Demenz bei Parkinson-Syndromen

Zusammenfassung

Eine ausgeprägte Demenz früh im Verlauf bei einem Parkinson-Syndrom spricht gegen die Diagnosen Morbus Parkinson (idiopathisches Parkinson-Syndrom) und Multisystematrophie (MSA). Eine Vergesellschaftung von früher Demenz und Parkinson tritt bei der progressiven supranukleären Blickparese (PSP) und der kortikobasalen Degeneration (CBD) auf. Ein Parkinson-Syndrom mit Demenz kommt außerdem bei der diffusen Lewy-Körper-Krankheit (Lewy-Body-Demenz), spät im Verlauf beim Morbus Alzheimer, bei der subkortikalen arteriosklerotischen Enzephalopathie (vaskulärer Parkinsonismus) und beim Normaldruckhydrozephalus vor. Parkinson-Syndrom plus Demenz stellt ein therapeutisches Problem dar. Diese Patienten reagieren besonders schnell mit Verwirrtheit und exogenen Psychosen auf Antiparkinsonika. Neuroleptika sind bei bestehendem Parkinson-Syndrom kontraindiziert. Hier kommt den Cholinesterase-Hemmer eine neue Rolle zu, da sie nach jüngeren Studien die nicht-kognitiven Demenz-Symptome bessern, ohne das Parkinson-Syndrom zu verschlechtern.

Summary

Dementia early in the course of parkinsonism represents an exclusion criteria for the diagnosis Parkinson’s disease and multiple system atrophy. Dementia with parkinsonism develops in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Parkinsonism together with dementia also occurs in a varierty of other conditions such as in diffuse Lewy-disease, late in the course of Alzheimer’s disease, in vascular parkinsonism and normal pressure hydrocephalus. Parkinsonism plus dementia is a therapeutic challenge. Antiparkinsonian drugs commonly cause delirium and psychosis. Neuroleptics are contraindicated as they worsen parkinsonism. Cholinesterase inhibitors may play here a new role as recent studies show that these compounds are effective for the behavioural signs of dementia without worsening parkinsonism.

Schlüsselwörter

Parkinson-Syndrom - Demenz - Cholinesterase-Hemmer - Dopaminergika

Keywords

Parkinson’s disease - dementia - cholinesterase inhibitors - dopaminergics

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