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Aktuelle Neurologie 2009; 36: S312-S319
DOI: 10.1055/s-0029-1220463
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Therapie geriatrischer Patienten mit Morbus Parkinson

Therapy of Geriatric Patients with Parkinson's DiseaseC.  Buhmann1
  • 1Ambulanzzentrum und Neurologische Klinik und Poliklinik am Universitätsklinikum Hamburg-Eppendorf
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Publication History

Publication Date:
21 October 2009 (online)

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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

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PD Dr. med. Carsten Buhmann

Ambulanzzentrum und Neurologische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf

Martinistr. 52

20246 Hamburg

Email: buhmann@uke.uni-hamburg.de