Zusammenfassung
Anders als früher angenommen gehören kognitive Störungen zu den Symptomen bei der Multiplen Sklerose (MS) und lassen sich bei bis zu 60% der Patienten bereits im frühen Verlauf der Erkrankung feststellen. Nach längerer Krankheitsdauer ist die Entwicklung einer Demenz möglich. Dennoch gelten kognitive Beeinträchtigungen nicht als typische Erstsymptome einer MS. Wir berichten über 4 ältere Patienten, die mit beginnenden demenziellen Syndromen in unserer Gedächtnissprechstunde vorgestellt wurden und bei denen durch die weiteren Untersuchungen eine MS als wahrscheinlichste Ursache diagnostiziert wurde. Alle Patienten waren bei Beginn ihrer kognitiven Störungen älter als 60 Jahre. Nur eine Patientin hatte im weiteren Verlauf eine ausgeprägte Gang- und Standataxie mit funktionellen Beeinträchtigungen entwickelt. Eine Literaturrecherche mit Auswertung der Daten von 239 Patienten ergab, dass bei spätem Beginn einer MS vor allen Dingen motorische Störungen als Erstsymptom und ein primär progredienter Verlauf mit ungünstiger Prognose beobachtet wurden. Eine Demenz als initiale Symptomatik wurde bei über 60-Jährigen bisher noch nicht beschrieben. Möglicherweise wird die MS als Differenzialdiagnose bei Demenzen älterer Patienten sowie eine kognitive Beeinträchtigung als Erstsymptom der MS zu selten in Betracht gezogen.
Summary
Cognitive impairment is meanwhile accepted as a well-known symptomatology affecting up to 60% of the patients even in the early disease course of multiple sclerosis (MS). After a longer duration the development of dementia is not unusual. However, cognitive dysfunction as the primary or only manifestation of MS is thought to be rare. We report on four elderly patients referred to the memory clinic of our psychiatric university hospital because of beginning dementia. All of them were found to have evidence of a chronic inflammatory CNS process compatible with the diagnosis of MS. At the beginning of their symptomatology all patients were older than 60 years . Just in one case, progressive gait disturbances beginning after cognitive decline contributed to restriction in the activities of daily living. Data of 239 cases of the literature were reviewed and revealed motor disturbances as the main initial symptom and often a primary progressive course with unfavourable prognosis in late onset MS. Until now dementia as the primary symptomatology has not been described in patients older than 60 years. Possibly MS as a differential diagnosis in dementia as well as cognitive impairment as an initial symptom of MS is underrecognized.
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Danksagung
Dr. Heinz Wiendl wird von Mitteln der Deutschen Forschungsgemeinschaft und dem IZKF Tübingen unterstützt.
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Leyhe, T., Laske, C., Buchkremer, G. et al. Demenz als Erstsymptom bei spät beginnender Multipler Sklerose . Nervenarzt 76, 748–755 (2005). https://doi.org/10.1007/s00115-004-1814-4
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DOI: https://doi.org/10.1007/s00115-004-1814-4