Kognitive Veränderungen bei spontan auftretendem Morbus Parkinson

Zusammenfassung

Der dem Morbus Parkinson unterliegende pathologische Prozess entwickelt sich über viele Jahre. Erste Veränderungen entstehen noch vor dem Erscheinen klinischer Symptome. Der Prozess befällt in vorbestimmter Weise übergeordnete Zentren des olfaktorischen, limbischen, viszeromotorischen und somatomotorischen Systems. Die zeitlich gestaffelte und räumlich geordnete Ausbreitung der Veränderungen über das zentrale Nervensystem ermöglicht eine Zuordnung individueller Autopsiefälle zu sechs neuropathologischen Stadien. Kognitive Beeinträchtigungen variablen Schweregrades ergänzen die klassische Symptomentrias des Morbus Parkinson. Diese Beeinträchtigungen kognitiver Fähigkeiten, ermittelt mit Hilfe des MMSE-Testes, korrelieren mit den Stadien der neurodegenerativen Veränderungen. Der Abbau kognitiver Fähigkeiten gehört zu den Kernsymptomen der Parkinsonschen Krankheit wie Bradykinesie, Rigor und Tremor und kann gelegentlich das klinische Bild beherrschen. Das pathomorphologische Korrelat der dementiven Veränderungen wird diskutiert.

Summary

In sporadic Morbus Parkinson, the disease-process usually requires years to reach its full extent. The neuronal damage, however, begins before the appearance of the initial clinical symptoms, and recent findings show that the brain pathology develops in a predictable manner and sequence with the result that superordinate portions of the olfactory, limbic, visceromotor, and somatomotor systems sustain heavy damage. The topographic advance of the lesions is so characteristic that autopsy cases can be assigned to one of six neuropathological stages. In addition to the classical symptom triad associated with Parkinson’s disease, patients can manifest signs of cognitive decline ranging from subtle mental dysfunction to overt dementia. Results of a new clinicopathological correlation study show for the first time that cognitive decline assessed by using the MMSE Test is associated with the recently proposed neuropathological stages. Thus, cognitive decline leading to dementia is as much a major symptom of sporadic M. Parkinson as bradykinesia, rigor, and tremor and may even come to dominate the clinical picture. Some possible pathomorphological correlates of dementia are discussed.

Schlüsselwörter

Demenz - Lewy-Körper/Lewy-Neuriten - Morbus Parkinson - Synukleinopathien

Keywords

Dementia - Lewy bodies/Lewy neurites - Parkinson’s disease - synucleinopathies

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