Der Internist

, Volume 55, Issue 6, pp 728–734

Pharmakotherapie des Morbus Parkinson beim älteren, multimorbiden Patienten

Arzneimitteltherapie
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Zusammenfassung

Hintergrund

Das idiopathische Parkinson-Syndrom ist eine häufige neurodegenerative Erkrankung, die insbesondere Patienten im höheren Lebensalter betrifft. Mit zunehmendem Alter und längerem Krankheitsverlauf ist die Therapie verschiedenen Komplikationen unterworfen, u. a. Wirkungsfluktuationen und Dyskinesien. In Anbetracht der Nebenwirkungen und Interaktionen ist es bei älteren, multimorbiden Patienten eine Herausforderung, die medikamentöse Parkinson-Therapie in ein meist weitreichendes Therapiekonzept einzubetten.

Zielsetzung

Die Behandlung umfasst nicht nur die medikamentöse Einstellung der motorischen Symptome, sondern auch die der nichtmotorischen Symptome wie Demenz, Depression, orthostatische Dysregulation und gastrointestinale Probleme. Die Behandlungsstrategien und deren Komplikationen beim geriatrischen Patienten werden erläutert.

Schlussfolgerung

Vor allem bei älteren Patienten sind die sorgfältige Symptomerfassung und die vorsichtige medikamentöse Einstellung unter Rücksichtnahme auf Multimorbidität und Risiken einer Polypharmakotherapie zum Erhalt von Lebensqualität, Alltagsfähigkeit und sozialer Integration besonders wichtig.

Schlüsselwörter

Dopaminagonisten Monoaminoxidasehemmer Polypharmazie Nichtmotorische Symptome Wirkstoffinteraktionen 

Medical treatment of Parkinson’s disease in elderly and multimorbid patients

Abstract

Background

Parkinson’s disease is a frequent neurodegenerative disease, which typically occurs in older age. With progression of the disease, therapeutic complications, such as dyskinesias and fluctuations in the response to medication are common. To embed the medication of Parkinson’s disease into a complex treatment plan of a patient suffering from multimorbidity can be challenging.

Objectives

Not only the cardinal motor symptoms have to be treated properly but also the non-motor symptoms e.g. depression, dementia, autonomic dysregulations and gastrointestinal disorders. Pharmacological treatment and their risks are presented.

Conclusion

Especially in older patients the symptoms need to be treated with regard to multimorbidity and the risks of polypharmacotherapy. The therapeutic strategy needs to be carefully planned in order to achieve a high quality of life and social interaction.

Keywords

Dopamine agonists Monoamine oxidase inhibitors Polypharmacy Non-motor symptoms Drug interactions 

Literatur

  1. 1.
    Arnulf I, Bonnet AM, Damier P et al (2000) Hallucinations, REM sleep, and Parkinson’s disease: a medical hypothesis. Neurology 55:281–288PubMedCrossRefGoogle Scholar
  2. 2.
    Braak H, Bohl JR, Muller CM et al (2006) Stanley Fahn Lecture 2005: the staging procedure for the inclusion body pathology associated with sporadic Parkinson’s disease reconsidered. Mov Disord 21:2042–2051PubMedCrossRefGoogle Scholar
  3. 3.
    Rijk MC de, Breteler MM, Graveland GA et al (1995) Prevalence of Parkinson’s disease in the elderly: the Rotterdam Study. Neurology 45:2143–2146PubMedCrossRefGoogle Scholar
  4. 4.
    Deane KH, Spieker S, Clarke CE (2004) Catechol-O-methyltransferase inhibitors for levodopa-induced complications in Parkinson’s disease. Cochrane Database Syst Rev:CD004554Google Scholar
  5. 5.
    Eggert K, Oertel WH, Reichmann HA (2012) Leitlinien Parkinson-Syndrome: Diagnostik und Therapie. In: Diener HC, Weimar C, Kommission „Leitlinien“ der Deutschen Gesellschaft für Neurologie (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, StuttgartGoogle Scholar
  6. 6.
    Emre M, Aarsland D, Albanese A et al (2004) Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 351:2509–2518Google Scholar
  7. 7.
    Fahn S (2006) Levodopa in the treatment of Parkinson’s disease. J Neural Transm Suppl:1–15Google Scholar
  8. 8.
    Goldstein DS, Holmes CS, Dendi R et al (2002) Orthostatic hypotension from sympathetic denervation in Parkinson’s disease. Neurology 58:1247–1255PubMedCrossRefGoogle Scholar
  9. 9.
    Hauser RA (2006) Long-term care of Parkinson’s disease. Strategies for managing „wearing off“ symptom re-emergence and dyskinesias. Geriatrics 61:14–20PubMedGoogle Scholar
  10. 10.
    Hauser RA, McDermott MP, Messing S (2006) Factors associated with the development of motor fluctuations and dyskinesias in Parkinson disease. Arch Neurol 63:1756–1760PubMedCrossRefGoogle Scholar
  11. 11.
    Ives NJ, Stowe RL, Marro J et al (2004) Monoamine oxidase type B inhibitors in early Parkinson’s disease: meta-analysis of 17 randomised trials involving 3525 patients. BMJ 329:593PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Jenner P (2004) Avoidance of dyskinesia: preclinical evidence for continuous dopaminergic stimulation. Neurology 62:S47–S55PubMedCrossRefGoogle Scholar
  13. 13.
    Jörg J (1989)Google Scholar
  14. 14.
    Luginger E, Wenning GK, Bosch S, Poewe W (2000) Beneficial effects of amantadine on L-dopa-induced dyskinesias in Parkinson’s disease. Mov Disord 15:873–878PubMedCrossRefGoogle Scholar
  15. 15.
    Marrinan S, Emmanuel AV, Burn DJ (2014) Delayed gastric emptying in Parkinson’s disease. Mov Disord 29:23–32PubMedCrossRefGoogle Scholar
  16. 16.
    Menza M, Dobkin RD, Marin H et al (2009) A controlled trial of antidepressants in patients with Parkinson disease and depression. Neurology 72:886–892PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Moller JC, Oertel WH, Koster J et al (2005) Long-term efficacy and safety of pramipexole in advanced Parkinson’s disease: results from a European multicenter trial. Mov Disord 20:602–610PubMedCrossRefGoogle Scholar
  18. 18.
    Oertel WH, Wolters E, Sampaio C et al (2006) Pergolide versus levodopa monotherapy in early Parkinson’s disease patients: the PELMOPET study. Mov Disord 21:343–353PubMedCrossRefGoogle Scholar
  19. 19.
    Olanow CW, Kieburtz K, Odin P et al (2014) Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson’s disease: a randomised, controlled, double-blind, double-dummy study. Lancet Neurol 13:141–149PubMedCrossRefGoogle Scholar
  20. 20.
    Olanow CW, Rascol O, Hauser R et al (2009) A double-blind, delayed-start trial of rasagiline in Parkinson’s disease. N Engl J Med 361:1268–1278Google Scholar
  21. 21.
    Pinter MM, Pogarell O, Oertel WH (1999) Efficacy, safety, and tolerance of the non-ergoline dopamine agonist pramipexole in the treatment of advanced Parkinson’s disease: a double blind, placebo controlled, randomised, multicentre study. J Neurol Neurosurg Psychiatry 66:436–441Google Scholar
  22. 22.
    Rascol O, Brooks DJ, Korczyn AD et al (2006) Development of dyskinesias in a 5-year trial of ropinirole and L-dopa. Mov Disord 21:1844–1850PubMedCrossRefGoogle Scholar
  23. 23.
    Rascol O, Brooks DJ, Melamed E et al (2005) Rasagiline as an adjunct to levodopa in patients with Parkinson’s disease and motor fluctuations (LARGO, Lasting effect in Adjunct therapy with Rasagiline Given Once daily, study): a randomised, double-blind, parallel-group trial. Lancet 365:947–954PubMedCrossRefGoogle Scholar
  24. 24.
    Richard IH, Kurlan R, Tanner C et al (1997) Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson’s disease. Parkinson Study Group. Neurology 48:1070–1077PubMedCrossRefGoogle Scholar
  25. 25.
    Schuepbach WM, Rau J, Knudsen K et al (2013) Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 368:610–622Google Scholar
  26. 26.
    Stocchi F, Olanow CW (2004) Continuous dopaminergic stimulation in early and advanced Parkinson’s disease. Neurology 62:S56–S63PubMedCrossRefGoogle Scholar
  27. 27.
    Stocchi F, Rascol O, Kieburtz K et al (2010) Initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease: the STRIDE-PD study. Ann Neurol 68:18–27PubMedCrossRefGoogle Scholar
  28. 28.
    Von Reichmann H, Deuschl G, Riedel O et al (2010) The German Study on the Epidemiology of Parkinson’s Disease with Dementia (GEPAD): more than Parkinson. MMW Fortschr Med 152(Suppl 1):1–6Google Scholar
  29. 29.
    Voon V, Hassan K, Zurowski M et al (2006) Prospective prevalence of pathologic gambling and medication association in Parkinson disease. Neurology 66:1750–1752PubMedCrossRefGoogle Scholar
  30. 30.
    Winge K, Nielsen KK (2012) Bladder dysfunction in advanced Parkinson’s disease. Neurourol Urodyn 31:1279–1283PubMedCrossRefGoogle Scholar
  31. 31.
    Wolters EC, Werf YD van der, Heuvel OA van den (2008) Parkinson’s disease-related disorders in the impulsive-compulsive spectrum. J Neurol 255(Suppl 5):48–56Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Abteilung für Neurologie mit Stroke Unit, Neurologischer Intensivstation und GeriatrieAsklepios Klinik AltonaHamburgDeutschland

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