Zusammenfassung
Patienten mit einem idiopathischen Parkinson-Syndrom (IPS) entwickeln zu 20 % eine Demenz. Wichtig ist, dass Differenzialdiagnosen wie Demenz vom Lewy-Körperchen-Typ, kortikobasale Degeneration, progressive supranukleäre Paralyse und die Alzheimer-Krankheit mit in Erwägung gezogen werden. Besonders gefährdet für eine Demenz sind Patienten bei denen die Parkinson-Krankheit sehr rasch voranschreitet, die erst im Alter erkranken und die eine familiäre Belastung mit Demenz aufweisen. Anticholinergika sollten wegen der Möglichkeit der Verschlechterung kognitiver Leistungen bei der Behandlung des IPS vermieden werden. Gute Erfahrungen wurden mit den modernen Cholinergika (Azetylcholin-Esterase-Hemmer) gemacht, die nach ersten Untersuchungen nicht nur zu einer Besserung der Kognition beitragen, sondern auch zu keiner Verschlechterung des Tremors und anderer Parkinson-Symptome führen.
Dementia in Idiopathic Parkinson Disease
Patients with idiopathic Parkinson's disease (IPD) present with dementia in 20 %. It is important to exclude patients with corticobasal degeneration, supranuclear palsy, dementia of Lewy body type and Alzheimer's disease. High-risk patients for developing dementia are those who quickly deteriorate, start the disease late in life and who have other demented people in the family. We advocate to avoid anticholinergics for treatment of patients with IPD since a cholinergic deficit might enhance cognitive impairment. Several studies showed promising results for the new cholinergic drugs (cholinesterase inhibitors) with respect to improvement in cognitive function while these patients did not deteriorate concerning motor skills.
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Prof. Dr. med. Heinz Reichmann
Dr. med. Ulrike Sommer
Klinik und Poliklinik für Neurologie
Medizinische Fakultät Carl Gustav Carus
Technische Universität Dresden
Fetscherstraße 74
01307 Dresden
Email: Heinz.Reichmann@mailbox.tu-dresden.de
