Demenz und depression determinieren pflegebedürftigkeit bei M. Parkinson: Untersuchung an 1449 patienten im ambulanten versorgungssektor in Deutschland

Background: Parkinson's disease (PD) is fre-quently accompanied by dementia or depres-sion which can aggravate the clinical picture of the disease and increase the risk of care dependency (CD). Little is known about the associations between PD, these neuropsychi-atric comorbidities and CD in outpatients. Patients and methods: A nationwide sam-ple of outpatients (n=1,449) was examined by office-based neurologists (n=315) com-prising the documentation of the general, neurological status and the degree of CD. The dementia status was clinically rated according to the established DSM-IV criteria. De-pression was screened with the Montgom-ery-Asberg Depression Rating Scale (MADRS). Results: Overall, 18.3% of all patients were care dependent. Even after adjustment for PD severity, patients with depression (OR=2.8; 95% Cl 1.8-4.3), dementia (OR=2.7; 95% Cl 1.8-4.1) or both (OR=3.9; 95% Cl 2.5-60,0) were at higher risk for CD than patients with-out dementia or depression. Patients aged ≤76 years were fourfold more likely to be care dependent than patients aged ≥65 years (OR=3.5; 95% CI 2.3-5.5). Across all age groups, patients with depression featured the highest increments (from 11.9 to 42.0%). Conclusion: The risk for CD is substantial-ly elevated in outpatients with PD when fur-ther neuropsychiatric symptoms are present. The data suggest that depression contributes equally to disability as does dementia.