Die Alzheimer-Demenz ist nicht heilbar. Der Heilungs-Verlauf ist aber bei frühzeitiger Erkennung und Behandlung verzögerbar. Die mittlere Überlebens-Dauer nach Erkrankungsausbruch beträgt etwa 10 Jahre, bei der präsenilen Verlaufsform deutlich weniger.
Die zerebro-vaskuläre Demenz verläuft uneinheitlich und je nach Lokalisation der Schädigungen, grundsätzlich aber auch schleichend. Heilbar ist sie ebenfalls nicht. Der Verlauf und die Entstehung kann durch frühzeitige Behandlung sowie durch Prophylaxe besser beeinflusst werden, als der bei Alzheimer-Demenz.
Auch die fronto-temporalen Demenzen sind nicht heibar und führen zum Tod, allerdings erst im Laufe von ca 9 Jahren. Spiegelbildlich zum Verlauf der Alzheimer-Demenz kommt es hier zuletzt zum Ausfall der kognitiven Funktionen, während sich zuerst Störungen der Persönlichkeit und des Sozialverhaltens manifestieren.
Die Lewy-Body-Demenz verläuft schleichend mit stärkerer Ausprägung von Defiziten in den Bereichen Aufmerksamkeit, Wortflüssigkeit und visuoräumlichen Leistungen, als bei der Alzheimer-Demenz. Charakteristisch sind Schwankungen der kognitiven Leistungsfähigkeit von einem auf den anderen Tag, ferner optische Halluzinationen und motorische Parkinson-Symptome. Dadurch lässt sich diese Demenzform häufig klinisch gegenüber der Alzheimer-Demenz abgrenzen.
Die Demenzen bei anderen zerebralen Krankheiten sind in der Regel auch irreversibel:
- Die Parkinson-Krankheit ist gekennzeichnet durch die Verlangsamung der Hirnleistungen, die sogenannte „Bradyphrenie“. Die Gedächtnis-Störungen sind dagegen eher diskret. Diese Demenz-Form kann in jedem Stadium stehen bleiben!
- Die Huntington-Krankheit, welche zu 90% mittels Gentest diagnostiziert werden kann, beginnt ca im 40.Lj. und hat ein sehr komplexes klinisches Symptommuster. Charakteristisch sind die typischen choreatischen Bewegungsstörungen in Kombination mit Störungen der Affekte, der Impulskontrolle, des Denkens und der Persönlichkeit.
- Die Creutzfeldt-Jakob-Krankheit beginnt im Alter zwischen 30 und 70 Jahren und führt im Mittel nach 5 Jahren zum Tode. Charakteristisch sind spinozerebelläre Defekte mit der entsprechenden motorischen Symptomatik, während kognitive Störungen und Demenz erst später im Verlauf auftreten.
- Die HIV-Enzephalitis, die ebenfalls eine Demenz ist, betrifft ca 20% aller Aids-Patienten und verläuft besonders rasch tödlich (bereits im Mittel nach 1 Jahr).
Potentiell heilbare „Demenzen“ sind solche im Rahmen einer anderen „Grunderkrankung“, die heilbar ist, z.B. einer Depression, einer Schilddrüsenunterfunktion, einer Alkohol-Krankheit oder eines Normaldruckhydrozephalus (NPH). Der Verlauf ist hierbei meist abhängig vom Verlauf der Grunderkrankung.
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