Parkinson-Demenz und Demenz
mit Lewy-Körperchen – Grundlagen und Klinik
Dag Aarsland,
Wolfson Centre for Age Related Diseases, University of London, UK - London
Dementia with Lewy bodies
(DLB) and Dementia associated with Parkinson’s disease (PDD) represent
15-20% of the total dementia population, and share many clinical and pathological
features. The clinical profile is characterised by symmetrical parkinsonism
with a predominance of postural instability and gait disorders, a cognitive
profile characterised by attentional, executive, and visuospatial impairment,
fluctuating consciousness, and visual hallucinations. The clinical course
of DLB is more severe compared to other forms of dementia, with higher mortality,
more impaired quality of life, and higher costs. Management is difficult.
There is little empirical evidence, and a high risk for adverse drug reactions.
A very high cumulative prevalence of dementia in PD has been shown in two
independent long-term cohorts. Although dementia usually occurs 10 years
or more after onset of PD, mild cognitive impairment occurs even in early
PD, and is associated with a shorter time to dementia. Emerging evidence
from pathology, as well as in-vivo studies using novel techniques within
genetics, imaging and cerebrospinal fluid research, indicates that alpha-synuclein
aggregation, as well as disturbances of other candidate proteins, are associated
with dementia in PD. Randomised trials suggest that rivastigmine can improve
symptoms in both DLB and PDD, and a recent trial suggest that memantine is
effective as well.