REM-Schlaf-Verhaltensstörung und andere frühe Indikatoren des Morbus Parkinson

Zusammenfassung

Die Diagnose eines Morbus Parkinson erfolgt klinisch bei Vorliegen der definierenden motorischen Symptome (Bradykinese, Tremor, Rigor, posturale Instabilität) und nach Ausschluss anderer Differenzialdiagnosen eines ParkinsonSyndroms. Bereits viele Jahre vor dem Auftreten der ersten motorischen Symptome eines Parkinson können bestimmte nicht motorische Symptome (z. B. Hyposmie, Schlafstörungen, Obstipation) auftreten. Die meisten dieser prämotorischen Marker sind unspezifisch und haben jeweils isoliert betrachtet einen niedrigen Vorhersagewert für die spätere Entwicklung eine M. Parkinson. Die REM-Schlaf-Verhaltensstörungen, die klinisch durch das Ausleben von aktionsgeladenen Träumen gekennzeichnet ist, zählt zu den spezifischsten Risikomarkern für die spätere Entwicklung eines M. Parkinson. Ein Teil der Patienten mit REM-Schlaf-Verhaltensstörung entwickelt im Verlauf auch andere neurodegenerative Erkrankungen, insbesondere andere alpha-Synukleinopathien. Der positive prädiktive Wert der REM-Schlaf-Verhaltensstörung für die spätere Entwicklung eines M. Parkinson ist höher, wenn zeitgleich weitere prämotorische Marker des M. Parkinson vorliegen.

Summary

Diagnostic criteria for Parkinson’s disease are based on the presence of motor symptoms (bradykinesia, tremor, rigidity, postural instability) and the exclusion of other causes of parkinsonism. Some non-motor symptoms (e.g. hyposmia, sleep disorders and constipation) may emerge many years before the onset of the classical motor symptoms of Parkinson’s disease. Most of these early nonmotor symptoms are unspecific and have a low positive predictive value for the subsequent development of Parkinson’s disease. REM sleep behaviour disorder (a parasomnia that is clinically characterized by dream enactment) is one of the most specific risk markers for Parkinson’s disease. However, some patients with REM sleep behaviour disorder develop other neurodegenerative disorders, especially other alpha-synucleinopathies. The positive predictive value of REM sleep behaviour disorder for Parkinson’s disease is even higher in cases in which REM sleep behaviour disorder is accompanied by other premotor markers of Parkinson’s disease.

Schlüsselwörter

REM-Schlaf-Verhaltensstörung - Morbus Parkinson - Neurodegeneration - prämotorische Risikomarker

Keywords

REM sleep behaviour disorder - Parkinson’s disease - neurodegeneration - premotor risk markers

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