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Repetitive impulsassoziierte Verhaltensstörungen beim Morbus Parkinson

Repetitive impulse-associated behavioral disorders in Parkinson’s disease

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Zussamenfassung

Die Parkinson-Erkrankung kann mit einer Reihe repetitiver, impulsassoziierter Verhaltensstörungen einhergehen, die schwerwiegende soziale, berufliche oder finanzielle Folgen nach sich ziehen können. Impulskontrollstörungen (pathologisches Glücksspiel, impulsives Essen oder Kaufen und Hypersexualität) treten bei ca. 13–14% der Parkinson-Patienten auf. Weitere beobachtete Verhaltensstörungen sind das dopaminerge Dysregulationssyndrom (DDS), eine Substanzabhängigkeit mit Verlangen („craving“) nach dopaminergen Substanzen und „punding“ (stundenlange Wiederholung nicht zielorientierter Verhaltensmuster).

Therapiebezogene Risikofaktoren sind Dopaminagonisten für Impulskontrollstörungen und eine hohe dopaminerge Gesamtdosis für DDS und Punding. Gemeinsame Risikofaktoren sind junges Erkrankungsalter, impulsive Persönlichkeit, Depression und möglicherweise Dyskinesien. Auf neuronaler Ebene scheinen diese Verhaltensstörungen mit Veränderungen im Belohnungsnetzwerk und einer Dysfunktion des orbitofrontalen Kortex assoziiert zu sein. Zum Management ist die Evidenzlage bisher unzureichend. Die derzeitige Praxis bei Impulskontrollstörungen besteht in Absetzen bzw. Reduzieren der Dopaminagonisten.

Summary

Parkinson’s disease (PD) is associated with a number of behavioral disorders which may cause considerable social, professional or financial problems. Impulse control disorders (ICDs), such as pathological gambling, binge eating, compulsive shopping and hypersexuality occur in approximately 13–14% of PD patients. Further behavioral disorders are the dopamine dysregulation syndrome (DDS), a substance dependence characterized by craving for dopaminergic substances and punding (prolonged repetitive activities which are not goal-oriented).

Treatment-related risk factors are dopamine agonists for ICDs and a high total dopaminergic dose for DDS and punding. Shared risk factors are young age at onset, impulsive personality traits, depression and possibly dyskinesia. At the neuronal level these behavioral disorders seem to be associated with changes in the reward system and dysfunction of the orbitofrontal cortex. The evidence level for management strategies is at present insufficient. For ICDs current clinical practice consists of discontinuation or reduction of dopamine agonists.

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Authors and Affiliations

  1. Neurologische Abteilung, Donauspital/SMZ-Ost, Wien, Österreich

    R. Katzenschlager

  2. Klinik für Neurologie, Universitätsklinik Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland

    K.S. Goerlich &  T. van Eimeren

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  1. R. Katzenschlager
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  2. K.S. Goerlich
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  3. T. van Eimeren
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Correspondence to T. van Eimeren.

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Katzenschlager, R., Goerlich, K. & van Eimeren, T. Repetitive impulsassoziierte Verhaltensstörungen beim Morbus Parkinson. Nervenarzt 83, 1582–1589 (2012). https://doi.org/10.1007/s00115-012-3631-5

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