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PSYCH up2date 2013; 7(01): 9-20
DOI: 10.1055/s-0032-1327286
Organische psychische Störungen
© Georg Thieme Verlag KG Stuttgart · New York

Leichte kognitive Störung

Berit Prinz
,
Michael Hüll
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Publication Date:
30 November 2012 (online)

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Kernaussagen

Patienten mit kognitiven Beeinträchtigungen im Alter, welche nicht an einer Demenz leiden, jedoch die diagnostischen Kriterien einer (amnestischen) MCI erfüllen, können zur Beantwortung der Frage nach ihrer individuellen Prognose im Hinblick auf das Risiko, zu einer (Alzheimer-)Demenz zu konvertieren, in Gedächtnissprechstunden vorgestellt werden. Dort wird mit Bestimmung der Biomarker der neuronalen Degeneration und der Beta-Amyloid-Akkumulation ggf. eine Aussage zur individuellen Prognose des Patienten möglich sein. Dabei ist jedoch unbedingt zu berücksichtigen, dass es bisher keine medikamentöse Therapie gibt, die zur Behandlung des MCI zugelassen ist, da eine positive Beeinflussung des Verlaufs mit den bisherigen Präparaten in Studien nicht nachzuweisen war. Insbesondere wird von einer Verordnung von Antidementiva aus der Gruppe der Azetylcholinesterase-Inhibitoren vor der Konversion zur Demenz im Allgemeinen abgeraten. Leitliniengemäß wird bei Feststellung der Konversion resp. Diagnose einer leichten und mittelschweren AD eine medikamentöse Therapie mit einem Azetylcholinesterase-Inhibitor empfohlen.

Vom National Institute on Aging und der Amerikanischen Alzheimer-Gesellschaft wurde im April 2011 nach 27 Jahren die Alzheimererkrankung neu definiert. Ein Schwerpunkt dieser neuen Diagnosekriterien ist der Versuch, unter Zuhilfenahme der Erkenntnisse über die Biomarker MCI-Patienten mit einer Alzheimererkrankung, welche letztlich dann auch zu einer Alzheimerdemenz konvertieren werden, von jenen abzugrenzen, für die keine Alzheimererkrankung als Ursache der MCI vorliegt oder die auch als gutartig zu bezeichnen sind.

 

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