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Neurologie up2date 2025; 08(02): 121-136
DOI: 10.1055/a-2565-7885
Bewegungsstörungen

Parkinson-Krankheit – nicht-motorische Symptome für die Praxis

Teil 2: Gastrointestinale und urogenitale Störungen
Wolfgang Jost 
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Vorheriger Teil dieser Serie:

Parkinson-Krankheit – nicht-motorische Symptome für die PraxisNeurologie up2date 2025; 08(01): 65-78
DOI: 10.1055/a-2127-6711

In Teil 1 hatten wir neuropsychiatrische und kardiovaskuläre Störungen besprochen, jetzt folgen die gastrointestinalen und urogenitalen Störungen. Sie können erwidern, dass wir damit nur einen Teil der nicht-motorischen Symptome abgehandelt haben. Dies trifft zu, ist aber dem Problem geschuldet, dass wir aktuell noch nicht alle nicht-motorischen Symptome erkannt haben. Neben den neuropsychiatrischen und kardiovaskulären Störungen sind die gastrointestinalen und urogenitalen Störungen sehr relevant, bereits gut zu diagnostizieren und auch zu therapieren.

Kernaussagen

  • Bei Parkinson-Patienten treten gastrointestinale Störungen häufig auf, insbesondere Schluckstörungen, verzögerte Magenentleerung und Obstipation, die durch Parkinson-typische Veränderungen im Gastrointestinaltrakt verursacht werden.

  • Der vermehrte Speichelfluss bei Parkinson-Patienten ist meist die Folge von Schluckstörungen und nicht von erhöhter Speichelproduktion. Therapeutisch werden Anticholinergika eingesetzt, jedoch mit Vorsicht aufgrund potenzieller Nebenwirkungen. Die Injektion von Botulinumtoxin ist zugelassen und gut wirksam.

  • Bis zu 95% der Parkinson-Patienten leiden an Schluckstörungen, die durch reduzierte Peristaltik und mangelnde Koordination des Ösophagussphinkters verursacht werden können. Diese Störungen erhöhen das Risiko für Aspiration und Pneumonie.

  • Parkinson-Patienten haben häufig eine verzögerte Magenentleerung, was die Resorption von Levodopa beeinträchtigt und zu Schwankungen der Symptomkontrolle führt.

  • Etwa 80% der Parkinson-Patienten leiden an Obstipation, die als Frühsymptom der Erkrankung gilt. Ursache ist eine verzögerte Darmpassage, die durch degenerative Veränderungen im enterischen Nervensystem begünstigt wird.

  • Bei bis zu 93% der Parkinson-Patienten treten Blasenentleerungsprobleme auf, meist in Form einer Detrusorhyperaktivität.

  • Ein Drittel der Parkinson-Patienten leidet an Harninkontinenz, oft als Dranginkontinenz. Bei Männern kann eine Belastungsinkontinenz auftreten.

  • Bei bis zu 60% der männlichen Parkinson-Patienten treten erektile Dysfunktionen auf. Auch sexuelle Hyperaktivität kann als Nebenwirkung von Dopaminagonisten auftreten.

  • Parkinson-Patienten weisen häufig Atemstörungen und eine erhöhte Schlafapnoe-Wahrscheinlichkeit auf.



Publikationsverlauf

Artikel online veröffentlicht:
03. Juni 2025

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