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Pharmakotherapie des Morbus Parkinson beim älteren, multimorbiden Patienten

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

  • 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.

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.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. I. Lettow und J. Röther geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Neurologie mit Stroke Unit, Neurologischer Intensivstation und Geriatrie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland

    I. Lettow & J. Röther

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  1. I. Lettow
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  2. J. Röther
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Correspondence to I. Lettow.

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Lettow, I., Röther, J. Pharmakotherapie des Morbus Parkinson beim älteren, multimorbiden Patienten. Internist 55, 728–734 (2014). https://doi.org/10.1007/s00108-014-3502-1

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  • DOI: https://doi.org/10.1007/s00108-014-3502-1

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