Prodromale Marker der Parkinson-Krankheit

Zusammenfassung

Die Parkinson-Krankheit (PK) ist die zweithäufigste neurodegenerative Erkrankung des älteren Menschen. Sie ist definiert durch die Kardinalsymptome Akinese, Rigor und Ruhetremor. Neben diesen motorischen Symptomen treten aber auch nichtmotorische Symptome wie Depression, Hyposmie, autonome Störungen und spezifische Schlafstörungen auf. Viele PK-Patienten leiden schon vor dem Zeitpunkt der neurologischen Diagnosestellung unter nichtmotorischen Symptomen. Diese Prodromalphase kann unterschiedlich lang sein. Nach bisherigen Studien erreicht als prodromale Marker die höchste Sensitivität die Hyposmie gefolgt von autonomer Dysfunk­tion (Obstipation), eine hohe Spezifität wird durch die REM-Schlaf-Verhaltensstörung erreicht. Mit dieser Ausnahme sind die Spezifitäten aller bisherigen klinischen prodromalen Marker gering. Sogenannte Biomarker, die das Auftreten der motorischer PK-Symptome voraussagen, sind in der klinischen Routine bisher nicht etabliert. Neue Marker oder die Kombination von verschiedenen Markern könnten möglicherweise eine bessere prognostische Aussage ermöglichen, und insbesondere bei der Identifizierung von geeigneten Patienten für krankheitsmodifizierende Therapiestudien hilfreich sein.

Abstract

Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elderly. It is characterised by the cardinal symptoms akinesia, rigidity and rest tremor. Besides these motor symptoms there are also non-motor signs like depression, hyposmia, autonomic dysfunction and specific sleep disorders. Many PD patients suffer from non-motor symptoms before the time of the neurological diagnosis. This prodromal phase can vary in duration. According to existing studies the highest sensitivity as prodromal marker is reached by hyposmia followed by autonomic dysfunction (constipation). Except for REM sleep behaviour disorder, the specificities for all current clinical markers are low. So-called biomarkers that predict the manifestation of motor symptoms of PD are not yet established in clinical routine. New markers or the combination of different markers may allow a better prognostic statement and, especially, may be helpful in the identification of appropriate patients for disease-modifying therapeutical studies.

Schlüsselwörter

Parkinson-Krankheit - prodromal - REM-Schlaf-Verhaltensstörung - Dysautonomie - Hyposmie

Keywords

Parkinson’s disease - prodromal marker - REM sleep behaviour disorder - dysautonomy - hyposmia

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