Zusammenfassung
Bei der Bewertung des Krankheitszustandes sowie des Einflusses von therapeutischen Interventionen beim Morbus Parkinson spielt die Erfassung der Lebensqualität eine zunehmend größere Rolle. Insbesondere die gesundheitsbezogene Lebensqualität (Health-related Quality of Life, HRQoL) wird in immer mehr klinischen Studien als Zielparameter integriert und kann mithilfe von generischen oder krankheitsspezifischen Skalen erfasst werden. Die HRQoL von Parkinson-Patienten wird durch unterschiedliche klinische Faktoren ungünstig beeinflusst, u. a. Schwere und Dauer der Erkrankung, aber auch Fluktuationen, Dyskinesien, nächtliche und morgendliche Akinesie, axiale Symptome, Schlaflosigkeit und mentale Störungen. Metaanalysen zeigen, dass sich das Vorliegen einer Depression und axialer Symptome einschließlich Gangstörungen besonders ungünstig auf die Lebensqualität von Parkinson-Patienten auswirkt. Nach den Kriterien der evidenzbasierten Medizin können derzeit die tiefe Hirnstimulation des Nucleus subthalamicus, die unilaterale Pallidotomie sowie die medikamentöse Therapie mit Rasagilin als klinisch effektiv gelten. Zukünftige Therapiestrategien werden einen Schwerpunkt auf die Behandlung depressiver und axialer Symptome legen, um einen substanziellen therapeutischen Effekt für Parkinson-Patienten erzielen zu können.
Abstract
Assessment of quality of life parameters plays an increasingly important role in the evaluation of the health state of patients with Parkinson's disease (PD) and has an influence on therapeutic interventions. More specifically, the health-related quality of life (HRQoL) is usually investigated by clinical studies using both generic and PD-specific evaluation scores. Clinical factors including disease duration and severity, fluctuations, dyskinesias, nocturnal akinesia, insomnia, axial and mental symptoms have been shown to negatively impact on the HRQoL. Based on meta-analyses, depression and axial symptoms including freezing of gait are largely responsible for the variability in life quality of PD patients. Therefore, future therapeutic approaches might focus on the amelioration of these specific symptoms. At present, following the criteria of evidence-based medicine, unilateral pallidotomy, bilateral subthalamic stimulation as well as rasagiline are regarded as clinically efficacious with respect to improvement of HRQoL.
Schlüsselwörter
Lebensqualität - Morbus Parkinson - medikamentöse Therapie - tiefe Hirnstimulation
Key words
quality of life - Parkinson's disease - Pharmacology - deep brain stimulation
Literatur
-
1
Lee M A, Walker R W, Hildreth A J. et al .
Individualized assessment of quality of life in idiopathic Parkinson's disease.
Mov Disord.
2006;
21
1929-1934
-
2
Welsh M D.
Measurement of quality of life in neurodegenerative disorders.
Curr Neurol Neurosci Rep.
2001;
1
346-349
-
3
Chapuis S, Ouchchane L, Metz O. et al .
Impact of the motor complications of Parkinson's disease on the quality of life.
Mov Disord.
2005;
20
224-230
-
4
Schrag A, Jahanshahi M, Quinn N P.
What contributes to depression in Parkinson's disease?.
Psychol Med.
2001;
31
65-73
-
5
Witjas T, Kaphan E, Azulay J P.
Non-motor fluctuations in Parkinson's disease.
Rev Neurol (Paris).
2007;
163
846-850
-
6
The World Health Organization Quality of Life assessment (WHOQOL) .
Position paper from the World Health Organization.
Soc Sci Med.
1995;
41
1403-1409
-
7
Greer S.
The psychological dimension in cancer treatment.
Soc Sci Med.
1984;
18
345-349
-
8
Browne J P, O'Boyle C A, McGee H M. et al .
Individual quality of life in the healthy elderly.
Qual Life Res.
1994;
3
235-244
-
9
Neudert C, Wasner M, Borasio G D.
Patients' assessment of quality of life instruments: a randomised study of SIP, SF-36 and SEIQoL-DW in patients with amyotrophic lateral sclerosis.
J Neurol Sci.
2001;
191
103-109
-
10
Den Oudsten B L, Van Heck G L, De Vries J.
Quality of life and related concepts in Parkinson's disease: a systematic review.
Mov Disord.
2007;
22
1528-1537
-
11
Haave E, Hyland M E, Skumlien S.
The relation between measures of health status and quality of life in COPD.
Chron Respir Dis.
2006;
3
195-199
-
12
Ware Jr J E.
Conceptualization and measurement of health-related quality of life: comments on an evolving field.
Arch Phys Med Rehabil.
2003;
84, 4 (Suppl. 2)
S43-51
-
13
Hunt S M, McEwen J, McKenna S P.
Measuring health status: a new tool for clinicians and epidemiologists.
J R Coll Gen Pract.
1985;
35
185-188
-
14
Bergner M, Bobbitt R A, Carter W B. et al .
The Sickness Impact Profile: development and final revision of a health status measure.
Med Care.
1981;
19
787-805
-
15
Ware Jr J E, Sherbourne C D.
The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
Med Care.
1992;
30
473-483
-
16
Haapaniemi T H, Sotaniemi K A, Sintonen H. et al .
The generic 15D instrument is valid and feasible for measuring health related quality of life in Parkinson's disease.
J Neurol Neurosurg Psychiatry.
2004;
75
976-983
-
17
The EuroQol Group .
EuroQol – a new facility for the measurement of health-related quality of life.
Health Policy.
1990;
16
199-208
-
18
de Boer A G, Wijker W, Speelman J D. et al .
Quality of life in patients with Parkinson's disease: development of a questionnaire.
J Neurol Neurosurg Psychiatry.
1996;
61
70-74
-
19
Peto V, Jenkinson C, Fitzpatrick R.
PDQ-39: a review of the development, validation and application of a Parkinson's disease quality of life questionnaire and its associated measures.
J Neurol.
1998;
245 (Suppl. 1)
10-14
-
20
Calne S M, Mak E, Hall J. et al .
Validating a quality-of-life scale in caregivers of patients with Parkinson's disease: Parkinson's Impact Scale (PIMS).
Adv Neurol.
2003;
91
115-122
-
21
Welsh M, McDermott M P, Holloway R G. et al .
Development and testing of the Parkinson's disease quality of life scale.
Mov Disord.
2003;
18
637-645
-
22
Hagell P, Nygren C.
The 39 item Parkinson's disease questionnaire (PDQ-39) revisited: implications for evidence based medicine.
J Neurol Neurosurg Psychiatry.
2007;
78
1191-1198
-
23
Damiano A M, McGrath M M, Willian M K. et al .
Evaluation of a measurement strategy for Parkinson's disease: assessing patient health-related quality of life.
Qual Life Res.
2000;
9
87-100
-
24
Fitzpatrick R, Peto V, Jenkinson C. et al .
Health-related quality of life in Parkinson's disease: a study of outpatient clinic attenders.
Mov Disord.
1997;
12
916-922
-
25
Kuopio A M, Marttila R J, Helenius H. et al .
The quality of life in Parkinson's disease.
Mov Disord.
2000;
15
216-223
-
26
Martinez-Martin P, Frades Payo B, Fontan Tirado C. et al .
Assessing quality of life in Parkinson's disease using the PDQ-39. A pilot study.
Neurologia.
1997;
12
56-60
-
27
Lyons K E, Pahwa R, Troster A I. et al .
A comparison of Parkinson's disease symptoms and self-reported functioning and well being.
Parkinsonism Relat Disord.
1997;
3
207-209
-
28
Rubenstein L M, Voelker M D, Chrischilles E A. et al .
The usefulness of the Functional Status Questionnaire and Medical Outcomes Study Short-Form in Parkinson's disease research.
Qual Life Res.
1998;
7
279-290
-
29
Karlsen K H, Larsen J P, Tandberg E. et al .
Quality of life measurements in patients with Parkinson's disease: A community-based study.
Eur J Neurol.
1998;
5
443-450
-
30
Caap-Ahlgren M, Dehlin O.
Insomnia and depressive symptoms in patients with Parkinson's disease. Relationship to health-related quality of life. An interview study of patients living at home.
Arch Gerontol Geriatr.
2001;
32
23-33
-
31
Hobson P, Holden A, Meara J.
Measuring the impact of Parkinson's disease with the Parkinson's Disease Quality of Life questionnaire.
Age Ageing.
1999;
28
341-346
-
32
Karlsen K H, Larsen J P, Tandberg E. et al .
Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease.
J Neurol Neurosurg Psychiatry.
1999;
66
431-435
-
33
Schrag A.
Quality of life and depression in Parkinson's disease.
J Neurol Sci.
2006;
248
151-157
-
34
Moore O, Peretz C, Giladi N.
Freezing of gait affects quality of life of peoples with Parkinson's disease beyond its relationships with mobility and gait.
Mov Disord.
2007;
22
2192-2195
-
35
Muslimovic D, Post B, Speelman J D. et al .
Determinants of disability and quality of life in mild to moderate Parkinson disease.
Neurology.
2008;
70
2241-2247
-
36
Martinez-Martin P, Deuschl G.
Effect of medical and surgical interventions on health-related quality of life in Parkinson's disease.
Mov Disord.
2007;
22
757-765
-
37
Grandas F, Martinez-Martin P, Linazasoro G.
Quality of life in patients with Parkinson's disease who transfer from standard levodopa to Sinemet CR: the STAR Study. The STAR Multicenter Study Group.
J Neurol.
1998;
245 (Suppl. 1)
S31-33
-
38
Martinez-Martin P, Grandas F, Linazasoro G. et al .
Conversion to controlled-release levodopa / carbidopa treatment and quality of life as measured by the Nottingham Health Profile. The STAR Study Group.
Neurologia.
1999;
14
338-343
-
39
Durif F, Devaux I, Pere J J. et al .
Efficacy and tolerability of entacapone as adjunctive therapy to levodopa in patients with Parkinson's disease and end-of-dose deterioration in daily medical practice: an open, multicenter study.
Eur Neurol.
2001;
45
111-118
-
40
Gershanik O, Emre M, Bernhard G. et al .
Efficacy and safety of levodopa with entacapone in Parkinson's disease patients suboptimally controlled with levodopa alone, in daily clinical practice: an international, multicentre, open-label study.
Prog Neuropsychopharmacol Biol Psychiatry.
2003;
27
963-971
-
41
Koller W, Guarnieri M, Hubble J. et al .
An open-label evaluation of the tolerability and safety of Stalevo (carbidopa, levodopa and entacapone) in Parkinson's disease patients experiencing wearing-off.
J Neural Transm.
2005;
112
221-230
-
42
Onofrj M, Thomas A, Vingerhoets F. et al .
Combining entacapone with levodopa/DDCI improves clinical status and quality of life in Parkinson's Disease (PD) patients experiencing wearing-off, regardless of the dosing frequency: results of a large multicentre open-label study.
J Neural Transm.
2004;
111
1053-1063
-
43
Koller W, Lees A, Doder M. et al .
Randomized trial of tolcapone versus pergolide as add-on to levodopa therapy in Parkinson's disease patients with motor fluctuations.
Mov Disord.
2001;
16
858-866
-
44
Welsh M D, Dorflinger E, Chernik D. et al .
Illness impact and adjustment to Parkinson's disease: before and after treatment with tolcapone.
Mov Disord.
2000;
15
497-502
-
45
Holloway R G, Shoulson I, Fahn S. et al .
Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.
Arch Neurol.
2004;
61
1044-1053
-
46
Baas H K, Schueler P.
Efficacy of cabergoline in long-term use: results of three observational studies in 1,500 patients with Parkinson's disease.
Eur Neurol.
2001;
46 (Suppl. 1)
18-23
-
47
Biglan K M, Schwid S, Eberly S. et al .
Rasagiline improves quality of life in patients with early Parkinson's disease.
Mov Disord.
2006;
21
616-623
-
48
Deuschl G, Schade-Brittinger C, Krack P. et al .
A randomized trial of deep-brain stimulation for Parkinson's disease.
N Engl J Med.
2006;
355
896-908
-
49
Esselink R A, de Bie R M, de Haan R J. et al .
Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial.
Neurology.
2004;
62
201-207
-
50
Just H, Ostergaard K.
Health-related quality of life in patients with advanced Parkinson's disease treated with deep brain stimulation of the subthalamic nuclei.
Mov Disord.
2002;
17
539-545
-
51
Kleiner-Fisman G, Herzog J, Fisman D N. et al .
Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes.
Mov Disord.
2006;
21 (Suppl. 14)
S290-304
Prof. Dr. G. Deuschl
Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
Schittenhelmstr. 10
24105 Kiel
Email: g.deuschl@neurologie.uni-kiel.de
