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Klinik und bildgebende Diagnostik neurodegenerativer Demenzen

Symptoms and imaging diagnostics of neurodegenerative dementia

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Zusammenfassung

Verschiedene neurodegenerative Erkrankungen, die einer klinischen Differenzialdiagnostik zugänglich sind, können ein Demenzsyndrom begründen. Neben der ausführlich darzustellenden Alzheimer-Demenz (AD) sowie ihren klinischen Vorläuferstadien zählen hierzu insbesondere frontotemporale Degenerationen, die Lewy-Körperchen-Demenz, aber auch die Demenz bei Morbus Parkinson, progressiver supranukleärer Parese, kortikobasaler Degeneration oder Chorea Huntington. Obgleich nicht den neurodegenerativen Hirnerkrankungen zuzuordnen, gilt für alle klinischen Diagnosen die Notwendigkeit einer differenzialdiagnostischen Abgrenzung von vaskulären Demenzformen. Des Weiteren sind aus klinisch-psychiatrischer Sicht differenzialdiagnostische Abgrenzungen affektiver Störungen wie der minoren Depression erforderlich. Nicht zuletzt stellt die AD in ihren Vorläuferstadien ein oftmals uncharakteristisches Syndrom dar, bei dem neben ersten kognitiven Defiziten insbesondere im Bereich der Gedächtnisleistung affektive Krankheitszeichen auftreten können. Zusammengefasst erlauben klinische und neuropsychologische zusammen mit strukturellen und funktionellen bildgebenden Verfahren in der klinischen Anwendung eine verfeinerte differenzialdiagnostische Bewertung neurodegenerativer Demenzsyndrome, die durch neurochemische Biomarker und innovative bildgebende Verfahren wie Diffusionsbildgebung oder MR-Spektroskopie weiter unterstützt werden kann.

Abstract

A variety of neurodegenerative diseases can underlie dementia syndromes. In addition to Alzheimer’s disease (AD) and its prodromal stages, these include in particular frontotemporal degeneration, Lewy body dementia and Parkinson’s dementia, progressive supranuclear paresis, corticobasal degeneration and chorea Huntington. Although not classified as a neurodegenerative brain disease, for all clinical diagnoses there must be a differential diagnostic separation from vascular forms of dementia. Furthermore an exclusion of affective disorders, such as minor depression is necessary from a clinical psychiatric perspective. Moreover the preclinical stages of AD often present with uncharacteristic symptoms. Especially affective symptoms can occur in addition to initial cognitive deficits such as memory decline. In summary, clinical and neuropsychological procedures together with functional imaging techniques allow a detailed diagnostic assessment of neurodegenerative dementia syndromes which can be additionally supported by neurochemical biomarkers and innovative imaging procedures, such as diffusion imaging or magnetic resonance spectroscopy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig (AöR), Semmelweisstr. 10, 04103, Leipzig, Deutschland

    P. Schönknecht

  2. Sektion Gerontopsychiatrie und Marsilius-Kolleg, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    C. Sattler & P. Toro

  3. Klinik für Psychiatrie, Universidad Católica de Chile, Santiago, Chile

    P. Toro

  4. Abteilung Radiologie, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Deutschland

    M. Essig

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  1. P. Schönknecht
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  2. C. Sattler
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  3. P. Toro
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  4. M. Essig
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Correspondence to P. Schönknecht.

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Schönknecht, P., Sattler, C., Toro, P. et al. Klinik und bildgebende Diagnostik neurodegenerativer Demenzen. Radiologe 51, 278–284 (2011). https://doi.org/10.1007/s00117-010-2092-8

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