Depression beim idiopathischen Parkinson-Syndrom

Zusammenfassung

Nicht-motorische Störungen des idiopathischen Parkinson-Syndroms (IPS) wie depressive Symptome finden in den letzten Jahren zunehmend Beachtung, da sie die Lebensqualität der Patienten maßgeblich beeinträchtigen und sich auch auf die motorische Behinderung negativ auswirken. In der Gruppe der neuropsychiatrischen Störungen sind die depressiven Symptome am häufigsten. Doch trotz Häufigkeit und zunehmender Bedeutung wird die Depression beim IPS häufig nicht erkannt. Diagnostische Probleme bereiten die Symptomüberlappung depressiver Symptome mit motorischen und kognitiven Symptomen des IPS. Zudem fehlt es an validierten und standardisierten Meßmethoden, was letztlich auch dazu geführt hat, dass bislang keine genauen Angaben zur Frequenz depressiver Symptome bei Parkinsonerkrankungen vorliegen. Entsprechend finden sich in der Literatur je nach verwendetem Diagnoseinstrumentarium und Studiendesign Angaben zur Prävalenz depressiver Symptome beim IPS, die von 7 – 72 % reichen, mit ca. 40 % in den meisten Querschnittsstudien. Während es zu Prävalenz und Psychopathologie depressiver Störungen einige Studien mit unselektierten Parkinson-Patienten gibt, ist nur wenig über deren Genese und Langzeitverlauf bekannt. Die vorliegende Arbeit fasst die zurzeit vorliegenden Erkenntnisse zu Bedeutung, Häufigkeit, Pathogenese und Diagnostik depressiver Symptome beim IPS zusammen und schlägt auf der Basis vorhandener Daten ein Prozedere zu Screening und Diagnostik vor.

Abstract

Non-motor symptoms, such as psychiatric symptoms and autonomic dysfunction, are common co-morbid conditions in Parkinson's disease (PD) and major contributors to poor quality of life and disability. Within the group of neuropsychiatric conditions, depressive symptoms are the most common condition. Despite their frequency and importance, depressive symptoms can be difficult to assess and diagnose and thus depression in PD is frequently unrealized. Diagnostic challenges include the overlap of depressive symptoms with motor and non-motor symptoms of PD, such as dementia and apathy. Furthermore, there are no definite standards to assess and diagnose depression in PD leading also to the lack of exact data on the epidemiology of this non-motor symptom in PD. Depending on the diagnostic test and the study design the prevalence of depression in PD is reported between 7 and 72 % of PD patients with approximately 40 % in most cross-sectional studies. In contrast, the pathogenesis and long-term course of depression in PD remain elusive. Current hypothesis, however, includes that depressive symptoms are part of the core condition of PD when regarded as an entity. The present review summarizes the current knowledge on epidemiology, pathogenesis and diagnosis of depression in PD and proposes on this data base a standard procedure for screening and diagnosis of depressive symptoms in PD.

Schlüsselwörter

Depression - Morbus Parkinson - Epidemiologie - Pathophysiologie - Diagnostik - Skalen

Key words

depression - Parkinson's disease - epidemiology - pathophysiology - diagnosis - scales

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