Frühe Diagnostik des idiopathischen Parkinson-Syndroms

Zusammenfassung

Für einzelne Substanzen wie Rasagilin, Selegilin, Dopaminagonisten und Amantadin stehen zunehmend klinische Studien zur Verfügung, die einen krankheitsmodifizierenden Effekt nahelegen. Sollte dieser Effekt tatsächlich vorhanden sein, wäre es wichtig, ein idiopathisches Parkinson-Syndrom früher zu diagnostizieren. Bisher haben wir Parkinson-Patienten nur behandelt, wenn sie sich durch ihre Symptome genügend beeinträchtigt fühlten, d. h. durch Bradykinese oder Tremor in den Aktivitäten des täglichen Lebens behindert waren. Unsere eigenen Untersuchungen sprechen dafür, dass Hyposmie bzw. Anosmie zu den ersten Parkinson-Symptomen überhaupt gehören. Bis zu 90 % aller Parkinson-Patienten weisen eine Hyposmie auf, viele von ihnen, ohne es selbst bemerkt zu haben. Somit gibt es gute Gründe, die Hyposmie als fünftes Kardinalsymptom zu bezeichnen. Die REM-Schlaf-Verhaltensstörung ist ein weiteres Symptom, das den motorischen Parkinson-Symptomen vorausgehen kann. Darüber hinaus sind auch Veränderungen des Schriftbildes oder Schulterschmerzen frühe mögliche Parkinson-Symptome. Mit dem Farmsworth-Test kann man Störungen der Farbwahrnehmung objektivieren. Dazu kommen ein Mindermitpendeln des Armes und die Hypomimie als hilfreiche Frühsymptome des idiopathischen Parkinson-Syndroms. Zusammengefasst ist die Hyposmie der wichtigste frühe klinische Marker, um ein idiopathisches Parkinson-Syndrom zu diagnostizieren. Weniger spezifisch sind eine depressive Verstimmung, die in 30 % der Fälle den motorischen Symptomen vorangeht, und eine Obstipation.

Abstract

There is an increasing body of literature on possible substances which may offer disease modification for Parkinson's disease (PD). To name a few, rasagiline, selegiline, dopamine agonists and amantadine may possibly be disease-modifying substances. If this holds true, it becomes necessary and rewarding to diagnose PD earlier than is so far the case. So far, we have treated patients only if they felt impaired by the disease, i. e., by symptoms such as bradykinesia or tremor. We strongly believe that hyposmia is the first clinical marker for PD. At least 90 % of all PD patients suffer from hyposmia, many of them without having noticed it. This large number of hyposmic patients influenced us to introduce hyposmia as the fifth cardinal symptom. REM sleep disturbance is another early clinical symptom but it is certainly less often seen in PD patients than hyposmia. Abnormalities in hand writing are another early clinical sign since most patients develop due to their rigidity a smaller and less clearly readable typeface (micrographia). Another less characteristic symptom is pain in the shoulder girdle, which is also a symptom caused by muscular rigidity. The Farmsworth test is good to objectify problems in colour discrimination. A reduced arm swing and hypomimia are additional early clinical symptoms. Taken together, in our view, hyposmia is the most useful early clinical marker to detect imminent PD. Less specific is depression which occurs in up to 30 % prior to the motor symptoms. The same is true for constipation.

Schlüsselwörter

idiopathisches Parkinson-Syndrom - Frühdiagnose - Hyposmie - REM-Schlaf-Verhaltensstörung - Depression

Keywords

idiopathic Parkinson's syndrome - early diagnosis - hyposmia - REM sleep behavior disorder - depression

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