Lokomotion und Depression

 

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Zusammenfassung

Zielsetzung: Veränderungen motorischer Aktivität stellen ein zentrales klinisches, psychopathologisches Merkmal von Patienten dar, die an depressiven Episoden im Rahmen affektiver Störungen leiden, und sind relevant für Differenzialdiagnose und -therapie. Gangveränderungen sind beim Morbus Parkinson gut untersucht und bei depressiven Patienten häufig auftretende, klinisch beobachtbare Phänomene. Es soll daher ein Überblick über pathophysiologische Grundlagen, Möglichkeiten der instrumentellen Erfassung und empirische Befunde bei Patienten mit depressiven Störungen gegeben werden. Methodik: Recherchiert wurden Informationsmaterial der Hersteller, Monografien und Veröffentlichungen in Medline, PubMed, Excerpta Medica und PsychLIT. Die Befunde zu Pathophysiologie, Messmethodik, Diagnostik und Verlauf werden unter klinischen und wissenschaftlichen Gesichtspunkten diskutiert. Ergebnisse: Gangbewegungen unterliegen der Steuerung kortikaler und subkortikaler Mechanismen, wobei die genaue kinematische Analyse der Regulationsmechanismen Hinweise auf Störungen zentralnervöser Bewegungsprogramme liefert. Methodisch stehen Videographie, Ultraschall, opto-elektronische und andere Methoden zur Verfügung. Empirisch liegen viele Befunde zum Morbus Parkinson und nur wenige quantitative Befunde bei depressiven Patienten vor. Diese zeigen signifikante Unterschiede zu gesunden Kontrollen und deuten auf gestörte Basalganglienfunktionen hin. Schlussfolgerungen: Die Analyse von Gangveränderungen mit moderner Technologie liefert Hinweise auf zentralnervöse Dysfunktionen. Empirisch nachgewiesene Gangveränderungen bei depressiven Patienten sollten hinsichtlich ihrer Bedeutung als Residualsymptome für den Verlauf und als Prädiktoren von Therapieeffekten untersucht werden. Möglicherweise sind durch Nachweis motorischer Auffälligkeiten depressive Patienten mit erhöhtem Risiko für eine sich später manifestierende Parkinson-Erkrankung zu identifizieren.

Abstract

Background: Behavioral disturbances of patients with major depression manifest in various motor domains and are relevant for differential diagnosis, therapeutic interventions, as residual symptoms and possibly early manifestation of Parkinson's disease. Alterations of gait as the main component of locomotion are a clinically well-known motor phenomenon of depressed patients. Therefore, pathophysiology of gait disturbances, different methods to analyze gait and empirical findings in patients with major depression are summarized. Methods: The current literature was examined including information of manufacturers, Medline, PubMed, PsychLIT and Excerpta Medica. Findings in healthy subjects, in Parkinson's disease, and in major depression are discussed in detail regarding specificity and clinical relevance. Results: Kinematic analysis of gait regulation by videography, ultrasound, opto-electronic measures reveals information about disturbances in central nervous motor programming. Only few studies exist about quantitative data of gait alterations in patients with major depression. Results indicate disturbances in functions of the basal ganglia. Conclusions: Analysis of gait using modern technology yields information about cortical and subcortical dysfunctions. Empirical findings in major depression need further investigation regarding their relevance as residual symptoms, as response predictors, and as risk factors for manifestation of Parkinson's disease.

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Priv.-Doz. Dr. med. M. R. Lemke

Rheinische Kliniken

Kaiser-Karl-Ring 20

53111 Bonn

Email: mr.lemke@lvr.de