Parkinsonbedingte Dysphagien

Zusammenfassung

Mehr als die Hälfte aller Patienten mit idiopathischem Parkinson-Syndrom (IPS) entwickelt im Krankheitsverlauf eine Dysphagie. Klinischen Folgen sind eine verringerte Lebensqualität, unzureichende Medikamentenwirkung, Mangelernährung sowie Aspirations - pneumonien, die eine häufige Todesursache darstellen. Die klinische Diagnostik parkinsonbedingter Dysphagien ist schwierig und oft unzuverlässig. Mithilfe parkinsonspezifischer Fragebögen können Risikopatienten identifiziert werden. Den Goldstandard in der Diagnostik parkinsonbedingter Dysphagien stellen aber apparative Verfahren und zwar die endoskopische Evaluation des Schluckaktes (FESS) sowie die radiologische Untersuchung des Schluckaktes (VFSS) dar. Mit diesen Untersuchungsmethoden können Aspirationen zuverlässig nachgewiesen werden. Außerdem können IPS-typische Störungsmuster in oraler, pharyngealer und/oder ösophagealer Phase des Schluckaktes identifiziert werden. Die Behandlung parkinsonbedingter Dysphagien umfasst medikamentöse und logopädische Maßnahmen. Parkinsonbedingte Dysphagien, die eine Fluktuation mit Verschlechterung im Off-Zustand aufweisen, sollten durch eine Optimierung der dopaminergen Medikation behandelt werden. Die Auswahl der in der logopädischen Behandlung zum Einsatz kommenden schlucktherapeutischen Verfahren hängt von dem Störungsmuster ab. Auch das Lee-Silverman-Voice-Treatment (LSVT®-LOUD) kann eine Verbesserung parkinsonbedingter Dysphagien bewirken. Ein vielversprechendes neues Verfahren stellt ein intensives Training der exspiratorischen Muskulatur mit einem speziellen Atemtrainer dar.

Summary

More than half of all patients with Parkinson’s disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Clinical assessment of PD related dysphagia is challenging and often reveals unreliable results. PD specific questionnaires may be used to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) are both considered as gold standard for evaluation of PD related dysphagia. These instrumental swallowing assessment tools allow a reliable detection of aspiration events. Furthermore, typical patterns of disturbance during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of PD related dysphagia consist of medicaments and logopedic interventions. Fluctuating PD dysphagia with deterioration during the off state should be treated by optimizing dopaminergic medication. The methods used during logopedic treatment of swallowing dysfunction depend on the individual dysphagia pattern of each PD patient as assessed by FEES and/or VFSS. The Lee-Silverman- Voice-Treatment (LSVT®-LOUD) may also improve PD related dysphagia. A promising novel method is an intensive training of expiratory muscle strength with a special device.

Schlüsselwörter

Morbus Parkinson - Dysphagie - Pathophysiologie - apparative Diagnostik - Schlucktherapie

Keywords

Parkinson’s disease - dysphagia - pathophysiology - diagnostic - swallowing therapy

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