Therapie geriatrischer Patienten mit Morbus Parkinson

 

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Zusammenfassung

Die Therapie geriatrischer Patienten mit Morbus Parkinson weist zahlreiche Besonderheiten auf. Multimorbidität, medikamentös wenig beeinflussbare Symptome wie Gang-, Haltungs-, Sprech- und Schluckstörungen, autonome Dysfunktion sowie neuropsychiatrische Auffälligkeiten wie Demenz, Psychose und Depression treten zunehmend in den Vordergrund. Auf der anderen Seite führen die steigende Lebenserwartung und die epidemiologische Entwicklung in Westeuropa dazu, dass wir zukünftig eine steigende Zahl alter, doch vitaler Patienten behandeln werden. Bereits heute sind 2 Drittel aller Parkinson-Patienten älter als 70 Jahre und in den nächsten 25 Jahren wird sich die Anzahl der alten Parkinson-Patienten verdoppeln. Trotzdem steht die Therapie der geriatrischen Patienten nicht im Fokus der Aufmerksamkeit. Pharmakologische Studien berücksichtigen primär deutliche jüngere Patienten ohne Komorbiditäten und psychiatrische Begleiterkrankungen. Erkenntnisse aus diesen Studien sind nur bedingt auf alte Patienten zu übertragen. Medikamentöse kontrollierte Studien an geriatrischen Patienten fehlen und differenzierte Therapieempfehlungen für Patienten jenseits des 70. Lebensjahres existieren nicht. Obwohl nicht motorische Symptome im Alter die Hauptursache für die eingeschränkte Lebensqualität der Parkinson-Patienten darstellen, ist die Studienlage in dieser Hinsicht ebenfalls unbefriedigend. Den aktivierenden und übenden Verfahren wird erst in letzter Zeit vermehrt Aufmerksamkeit zuteil. Verschiedene Verfahren sind in kleineren kontrollierten Studien untersucht.

Abstract

Some special features characterise the therapy for geriatric Parkinson patients. Multimorbidity, symptoms only hardly controlled by pharmacotherapy like freezing of gait, dysarthria, dysphagia and disturbances of the autonomic system as well as neuropsychiatric features like dementia, psychosis and depression are coming increasingly to the fore. On the other hand, the increased expectation of life and epidemiology of Western Europe will increase the need to medicate a soaring number of old, but vital patients. Today, two-thirds of the patients with Parkinson's disease are older than 70 years and in the next 25 years the number of older patients with Parkinson's disease will double. The therapy for geriatric patients is still not in the focus of interest. The participants of pharmacological studies are primarily younger patients without comorbidity and psychiatric concomitant diseases. The findings from these studies cannot be fully transferred to older patients. There is a lack of pharmacotherapeutical studies on geriatric patients and there are no differentiated treatment recommendations for patients older than 70 years. Although non-motoric symptoms are the main cause of the diminished quality of life in patients with Parkinson's disease, there are not many studies available covering this theme. Activating and training therapies are coming more and more to the centre of interest. Some therapies are being tested within controlled studies.

Literatur

• 1 Chaudhuri K R, Schapira A H. Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment.  Lancet Neurol. 2009;  8 464-474
  CrossrefPubMedGoogle Scholar
• 2 Kostic V, Przedborski S, Flaster E. et al . Early development of levodopa-induced dyskinesias and response fluctuations in young-onset Parkinson's disease.  Neurology. 1991;  41 202-205
  CrossrefPubMedGoogle Scholar
• 3 Parkinson Study Group . A randomized controlled trial comparing pramipexole with levodopa in early Parkinson's disease: design and methods of the CALM-PD Study. Parkinson Study Group.  Clin Neuropharmacol. 2000;  23 34-44
  CrossrefPubMedGoogle Scholar
• 4 Rinne U K, Bracco F, Chouza C. et al . Early treatment of Parkinson's disease with cabergoline delays the onset of motor complications. Results of a double-blind levodopa controlled trial. The PKDS009 Study Group.  Drugs. 1998;  55 (Suppl. 1) 23-30
  CrossrefPubMedGoogle Scholar
• 5 Rascol O, Brooks D J, Korczyn A D. et al . A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group.  N Engl J Med. 2000;  342 1484-1491
  CrossrefPubMedGoogle Scholar
• 6 Rascol O, Brooks D J, Korczyn A D. et al . Development of dyskinesias in a 5-year trial of ropinirole and L-dopa.  Mov Disord. 2006;  21 1844-1850
  CrossrefPubMedGoogle Scholar
• 7 Katzenschlager R, Head J, Schrag A. et al . Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD.  Neurology. 2008;  71 474-480
  CrossrefPubMedGoogle Scholar
• 8 Playfer J R. Ageing and Parkinson's disease.  Pract Neurol. 2007;  7 4-5
  PubMedGoogle Scholar
• 9 Fornadi F, Werner M. Quelle: Parkinson Netz 2009;. http://www.parkinson-net.de/med/haus-ein.htm
  PubMedGoogle Scholar
• 10 Driver J A, Logroscino G, Gaziano J M. et al . Incidence and remaining lifetime risk of Parkinson disease in advanced age.  Neurology. 2009;  72 432-438
  CrossrefPubMedGoogle Scholar
• 11 de Rijk M C, Launer L J, Berger K. et al . Prevalence of Parkinson's disease in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group.  Neurology. 2000;  54 (11 Suppl. 5) S21-S23
  PubMedGoogle Scholar
• 12 Diem-Zangerl A, Seppi K, Wenning G K. et al . Mortality in Parkinson's disease: a 20-year follow-up study.  Mov Disord. 2009;  24 819-825
  CrossrefPubMedGoogle Scholar
• 13 Ishihara L S, Cheesbrough A, Brayne C. et al . Estimated life expectancy of Parkinson's patients compared with the UK population.  J Neurol Neurosurg Psychiatry. 2007;  78 1304-1309
  CrossrefPubMedGoogle Scholar
• 14 Dorsey E R, Constantinescu R, Thompson J P. et al . Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030.  Neurology. 2007;  68 384-386
  CrossrefPubMedGoogle Scholar
• 15 Leoni O, Martignoni E, Cosentino M. et al . Drug prescribing patterns in Parkinson's disease: a pharmacoepidemiological survey in a cohort of ambulatory patients.  Pharmacoepidemiol Drug Saf. 2002;  11 149-157
  CrossrefPubMedGoogle Scholar
• 16 Grosset K A, Bone I, Grosset D G. Suboptimal medication adherence in Parkinson's disease.  Mov Disord. 2005;  20 1502-1507
  CrossrefPubMedGoogle Scholar
• 17 Parkinson Study Group . Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease. The Parkinson Study Group.  N Engl J Med. 1999;  340 757-763
  CrossrefPubMedGoogle Scholar
• 18 Aarsland D, Kvaloy J T, Andersen K. et al . The effect of age of onset of PD on risk of dementia.  J Neurol. 2007;  254 38-45
  CrossrefPubMedGoogle Scholar
• 19 Aarsland D, Zaccai J, Brayne C. A systematic review of prevalence studies of dementia in Parkinson's disease.  Mov Disord. 2005;  20 1255-1263
  CrossrefPubMedGoogle Scholar
• 20 Reid W G, Broe G A, Hely M A. et al . The neuropsychology of de novo patients with idiopathic Parkinson's disease: the effects of age of onset.  Int J Neurosci. 1989;  48 205-217
  CrossrefPubMedGoogle Scholar
• 21 Reid W G, Hely M A, Morris J G. et al . A longitudinal of Parkinson's disease: clinical and neuropsychological correlates of dementia.  J Clin Neurosci. 1996;  3 327-333
  CrossrefPubMedGoogle Scholar
• 22 Hely M A, Morris J G, Reid W G. et al . Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years.  Mov Disord. 2005;  20 190-199
  CrossrefPubMedGoogle Scholar
• 23 Hely M A, Reid W G, Adena M A. et al . The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years.  Mov Disord. 2008;  23 837-844
  CrossrefPubMedGoogle Scholar
• 24 Kalbe E, Calabrese P, Kohn N. et al . Screening for cognitive deficits in Parkinson's disease with the Parkinson neuropsychometric dementia assessment (PANDA) instrument.  Parkinsonism Relat Disord. 2008;  14 93-101
  CrossrefPubMedGoogle Scholar
• 25 Emre M, Aarsland D, Albanese A. et al . Rivastigmine for dementia associated with Parkinson's disease.  N Engl J Med. 2004;  351 2509-2518
  CrossrefPubMedGoogle Scholar
• 26 Ravina B, Putt M, Siderowf A. et al . Donepezil for dementia in Parkinson's disease: a randomised, double blind, placebo controlled, crossover study.  J Neurol Neurosurg Psychiatry. 2005;  76 934-939
  CrossrefPubMedGoogle Scholar
• 27 Cummings J L, Masterman D L. Depression in patients with Parkinson's disease.  Int J Geriatr Psychiatry. 1999;  14 711-718
  CrossrefPubMedGoogle Scholar
• 28 Brown R G, MacCarthy B, Gotham A M. et al . Depression and disability in Parkinson's disease: a follow-up of 132 cases.  Psychol Med. 1988;  18 49-55
  CrossrefPubMedGoogle Scholar
• 29 Cummings J L. Depression and Parkinson's disease: a review.  Am J Psychiatry. 1992;  149 443-454
  PubMedGoogle Scholar
• 30 Strang R R. Imipramine in treatment of Parkinsonism: A double-blind placebo study.  Br Med J. 1965;  2 33-34
  CrossrefPubMedGoogle Scholar
• 31 Laitinen L. Desipramine in treatment of Parkinson's disease. A placebo-controlled study.  Acta Neurol Scand. 1969;  45 109-113
  CrossrefPubMedGoogle Scholar
• 32 Andersen J, Aabro E, Gulmann N. et al . Anti-depressive treatment in Parkinson's disease. A controlled trial of the effect of nortriptyline in patients with Parkinson's disease treated with L-DOPA.  Acta Neurol Scand. 1980;  62 210-219
  CrossrefPubMedGoogle Scholar
• 33 Devos D, Dujardin K, Poirot I. et al . Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double-blind, randomized, placebo-controlled study.  Mov Disord. 2008;  23 850-857
  CrossrefPubMedGoogle Scholar
• 34 Steur E N. Increase of Parkinson disability after fluoxetine medication.  Neurology. 1993;  43 211-213
  PubMedGoogle Scholar
• 35 Jimenez-Jimenez F J, Tejeiro J, Martinez-Junquera G. et al . Parkinsonism exacerbated by paroxetine.  Neurology. 1994;  44 2406
  PubMedGoogle Scholar
• 36 Linazasoro G. Worsening of Parkinson's disease by citalopram.  Parkinsonism Relat Disord. 2000;  6 111-113
  CrossrefPubMedGoogle Scholar
• 37 Dell'Agnello G, Ceravolo R, Nuti A. et al . SSRIs do not worsen Parkinson's disease: evidence from an open-label, prospective study.  Clin Neuropharmacol. 2001;  24 221-227
  CrossrefPubMedGoogle Scholar
• 38 Marino S, Sessa E, Di Lorenzo G. et al . Sertraline in the treatment of depressive disorders in patients with Parkinson's disease.  Neurol Sci. 2008;  29 391-395
  CrossrefPubMedGoogle Scholar
• 39 Tesei S, Antonini A, Canesi M. et al . Tolerability of paroxetine in Parkinson's disease: a prospective study.  Mov Disord. 2000;  15 986-989
  CrossrefPubMedGoogle Scholar
• 40 Menza M, Dobkin R D, Marin H. et al . A controlled trial of antidepressants in patients with Parkinson disease and depression.  Neurology. 2009;  72 886-892
  CrossrefPubMedGoogle Scholar
• 41 Rascol O, Goetz C, Koller W. et al . Treatment interventions for Parkinson's disease: an evidence based assessment.  Lancet. 2002;  359 1589-1598
  CrossrefPubMedGoogle Scholar
• 42 El Sharkawi A, Ramig L, Logemann J A. et al . Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study.  J Neurol Neurosurg Psychiatry. 2002;  72 31-36
  CrossrefPubMedGoogle Scholar
• 43 Bhatia K P, Munchau A, Brown P. Botulinum toxin is a useful treatment in excessive drooling in saliva.  J Neurol Neurosurg Psychiatry. 1999;  67 697
  CrossrefPubMedGoogle Scholar
• 44 Lipp A, Trottenberg T, Schink T. et al . A randomized trial of botulinum toxin A for treatment of drooling.  Neurology. 2003;  61 1279-1281
  CrossrefPubMedGoogle Scholar
• 45 Lees A J, Blackburn N A, Campbell V L. The nighttime problems of Parkinson's disease.  Clin Neuropharmacol. 1988;  11 512-519
  CrossrefPubMedGoogle Scholar
• 46 Pact V, Giduz T. Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias.  Neurology. 1999;  53 1154
  PubMedGoogle Scholar
• 47 Nieuwboer A, Kwakkel G, Rochester L. et al . Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial.  J Neurol Neurosurg Psychiatry. 2007;  78 134-140
  CrossrefPubMedGoogle Scholar
• 48 Ellis T, de Goede C J, Feldman R G. et al . Efficacy of a physical therapy program in patients with Parkinson's disease: a randomized controlled trial.  Arch Phys Med Rehabil. 2005;  86 626-632
  CrossrefPubMedGoogle Scholar
• 49 Koller W C, Glatt S, Vetere-Overfield B. et al . Falls and Parkinson's disease.  Clin Neuropharmacol. 1989;  12 98-105
  CrossrefPubMedGoogle Scholar
• 50 Ceballos-Baumann A, Ebersbach G. Aktivierende Therapien bei Parkinsonsyndromen.  DNP. 2009;  5 56-60
  PubMedGoogle Scholar
• 51 Thaut M H, McIntosh G C, Rice R R. et al . Rhythmic auditory stimulation in gait training for Parkinson's disease patients.  Mov Disord. 1996;  11 193-200
  CrossrefPubMedGoogle Scholar
• 52 Morris M E, Iansek R, Matyas T A. et al . Stride length regulation in Parkinson's disease. Normalization strategies and underlying mechanisms.  Brain. 1996;  119 551-568
  CrossrefPubMedGoogle Scholar
• 53 Miyai I, Fujimoto Y, Ueda Y. et al . Treadmill training with body weight support: its effect on Parkinson's disease.  Arch Phys Med Rehabil. 2000;  81 849-852
  CrossrefPubMedGoogle Scholar
• 54 Jobges M, Heuschkel G, Pretzel C. et al . Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2004;  75 1682-1687
  CrossrefPubMedGoogle Scholar
• 55 Protas E J, Mitchell K, Williams A. et al . Gait and step training to reduce falls in Parkinson's disease.  NeuroRehabilitation. 2005;  20 183-190
  PubMedGoogle Scholar
• 56 Koller W, Kase S. Muscle strength testing in Parkinson's disease.  Eur Neurol. 1986;  25 130-133
  CrossrefPubMedGoogle Scholar
• 57 Hass C J, Collins M A, Juncos J L. Resistance training with creatine monohydrate improves upper-body strength in patients with Parkinson disease: a randomized trial.  Neurorehabil Neural Repair. 2007;  21 107-115
  PubMedGoogle Scholar
• 58 Toole T, Hirsch M A, Forkink A. et al . The effects of a balance and strength training program on equilibrium in Parkinsonism: A preliminary study.  NeuroRehabilitation. 2000;  14 165-174
  PubMedGoogle Scholar
• 59 Dibble L E, Hale T, Marcus R L. et al . The safety and feasibility of high-force eccentric resistance exercise in persons with Parkinson's disease.  Arch Phys Med Rehabil. 2006;  87 1280-1282
  CrossrefPubMedGoogle Scholar
• 60 Ramig L O, Sapir S, Fox C. et al . Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-matched controls.  Mov Disord. 2001;  16 79-83
  CrossrefPubMedGoogle Scholar

PD Dr. med. Carsten Buhmann

Ambulanzzentrum und Neurologische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf

Martinistr. 52

20246 Hamburg

Email: buhmann@uke.uni-hamburg.de