Download PDF
Aktuelle Neurologie 2009; 36: S2-S6
DOI: 10.1055/s-0028-1090175
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Lebensqualität als Ziel therapeutischer Interventionen bei Morbus Parkinson

Quality of Life in the Treatment of Parkinson's DiseaseJ.  Herzog1 , G.  Deuschl1
  • 1Klinik für Neurologie, Christian-Albrechts-Universität Kiel, Deutschland
Further Information

Publication History

Publication Date:
02 April 2009 (online)

Also available at
    Permissions and Reprints

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
    CrossrefPubMedGoogle Scholar
  • 2 Welsh M D. Measurement of quality of life in neurodegenerative disorders.  Curr Neurol Neurosci Rep. 2001;  1 346-349
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 4 Schrag A, Jahanshahi M, Quinn N P. What contributes to depression in Parkinson's disease?.  Psychol Med. 2001;  31 65-73
    CrossrefPubMedGoogle Scholar
  • 5 Witjas T, Kaphan E, Azulay J P. Non-motor fluctuations in Parkinson's disease.  Rev Neurol (Paris). 2007;  163 846-850
    CrossrefPubMedGoogle Scholar
  • 6 The World Health Organization Quality of Life assessment (WHOQOL) . Position paper from the World Health Organization.  Soc Sci Med. 1995;  41 1403-1409
    CrossrefPubMedGoogle Scholar
  • 7 Greer S. The psychological dimension in cancer treatment.  Soc Sci Med. 1984;  18 345-349
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 The EuroQol Group . EuroQol – a new facility for the measurement of health-related quality of life.  Health Policy. 1990;  16 199-208
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 33 Schrag A. Quality of life and depression in Parkinson's disease.  J Neurol Sci. 2006;  248 151-157
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Prof. Dr. G. Deuschl

Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel

Schittenhelmstr. 10

24105 Kiel

Email: g.deuschl@neurologie.uni-kiel.de