Multifaktorielle Gangstörung und Stürze

Zusammenfassung

Jeder zweite über 80-Jährige fällt mindestens einmal pro Jahr. Stürze sind im Alter die häufigste traumatische Todesursache. Wer überlebt, büßt Autonomie und Lebensqualität ein. Diese Übersicht beschäftigt sich mit multifaktoriellen Gangstörungen aus neurogeriatrischer Sicht, gibt Hinweise zu Anamnese, Diagnose, Therapie, Prävention. Ärzte sollten nach Gangunsicherheit explizit fragen, da Patienten diese oft bagatellisieren. Zur Untersuchung gehört eine neurologische ebenso wie auf körperliche Leistungsfähigkeit und Bewegungsapparat fokussierte Begutachtung. Die Therapie richtet sich in der Regel nach der Grunderkrankung, die zu Stürzen führt: Bei Morbus Parkinson ist dopaminerge Medikation indiziert, bei Demenz z. B. ein zentral wirksamer Cholinesterasehemmer, bei Myelopathie eine Dekompression. Präventiv wirksam sind rutschfeste Schuhe, Entfernen von Stolperfallen und Ausleuchten der Wegstrecke, aber auch die Reduktion schwindelfördernder Medikamente ebenso wie Physiotherapie zur Belastbarkeitssteigerung. In der Summe wirken individuelle Therapiepakete besser als Einzelmaßnahmen. Vorausdenken und Wachsamkeit können sturzgefährdeten Patienten das Leben retten.

Summary

A person over eighty drops down at least once a year. In the elderly, drops are the common cause for death after trauma. This article deals with multi-factorial gait disorders from a neuro-geriatric perspective. It gives advice for specific history taking, diagnosis criteria, therapies and prevention. Physicians should ask their patients if they were insecure while walking. Drops are often trivialized. During the examination the expert should focus on a neurological assessment as well as on physical capacity and musculoskeletal system. Usually, therapeutic strategies follow the affliction leading to falling: Patients with Parkinson’s disease may need dopaminergic medication, those suffering from dementia may be helped by central cholinesterase inhibitors, those with spinal myelopathy may profit from decompression. Prophylaxis involves non-slippery shoes, removing tripping hazards, and illuminating pathways as well as reducing dizzinesscausing medication or starting physical therapy for better balance. To sum it up: Dealing with gait disorder individually developed arrangements have a higher effort than single actions. In either case being aware can save a falling patient’s life.

Schlüsselwörter

Gangstörung - Sturz - Parkinson - Schlaganfall - Polyneuropathie - Myelopathie

Keywords

Gait disorder - falling - Parkinson’s disease - stroke - polyneuropathy - myelopathy

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