Therapie geriatrischer Patienten mit Morbus Parkinson

Zusammenfassung

Die Therapie geriatrischer Patienten mit Morbus Parkinson weist zahlreiche Besonderheiten auf. Multimorbidität, medikamentös wenig beeinflussbare Symptome wie Gang-, Haltungs-, Sprech- und Schluckstörungen, autonome Dysfunktion sowie neuropsychiatrische Auffälligkeiten wie Demenz, Psychose und Depression treten zunehmend in den Vordergrund. Auf der anderen Seite führen die steigende Lebenserwartung und die epidemiologische Entwicklung in Westeuropa dazu, dass wir zukünftig eine steigende Zahl alter, doch vitaler Patienten behandeln werden. Bereits heute sind 2 Drittel aller Parkinson-Patienten älter als 70 Jahre und in den nächsten 25 Jahren wird sich die Anzahl der alten Parkinson-Patienten verdoppeln. Trotzdem steht die Therapie der geriatrischen Patienten nicht im Fokus der Aufmerksamkeit. Pharmakologische Studien berücksichtigen primär deutliche jüngere Patienten ohne Komorbiditäten und psychiatrische Begleiterkrankungen. Erkenntnisse aus diesen Studien sind nur bedingt auf alte Patienten zu übertragen. Medikamentöse kontrollierte Studien an geriatrischen Patienten fehlen und differenzierte Therapieempfehlungen für Patienten jenseits des 70. Lebensjahres existieren nicht. Obwohl nicht motorische Symptome im Alter die Hauptursache für die eingeschränkte Lebensqualität der Parkinson-Patienten darstellen, ist die Studienlage in dieser Hinsicht ebenfalls unbefriedigend. Den aktivierenden und übenden Verfahren wird erst in letzter Zeit vermehrt Aufmerksamkeit zuteil. Verschiedene Verfahren sind in kleineren kontrollierten Studien untersucht.

Abstract

Some special features characterise the therapy for geriatric Parkinson patients. Multimorbidity, symptoms only hardly controlled by pharmacotherapy like freezing of gait, dysarthria, dysphagia and disturbances of the autonomic system as well as neuropsychiatric features like dementia, psychosis and depression are coming increasingly to the fore. On the other hand, the increased expectation of life and epidemiology of Western Europe will increase the need to medicate a soaring number of old, but vital patients. Today, two-thirds of the patients with Parkinson's disease are older than 70 years and in the next 25 years the number of older patients with Parkinson's disease will double. The therapy for geriatric patients is still not in the focus of interest. The participants of pharmacological studies are primarily younger patients without comorbidity and psychiatric concomitant diseases. The findings from these studies cannot be fully transferred to older patients. There is a lack of pharmacotherapeutical studies on geriatric patients and there are no differentiated treatment recommendations for patients older than 70 years. Although non-motoric symptoms are the main cause of the diminished quality of life in patients with Parkinson's disease, there are not many studies available covering this theme. Activating and training therapies are coming more and more to the centre of interest. Some therapies are being tested within controlled studies.

Schlüsselwörter

Morbus Parkinson - Geriatrie - Alter - Epidemiologie - motorische Störungen

Keywords

Parkinson's disease - geriatric patients - age - epidemiology - motor deficits

Literatur

• 1 Chaudhuri K R, Schapira A H. Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment.  Lancet Neurol. 2009;  8 464-474
• 2 Kostic V, Przedborski S, Flaster E. et al . Early development of levodopa-induced dyskinesias and response fluctuations in young-onset Parkinson's disease.  Neurology. 1991;  41 202-205
• 3 Parkinson Study Group . A randomized controlled trial comparing pramipexole with levodopa in early Parkinson's disease: design and methods of the CALM-PD Study. Parkinson Study Group.  Clin Neuropharmacol. 2000;  23 34-44
• 4 Rinne U K, Bracco F, Chouza C. et al . Early treatment of Parkinson's disease with cabergoline delays the onset of motor complications. Results of a double-blind levodopa controlled trial. The PKDS009 Study Group.  Drugs. 1998;  55 (Suppl. 1) 23-30
• 5 Rascol O, Brooks D J, Korczyn A D. et al . A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group.  N Engl J Med. 2000;  342 1484-1491
• 6 Rascol O, Brooks D J, Korczyn A D. et al . Development of dyskinesias in a 5-year trial of ropinirole and L-dopa.  Mov Disord. 2006;  21 1844-1850
• 7 Katzenschlager R, Head J, Schrag A. et al . Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD.  Neurology. 2008;  71 474-480
• 8 Playfer J R. Ageing and Parkinson's disease.  Pract Neurol. 2007;  7 4-5
• 9 Fornadi F, Werner M. Quelle: Parkinson Netz 2009;. http://www.parkinson-net.de/med/haus-ein.htm
• 10 Driver J A, Logroscino G, Gaziano J M. et al . Incidence and remaining lifetime risk of Parkinson disease in advanced age.  Neurology. 2009;  72 432-438
• 11 de Rijk M C, Launer L J, Berger K. et al . Prevalence of Parkinson's disease in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group.  Neurology. 2000;  54 (11 Suppl. 5) S21-S23
• 12 Diem-Zangerl A, Seppi K, Wenning G K. et al . Mortality in Parkinson's disease: a 20-year follow-up study.  Mov Disord. 2009;  24 819-825
• 13 Ishihara L S, Cheesbrough A, Brayne C. et al . Estimated life expectancy of Parkinson's patients compared with the UK population.  J Neurol Neurosurg Psychiatry. 2007;  78 1304-1309
• 14 Dorsey E R, Constantinescu R, Thompson J P. et al . Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030.  Neurology. 2007;  68 384-386
• 15 Leoni O, Martignoni E, Cosentino M. et al . Drug prescribing patterns in Parkinson's disease: a pharmacoepidemiological survey in a cohort of ambulatory patients.  Pharmacoepidemiol Drug Saf. 2002;  11 149-157
• 16 Grosset K A, Bone I, Grosset D G. Suboptimal medication adherence in Parkinson's disease.  Mov Disord. 2005;  20 1502-1507
• 17 Parkinson Study Group . Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease. The Parkinson Study Group.  N Engl J Med. 1999;  340 757-763
• 18 Aarsland D, Kvaloy J T, Andersen K. et al . The effect of age of onset of PD on risk of dementia.  J Neurol. 2007;  254 38-45
• 19 Aarsland D, Zaccai J, Brayne C. A systematic review of prevalence studies of dementia in Parkinson's disease.  Mov Disord. 2005;  20 1255-1263
• 20 Reid W G, Broe G A, Hely M A. et al . The neuropsychology of de novo patients with idiopathic Parkinson's disease: the effects of age of onset.  Int J Neurosci. 1989;  48 205-217
• 21 Reid W G, Hely M A, Morris J G. et al . A longitudinal of Parkinson's disease: clinical and neuropsychological correlates of dementia.  J Clin Neurosci. 1996;  3 327-333
• 22 Hely M A, Morris J G, Reid W G. et al . Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years.  Mov Disord. 2005;  20 190-199
• 23 Hely M A, Reid W G, Adena M A. et al . The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years.  Mov Disord. 2008;  23 837-844
• 24 Kalbe E, Calabrese P, Kohn N. et al . Screening for cognitive deficits in Parkinson's disease with the Parkinson neuropsychometric dementia assessment (PANDA) instrument.  Parkinsonism Relat Disord. 2008;  14 93-101
• 25 Emre M, Aarsland D, Albanese A. et al . Rivastigmine for dementia associated with Parkinson's disease.  N Engl J Med. 2004;  351 2509-2518
• 26 Ravina B, Putt M, Siderowf A. et al . Donepezil for dementia in Parkinson's disease: a randomised, double blind, placebo controlled, crossover study.  J Neurol Neurosurg Psychiatry. 2005;  76 934-939
• 27 Cummings J L, Masterman D L. Depression in patients with Parkinson's disease.  Int J Geriatr Psychiatry. 1999;  14 711-718
• 28 Brown R G, MacCarthy B, Gotham A M. et al . Depression and disability in Parkinson's disease: a follow-up of 132 cases.  Psychol Med. 1988;  18 49-55
• 29 Cummings J L. Depression and Parkinson's disease: a review.  Am J Psychiatry. 1992;  149 443-454
• 30 Strang R R. Imipramine in treatment of Parkinsonism: A double-blind placebo study.  Br Med J. 1965;  2 33-34
• 31 Laitinen L. Desipramine in treatment of Parkinson's disease. A placebo-controlled study.  Acta Neurol Scand. 1969;  45 109-113
• 32 Andersen J, Aabro E, Gulmann N. et al . Anti-depressive treatment in Parkinson's disease. A controlled trial of the effect of nortriptyline in patients with Parkinson's disease treated with L-DOPA.  Acta Neurol Scand. 1980;  62 210-219
• 33 Devos D, Dujardin K, Poirot I. et al . Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double-blind, randomized, placebo-controlled study.  Mov Disord. 2008;  23 850-857
• 34 Steur E N. Increase of Parkinson disability after fluoxetine medication.  Neurology. 1993;  43 211-213
• 35 Jimenez-Jimenez F J, Tejeiro J, Martinez-Junquera G. et al . Parkinsonism exacerbated by paroxetine.  Neurology. 1994;  44 2406
• 36 Linazasoro G. Worsening of Parkinson's disease by citalopram.  Parkinsonism Relat Disord. 2000;  6 111-113
• 37 Dell'Agnello G, Ceravolo R, Nuti A. et al . SSRIs do not worsen Parkinson's disease: evidence from an open-label, prospective study.  Clin Neuropharmacol. 2001;  24 221-227
• 38 Marino S, Sessa E, Di Lorenzo G. et al . Sertraline in the treatment of depressive disorders in patients with Parkinson's disease.  Neurol Sci. 2008;  29 391-395
• 39 Tesei S, Antonini A, Canesi M. et al . Tolerability of paroxetine in Parkinson's disease: a prospective study.  Mov Disord. 2000;  15 986-989
• 40 Menza M, Dobkin R D, Marin H. et al . A controlled trial of antidepressants in patients with Parkinson disease and depression.  Neurology. 2009;  72 886-892
• 41 Rascol O, Goetz C, Koller W. et al . Treatment interventions for Parkinson's disease: an evidence based assessment.  Lancet. 2002;  359 1589-1598
• 42 El Sharkawi A, Ramig L, Logemann J A. et al . Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study.  J Neurol Neurosurg Psychiatry. 2002;  72 31-36
• 43 Bhatia K P, Munchau A, Brown P. Botulinum toxin is a useful treatment in excessive drooling in saliva.  J Neurol Neurosurg Psychiatry. 1999;  67 697
• 44 Lipp A, Trottenberg T, Schink T. et al . A randomized trial of botulinum toxin A for treatment of drooling.  Neurology. 2003;  61 1279-1281
• 45 Lees A J, Blackburn N A, Campbell V L. The nighttime problems of Parkinson's disease.  Clin Neuropharmacol. 1988;  11 512-519
• 46 Pact V, Giduz T. Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias.  Neurology. 1999;  53 1154
• 47 Nieuwboer A, Kwakkel G, Rochester L. et al . Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial.  J Neurol Neurosurg Psychiatry. 2007;  78 134-140
• 48 Ellis T, de Goede C J, Feldman R G. et al . Efficacy of a physical therapy program in patients with Parkinson's disease: a randomized controlled trial.  Arch Phys Med Rehabil. 2005;  86 626-632
• 49 Koller W C, Glatt S, Vetere-Overfield B. et al . Falls and Parkinson's disease.  Clin Neuropharmacol. 1989;  12 98-105
• 50 Ceballos-Baumann A, Ebersbach G. Aktivierende Therapien bei Parkinsonsyndromen.  DNP. 2009;  5 56-60
• 51 Thaut M H, McIntosh G C, Rice R R. et al . Rhythmic auditory stimulation in gait training for Parkinson's disease patients.  Mov Disord. 1996;  11 193-200
• 52 Morris M E, Iansek R, Matyas T A. et al . Stride length regulation in Parkinson's disease. Normalization strategies and underlying mechanisms.  Brain. 1996;  119 551-568
• 53 Miyai I, Fujimoto Y, Ueda Y. et al . Treadmill training with body weight support: its effect on Parkinson's disease.  Arch Phys Med Rehabil. 2000;  81 849-852
• 54 Jobges M, Heuschkel G, Pretzel C. et al . Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2004;  75 1682-1687
• 55 Protas E J, Mitchell K, Williams A. et al . Gait and step training to reduce falls in Parkinson's disease.  NeuroRehabilitation. 2005;  20 183-190
• 56 Koller W, Kase S. Muscle strength testing in Parkinson's disease.  Eur Neurol. 1986;  25 130-133
• 57 Hass C J, Collins M A, Juncos J L. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial.  Neurorehabil Neural Repair. 2007;  21 107-115
• 58 Toole T, Hirsch M A, Forkink A. et al . The effects of a balance and strength training program on equilibrium in Parkinsonism: A preliminary study.  NeuroRehabilitation. 2000;  14 165-174
• 59 Dibble L E, Hale T, Marcus R L. et al . The safety and feasibility of high-force eccentric resistance exercise in persons with Parkinson's disease.  Arch Phys Med Rehabil. 2006;  87 1280-1282
• 60 Ramig L O, Sapir S, Fox C. et al . Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-matched controls.  Mov Disord. 2001;  16 79-83