Der Nervenarzt

, Volume 82, Issue 9, pp 1151–1159 | Cite as

Diagnose ohne Therapie

Frühdiagnostik der Alzheimer-Krankheit im Stadium der leichten kognitiven Beeinträchtigung
Übersichten

Zusammenfassung

Die Alzheimer-Krankheit (AK) ist ein progredient verlaufender histopathologisch definierter neurodegenerativer Prozess, dessen klinische Manifestation sich in das Stadium der leichten kognitiven Beeinträchtigung (LKB) sowie in das Stadium der Demenz unterteilen lässt. Nach ICD-10 ist die Diagnose der AK an die Manifestation des Demenzsyndroms gebunden. Auch die Indikation medikamentöser Therapien ist auf das Demenzstadium beschränkt. Die diagnostischen Methoden haben sich in den vergangene Jahren dramatisch verbessert. Dazu gehören die Darstellung der Atrophie des medialen Temporallappens im MRT, die Messung von τ- und β-Amyloid im Liquor, die Visualisierung kortikaler Stoffwechseldefizite in der Positronenemissionstomographie (PET) mit [18F]-Fluoro-2-desoxy-D-Glucose (FDG) sowie die sich abzeichnende Möglichkeit, Amyloidablagerungen im Gehirn mithilfe von PET-Liganden in vivo sichtbar zu machen. Mithilfe dieser Verfahren kann heute die Diagnose AK mit großer Sicherheit bereits im Stadium der LKB gestellt werden. Aus dem damit verbundenen Auseinanderdriften von diagnostischen Möglichkeiten und therapeutischen Optionen ergeben sich zahlreiche neue Fragen bezüglich der möglichen Vor- und Nachteile der Frühdiagnose für den einzelnen Patienten. Wesentlich scheint es zu sein, die Patienten in die Entscheidung zur Frühdiagnostik mit einzubeziehen und die Begrenztheit bzw. das Fehlen therapeutischer Optionen im Stadium der LKB bei AK klarzustellen.

Schlüsselwörter

Alzheimer-Krankheit Leichte kognitive Beeinträchtigung Frühdiagnostik Therapie Diagnoseeröffnung 

Diagnosis without therapy

Early diagnosis of Alzheimer’s disease in the stage of mild cognitive impairment

Summary

Alzheimer’s disease (AD) is a histopathologically defined progressive neurodegenerative disorder. Its clinical manifestation can be subdivided into the stage of mild cognitive impairment (MCI) and the stage of dementia. According to ICD-10 the diagnosis of AD can only be made in the stage of dementia. The indication for anti-dementia drugs is restricted to the stage of dementia in AD, too. Diagnostic tools to detect AD have improved considerably in recent years. They include the MRI findings of atrophy of the medial temporal lobe, cerebrospinal fluid (CSF) biomarkers β-amyloid and τ, the visualisation of metabolic deficits on positron emission tomography (PET) using [18F]-fluoro-2-deoxy-D-glucose (FDG) and the emerging possibility to demonstrate amyloid deposits in vivo using PET ligands. The application of these methods allows the diagnosis of AD to be established already in the stage of MCI. While diagnostic methods improve and enable us to make the diagnosis of AD very early, there is no such progress in the development of treatment options. Early diagnosis of AD appears to have benefits and drawbacks. It is most important to include the patient in the decision on early diagnosis and to make clear that there is a lack of therapeutic options if the diagnosis is positive.

Keywords

Alzheimer’s disease Mild cognitive impairment Early diagnosis Therapy Disclosure of diagnosis 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Psychiatrie und PsychotherapieUniversitätsklinikum LeipzigLeipzigDeutschland

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