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Behandlung der Demenz bei Parkinson-Syndromen

Wirksamkeit von Cholinesterasehemmern

Treatment for dementia in parkinsonian syndromes

Efficacy of cholinesterase inhibitors

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Zusammenfassung

Demenz ist eine häufige Begleiterscheinung bei verschiedenen Parkinson-Syndromen. Eine Verringerung an Acetylcholin, d. h. eine Störung im cholinergen Neurotransmittersystem, wird als Ursache der kognitiven Leistungsbeeinträchtigung diskutiert. Studien weisen darauf hin, dass eine Behandlung mit Cholinesterasehemmern (ChEIs) eine mögliche Therapieoption zur Behandlung der Demenz bei Parkinson-Erkrankungen bietet. Nachfolgend werden die Hauptmerkmale der Demenz bei Morbus Parkinson (PDD), der Demenz mit Lewy-Körperchen (DLK), der Demenz bei progressiver supranukleärer Blickparese (PSP) und bei kortikobasaler Degeneration (CBD) dargestellt und der Behandlungseffekt mit ChEIs bei diesen Erkrankungen kritisch hinterfragt. Zusammenfassend besteht Evidenz, dass die Gabe einiger ChEIs bei PDD die kognitiven Fähigkeiten und, in einem geringeren Ausmaß, die Alltagskompetenz verbessern. Ebenso wirken sie positiv auf das Verhalten bei PDD und DLK. Für Aussagen zur Wirksamkeit der ChEIs bei PSP und CBD sind noch weitere Studien mit höheren Patientenzahlen, längeren Untersuchungszeiträumen und geeigneten Testverfahren notwendig.

Summary

In parkinsonian syndromes dementia frequently occurs in the disease progress. The cholinergic system has been proposed as playing a key role in cognitive disturbances. Therefore the application of cholinesterase inhibitors (ChEI) is also hotly argued for dementia associated with parkinsonian syndromes. This review focuses on the specific symptoms of dementia in Parkinson’s disease (PDD), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The effect of cholinergic treatment on cognition and behaviour is reported and critically discussed. There is evidence that medication with some ChEIs reduces cognitive disturbances and to a lesser extent improves activities of daily living in PDD. Behavioural symptoms also seem to be positively influenced by treatment with ChEIs in both PDD and DLB. The effect of treatment with cholinesterase inhibitors in PSP and CBD warrants more carefully designed studies including sufficient numbers of patients.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Die Erstellung des Manuskriptes wurde von Novartis unterstützt.

Kommentar der Autorin

Die Erstellung des Manuskriptes wurde von Novartis finanziell unterstützt.

Die Studien, die den Cholinesterasehemmer Rivastigmin zum Gegenstand haben, unterliegen jedoch selbstverständlich genau den gleichen Bewertungskriterien wie die zu den anderen Cholinesterasehemmern. Angaben zur Evidenzeinstufung der Studien können bei der Erstautorin angefragt werden. Die Aussagen des vorliegenden Review-Artikels sind kohärent mit den kürzlich publizierten Behandlungsempfehlungen der „American Academy of Neurology“ [48] sowie den verfassten Cochrane Reviews für die Parkinson-Demenz [42] und die Demenz mit Lewy-Körperchen (DLK) [66]. Somit erfolgte die Anfertigung des Manuskriptes mit großer methodischer Sorgfalt und der gebotenen wissenschaftlichen Neutralität und Transparenz.

Danksagung

Mit freundlicher Unterstützung der Firma Novartis GmbH.

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Authors and Affiliations

  1. Abteilung Neurologie mit Schwerpunkt Neurodegenerative Erkrankungen, Hertie-Institut für klinische Hirnforschung, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    I. Liepelt, W. Maetzler, T. Gasser & D. Berg

  2. Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland

    H.-P. Blaicher

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  1. I. Liepelt
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  2. W. Maetzler
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  3. H.-P. Blaicher
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  4. T. Gasser
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Correspondence to I. Liepelt.

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Liepelt, I., Maetzler, W., Blaicher, HP. et al. Behandlung der Demenz bei Parkinson-Syndromen. Nervenarzt 79, 36–46 (2008). https://doi.org/10.1007/s00115-007-2312-2

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