Riechstörungen - ein frühes Kardinalsymptom des idiopathischen Parkinson-Syndroms

 

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Zusammenfassung

Olfaktorische Störungen sind ein prominentes Symptom beim idiopathischen Parkinson-Syndrom (IPS) und werden bei 80 - 90 % der Patienten beobachtet. Erste größere Studien zum Riechvermögen mit validierten klinischen Tests liegen erst wenige Jahre zurück und bescheinigten den IPS-Patienten einen signifikanten Riechverlust unabhängig von Krankheitsstadium, Dauer und Schwere der Symptomatik. In geringerem Maße zeigte sich ein olfaktorisches Defizit bei differenzialdiagnostisch abzugrenzenden Patienten mit Multisystematrophie, während Patienten mit progressiver supranukleärer Ophthalmoplegie bzw. kortikobasaler Degeneration ein fast uneingeschränktes Riechvermögen aufwiesen. Durch die Messung olfaktorisch evozierter Potenziale bei Parkinson-Patienten konnte die isolierte Betroffenheit des olfaktorischen Systems bei dieser Erkrankung belegt werden. Im Gegensatz zur üblichen psychophysischen Messung (subjektive Wahrnehmung von Riechproben) ließ sich mit der Potenzialmessung eine Progression des Riechverlustes im Verlauf der Krankheit nachweisen. Dem entsprechen Ergebnisse von Post-mortem-Untersuchungen des Bulbus olfactorius IPS-Erkrankter, bei denen ein deutlicher Neuronenverlust und eine Infiltration mit Lewy-Körperchen in Korrelation zu Dauer und Schwere der Erkrankung aufgezeigt werden konnten. Beim Riechverlust ist von einem Frühsymptom - wenn nicht sogar Erstsymptom - des IPS auszugehen, dessen diagnostische (und differenzialdiagnostische) Relevanz noch immer unterbewertet wird.

Abstract

Olfactory loss is a prominent symptom in Parkinson's disease (PD), and it is found in about 80 - 90 % of patients. The high frequency of olfactory dysfunction in PD was not realized until recently, when more sophisticated tools for its measurement became available. In earlier studies olfactory dysfunction (1) seemed to be unrelated to disease duration, (2) did not correlate with motor function, and (3) was uninfluenced by anti-Parkinsonian medication. By olfactory evoked potential (OEP) recording prolonged latencies were seen in PD patients, and a correlation between disability and latency to OEP was demonstrated. Olfactory function is differentially impaired in distinct Parkinsonian syndromes. Preserved or mildly impaired olfactory function is more likely to be related to atypical parkinsonism such as multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. The presented data suggest that inexpensive olfactory tests may significantly enhance the diagnostic armamentarium in the differential and early diagnosis of PD. Patients with PD exhibit a specific decrease of olfactory function which appears to take place during very early stages of the disease. Evidence for olfactory disturbance in PD is reviewed from pathological and neurophysiological standpoints.

Literatur

• 1 Ansari K A, Johnson A. Olfactory function in patients with Parkinson's disease.  J Chron Dis. 1975;  28 493-497
  CrossrefPubMedGoogle Scholar
• 2 Doty R L, Deems D, Steller S. Olfactory dysfunction in Parkinson's disease: A general deficit unrelated to neurologic signs, disease stage, or disease duration.  Neurology. 1988;  38 1237-1244
  CrossrefPubMedGoogle Scholar
• 3 Hummel T, Sekinger B, Wolf S R. et al . „Sniffin' sticks”: olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold.  Chem Senses. 1997;  22 39-52
  CrossrefPubMedGoogle Scholar
• 4 Barz S, Hummel T, Pauli E. et al . Chemosensory event-related potentials in response to trigeminal and olfactory stimulation in idiopathic Parkinson's disease.  Neurology. 1997;  49 1424-1431
  CrossrefPubMedGoogle Scholar
• 5 Pearce R K, Hawkes C H, Daniel S E. The anterior olfactory nucleus in Parkinson's disease.  Mov Disord. 1995;  10 283-287
  CrossrefPubMedGoogle Scholar
• 6 Del Tredici K, Rub U, De Vos R A. et al . Where does parkinson disease pathology begin in the brain?.  J Neuropathol Exp Neurol. 2002;  61 413-426
  CrossrefPubMedGoogle Scholar
• 7 Wenning G K, Shephard B, Hawkes C. et al . Olfactory function in atypical parkinsonian syndromes.  Acta Neurol Scand. 1995;  91 247-250
  CrossrefPubMedGoogle Scholar
• 8 Doty R L, Singh A, Tetrud J, Langston J W. Lack of major olfactory dysfunction in MPTP-induced parkinsonism.  Ann Neurol. 1992;  32 97-100
  CrossrefPubMedGoogle Scholar
• 9 Hawkes C H, Shephard B C, Daniel S E. Is Parkinson's disease a primary olfactory disorder?.  Qjm. 1999;  92 473-480
  CrossrefPubMedGoogle Scholar
• 10 Polymeropoulos M H. et al . Mutation in the alpha-synuclein gene identified in families with Parkinson's disease.  Science. 1997;  276 2045-2047
  PubMedGoogle Scholar
• 11 Maroteaux L, Scheller R H. The rat brain synucleins; family of proteins transiently associated with neuronal membrane.  Brain Res Mol Brain Res. 1991;  11 335-343
  PubMedGoogle Scholar
• 12 Daum R F, Sekinger B, Kobal G, Lang C. Riechprüfung mit „Sniffin' Sticks” zur klinischen Diagnostik des Morbus Parkinson.  Nervenarzt. 2000;  71 643-650
  CrossrefPubMedGoogle Scholar
• 13 Hüttenbrink K B. Riech- und Schmeckstörungen - Bewährtes und Neues zu Diagnostik und Therapie.  Laryngo-Rhino-Otol. 1997;  76 506-514
  PubMedGoogle Scholar
• 14 Quint C, Temmel A F, Schickinger B. et al . Patterns of non-conductive olfactory disorders in eastern Austria: a study of 120 patients from the Department of Otorhinolaryngology at the University of Vienna.  Wien Klin Wochenschr. 2001;  113 52-57
  PubMedGoogle Scholar
• 15 Kobal G, Klimek L, Wolfensberger M. et al . Multicenter investigation of 1,036 subjects using a standardized method for the assessment of olfactory function combining tests of odor identification, odor discrimination, and olfactory thresholds.  Eur Arch Otorhinolaryngol. 2000;  257 205-211
  CrossrefPubMedGoogle Scholar
• 16 Müller A, Mungersdorf M, Reichmann H. et al . Olfactory function in Parkinsonian syndromes.  J Clin Neurosci. 2002;  9 521-524
  CrossrefPubMedGoogle Scholar
• 17 Stern M B, Doty R L, Dotti M. et al . Olfactory function in Parkinson's disease subtypes.  Neurology. 1994;  44 266-268
  PubMedGoogle Scholar
• 18 Müller A, Reichmann H, Livermore A, Hummel T. Olfactory function in idiopathic Parkinson's disease (IPD): results from cross-sectional studies in IPD patients and long-term follow-up of de-novo IPD patients.  J Neural Transm. 2002;  109 805-811
  CrossrefPubMedGoogle Scholar
• 19 Kobal G. Elektrophysiologische Untersuchungen des menschlichen Geruchssinns. Stuttgart; Thieme Verlag 1981
  Google Scholar
• 20 Hummel T, Kobal G. Olfactory event-related potentials. In: Simon SA, Nicolelis MAL (eds) Methods and Frontiers in Chemosensory Research. Boca Raton, Florida USA; CRC press 2001: 429-464
  Google Scholar
• 21 Hummel T, Pietsch H, Kobal G. Kallmann's syndrome and chemosensory evoked potentials.  Eur Arch Otorhinolaryngol. 1991;  248 311-312
  PubMedGoogle Scholar
• 22 Kobal G, Hummel T. Olfactory and intranasal trigeminal event-related potentials in anosmic patients.  Laryngoscope. 1998;  108 1033-1035
  PubMedGoogle Scholar
• 23 Doty R L, Brugger W PE, Jurs P C. et al . Intranasal trigeminal stimulation from odorous volatiles: psychometric responses from anosmic and normal humans.  Physiol Behav. 1978;  20 175-185
  CrossrefPubMedGoogle Scholar
• 24 Kobal G, Hummel T, Pauli E. Correlates of hedonic estimates in the olfactory evoked potential.  Chemical Senses. 1989;  14 718
  PubMedGoogle Scholar
• 25 Kettenmann B, Hummel C, Stefan H, Kobal G. Multiple olfactory activity in the human neocortex identified by magnetic source imaging.  Chemical Senses. 1997;  22 493-502
  PubMedGoogle Scholar
• 26 Hummel T, Pauli E, Stefan H. et al . Chemosensory event-related potentials in patients with temporal lobe epilepsy.  Epilepsia. 1995;  36 79-85
  CrossrefPubMedGoogle Scholar
• 27 Kobal G, Hummel C. Cerebral chemosensory evoked potentials elicited by chemical stimulation of the human olfactory and respiratory nasal mucosa.  Electroenceph Clin Neurophysiol. 1988;  71 241-250
  PubMedGoogle Scholar
• 28 Livermore A, Hummel T, Kobal G. Chemosensory event-related potentials in the investigation of interactions between the olfactory and the somatosensory (trigeminal) systems.  Electroencephalogr Clin Neurophysiol. 1992;  83 201-210
  PubMedGoogle Scholar
• 29 Pause B M, Krauel K. Chemosensory event-related potentials (CSERP) as a key to the psychology of odors.  Int J Psychophysiol. 2000;  36 105-122
  CrossrefPubMedGoogle Scholar
• 30 Abolmaali N D, Hietschold V, Vogl T J. et al . MR evaluation in patients with isolated anosmia since birth or early childhood.  Am J Neuroradiol. 2002;  23 157-164
  PubMedGoogle Scholar
• 31 Yousem D M, Geckle R J, Bilker W B, Doty R L. Olfactory bulb and tract and temporal lobe volumes. Normative data across decades.  Ann N Y Acad Sci. 1998;  855 546-555
  CrossrefPubMedGoogle Scholar
• 32 Berendse H W, Booij J, Francot C M. et al . Subclinical dopaminergic dysfunction in asymptomatic Parkinson's disease patients' relatives with a decreased sense of smell.  Ann Neurol. 2001;  50 34-41
  CrossrefPubMedGoogle Scholar
• 33 McGeer P L, Itagaki S, Akiyama H, McGeer E G. Rate of cell death in parkinsonism indicates active neuropathological process.  Ann Neurol. 1988;  24 574-576
  CrossrefPubMedGoogle Scholar
• 34 Koutssilieri E, Chen T S, Rausch W D, Riederer P. Selegeline is neuroprotective in primary brain cultures treated with 1-methyl-4-phenypyridinium.  Eur J Pharmacol. 1996;  303 181-186
  PubMedGoogle Scholar
• 35 Speiser Z, Levy R, Cohen S. Effects of N-propargyl-1-(R)-aminoindan (rasagiline) in models of motor and cognition disorders.  J Neural Transm. 1998;  52 (Suppl) 287-300
  PubMedGoogle Scholar
• 36 The Parkinson Study Group . Effect of Iazabemide on the progression of disability in early Parkinson's disease.  Ann Neurol. 1996;  40 99-107
  CrossrefPubMedGoogle Scholar
• 37 Gille G, Rausch W D, Hung S T. et al . Pergolide protects dopaminergic neurons in primary culture under stress conditions.  J Neural Transm. 2002;  109 633-643
  CrossrefPubMedGoogle Scholar
• 38 Gille G, Rausch W D, Hung S T. et al . Protection of dopaminergic neurons in primary culture by lisuride.  J Neural Transm. 2002;  109 157-169
  CrossrefPubMedGoogle Scholar
• 39 Gerlach M, Reichmann H, Riederer P. Noch in experimenteller Erprobung befindliche, zukünftige Therapien der Parkinson-Krankheit: Ausblick. In: Gerlach M, Reichmann H, Riederer P (Hrsg) Die Parkinson-Krankheit. Grundlagen, Klinik, Therapie. Wien, New York; Springer 2001: 210-216
  Google Scholar
• 40 Koller W C. et al . Does a long preclinical period occur in Parkinson's disease?.  Neurology. 1991;  41 8-13
  PubMedGoogle Scholar
• 41 Hawkes C H, Shephard B C, Daniel S E. Olfactory dysfunction in Parkinson's disease.  J Neurol Neurosurg Psychiatry. 1997;  62 436-446
  CrossrefPubMedGoogle Scholar

Dr. med. Antje Müller

Klinik und Poliklinik für Neurologie · Universitätsklinikum Dresden

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01307 Dresden