Demenz bei Parkinson-Syndromen: Lewy-Körper-Demenz, idiopathisches und andere Parkinson-Syndrome, Normaldruckhydrozephalus

Zusammenfassung

Das Erkennen von Demenz bei Parkinson-Syndromen bzw. von einem Parkinson-Syndrom bei einer dementiellen Entwicklung ist hilfreich, um durch die Wahl geeigneter und Meidung ungeeigneter Pharmaka folgende häufige iatrogene Probleme zu reduzieren: 1. Delire und Psychosen durch Antiparkinsonika und 2. motorische und kognitive Verschlechterung durch typische und auch atypische Neuroleptika. Bei neu aufgetretener dementieller Symptomatik bei Parkinson-Syndrom müssen zunächst auslösende Ursachen ausgeschlossen werden: Dehydrierung, Medikamente, Harnwegsinfekte und Pneumonien, metabolische Störungen, Herzinsuffizienz und Anämien. Abrupte Entzüge von Medikamenten wie Amantadin und Anticholinergika sind zu vermeiden. Studienergebnisse sprechen für eine wichtige Rolle von Cholinesterasehemmer bei Lewy-Körper-Demenz (LKD) und idiopathischem Parkinson-Syndrom (IPS) mit Demenz. Clozapin und Quetiapin (nicht zugelassen) sind als delirogene Pharmaka ungeeignet bei Demenz und sollten der typischen dopaminergen Psychose bei IPS vorbehalten bleiben.

Summary

The diagnosis of dementia in the context of parkinsonism or respectively of parkinsonism in dementia is the first step to minimize the following common iatrogenic problems: 1. delirium and psychosis caused by antiparkinsonian drugs and 2. motor and cognitive worsening caused by typical and atypical neuroleptics. An emerging dementia in parkinsonism asks for the exclusion of precipitating causes such as dehydration, drugs, urinary infections, pneumonia and metabolic causes before any other measures are taken. Sudden withdrawals of amantadine and anticholinergics should be avoided. Trials suggest an important role of cholinesterase-inhibitors in the treatment of Lewy body dementia and Parkinson’s disease with dementia. Clozapin and Quetiapine (off label) are potentially delirogenic compounds and if possible should be avoided in dementia and reserved for the classical dopaminergic psychosis.

Schlüsselwörter

Parkinson-Syndrom - Demenz - atypische Neuroleptika - Cholinesterasehemmer - Dopaminergika

Keywords

Parkinson’s disease - parkinsonism and dementia - atypical neuroleptics - cholinesterase inhibitors - dopamine agonists

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