andreasen N et al. Cerebrospinal fluid alpha-synuclein in neurodegenerative disorders – a marker of synapse loss?. Neurosci Lett 2009; 450: 332-335
• 41 Forbes D, Forbes S, Morgan DG et al. Physical activity programs for persons with dementia. Cochrane Database Syst Rev 2008; CD006489
• 42 Emre M, Aarsland D, Albanese A et al. Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351: 2509-2518
• 43 Emre M, Cummings JL, Lane RM. Rivastigmine in dementia associated with Parkinson’s disease and Alzheimer’s disease: similarities and differences. J Alzheimers Dis 2007; 11: 509-519
• 44 Storch A, De Deyn PP, Poewe W et al. Results of a long-term safety study of rivastigmine capsules and patch in patients with mild-to-moderate dementia associated with Parkinson’s disease. 10^th International Conference on AD/PD. Barcelona 2011;
• 45 Lefevre G, Klingelhöfer L, Mollenhauer B et al. Pharmakokinetics of rivastigmine patch in patients with Parkinson’s disease dementia. 10^th International Conference on AD/PD. Barcelona 2011;
• 46 Kurz A, Farlow M, Lefevre G. Pharmacokinetics of a novel transdermal rivastigmine patch for the treatment of Alzheimer’s disease: a review. Int J Clin Pract 2009; 63: 799-805
• 47 Winblad B, Cummings J, Andreasen N et al. A six-month double-blind, randomized, placebo-controlled study of a transdermal patch in Alzheimer’s disease-rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007; 22: 456-467
• 48 Aarsland D, Laake K, Larsen JP et al. Donepezil for cognitive impairment in Parkinson’s disease: a randomised controlled study. J Neurol Neurosurg Psychiatry 2002; 72: 708-712
• 49 Ravina B, Putt M, Siderowf A et al. Donepezil for dementia in Parkinson’s disease: a randomised, double blind, placebo controlled, crossover study. J Neurol Neurosurg Psychiatry 2005; 76: 934-939
• 50 Minett TS, Thomas A, Wilkinson LM et al. What happens when donepezil is suddenly withdrawn? An open label trial in dementia with Lewy bodies and Parkinson’s disease with dementia. Int J Geriatr Psychiatry 2003; 18: 988-993
• 51 Muller T, Welnic J, Fuchs G et al. The DONPAD-study – treatment of dementia in patients with Parkinson’s disease with donepezil. J Neural Transm Suppl 2006; 27-30
• 52 Leroi I, Brandt J, Reich SG et al. Randomized placebo-controlled trial of donepezil in cognitive impairment in Parkinson’s disease. Int J Geriatr Psychiatry 2004; 19: 1-8
• 53 Gerlach M, Reichmann H, Riederer P. Die Parkinson-Krankheit Grundlagen, Klinik, Therapie. 4 Auflage Heidelberg: Springer; 2007
• 54 Morgante L, Epifanio A, Spina E et al. Quetiapine and clozapine in parkinsonian patients with dopaminergic psychosis. Clin Neuropharmacol 2004; 27: 153-156
• 55 Reddy S, Factor SA, Molho ES et al. The effect of quetiapine on psychosis and motor function in parkinsonian patients with and without dementia. Mov Disord 2002; 17: 676-681
• 56 Fernandez HH, Trieschmann ME, Burke MA et al. Quetiapine for psychosis in Parkinson’s disease versus dementia with Lewy bodies. J Clin Psychiatry 2002; 63: 513-515
• 57 Tulloch JA, Ashwood TJ, Bateman DN et al. A single-dose study of the pharmacodynamic effects of chlormethiazole, temazepam and placebo in elderly parkinsonian patients. Age Ageing 1991; 20: 424-429
• 58 Aarsland D, Perry R, Larsen JP et al. Neuroleptic sensitivity in Parkinson’s disease and parkinsonian dementias. J Clin Psychiatry 2005; 66: 633-637
• 59 Burn D, Emre M, McKeith I et al. Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson’s disease. Mov Disord 2006; 21: 1899-1907