scholarly journals Frequency of REM sleep behavior disorders in patients with Parkinson’s disease

2015 ◽  
Vol 72 (5) ◽  
pp. 442-446 ◽  
Author(s):  
Marko Jankovic ◽  
Marina Svetel ◽  
Vladimir Kostic
Keyword(s):  
Family History ◽  
Eye Movement ◽  
Rem Sleep ◽  
Treatment Duration ◽  
Rating Scale ◽  
Disease Onset ◽  
Motor Score ◽  
Duration Of Treatment ◽  
Sleep Behavior ◽  
Updrs Motor Score

Background/Aim. Sleep is prompted by natural cycles of activity in the brain and consists of two basic states: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. REM sleep behavior disorder (RBD) is characterized by violent motor and vocal behavior during REM sleep which represents dream enactment. The normal loss of muscle tone, with the exception of respiratory, sphincter, extra ocular and middle ear muscles, is absent in patients with RBD. The origin of RBD is frequently unknown, but can be associated with degenerative neurological disorders, such as Parkinson?s disease (PD). PD patients do not necessarily express features of RBD, which is identified in approximately third to a half of them. The aim of this study was to estimate the prevalence of RBD in a cohort of PD patients, as well as to identify risk-factors for its development. Methods. In the period from December 2010 to September 2011 we recruited 97 consecutive PD outpatients, treated in the Institute of Neurology, Clinical Center of Serbia, Belgrade. After establishing the diagnosis, all the patients filled out a specially constructed questionnaire with the following items: actual age, sex, age at disease onset, disease duration, form of the disease, type of treatment, duration of treatment, the presence of constipation, lessening of smell sense, and family history of PD. At entring the study, patients disability was scored using the Unified Parkinson?s Disease Rating Scale (motor part - UPDRS). Cognitive abilities were assessed by the Mini Mental Status Examination (MMSE) scale, and depression symptoms by the 21-item Hamilton Depression Rating Scale (HDRS). The patients with PD were dichotomized to those with and without RBD using the RBD Questionnaire - Hong Kong (RBDQ-HK) in the manner of an interview. Forms of PD, mode of treatment, sex, constipation and family history were investigated using the Fishers ?2 test. Symptoms and treatment duration, the presence of smell disturbances, MMSE score, UPDRS motor score and HDRS score were analyzed by implementation of the Z-test. Actual age and age at disease onset were evaluated by the unpaired t-test. Results. The RBD-positive group contained 15 (15.5%) patients, while in the rest of them (82/97), RBD was not identified (non- RBD group). There was no difference between the two groups considering gender distribution (p = 0.847), age (p = 0.577), age at disease onset (p = 0.141), duration of PD (p = 0.069), family history (p = 0.591), type of initial symptoms (p = 0.899), constipation (p = 0.353), olfaction (p = 0.32) and MMSE scores (p = 0.217). The duration of treatment in the RBD group was longer than in the non-RBD group (9.4 ? 5.3 and 6.3 ? 3.9 years, respectively; p = 0.029), and the UPDRS motor score in the RBD group was higher (19.1 ? 9.4 and 12.7 ? 8.2, respectively; p = 0.013). Also, HDRS scores were higher in patients expressing RBD (10.1 ? 6.0 and 6.4 ? 4.5, respectively; p = 0.019). Conclusion. We found that 15.5% of the consecutive PD patients had RBD, and that the patients with RBD differed from the non-RBD ones regarding duration of treatment, disease and depressive symptoms severity.

scholarly journals REM Sleep Behavior Disorder (RBD) in Dementia with Lewy Bodies (DLB)

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Po-Chi Chan ◽  
Hsun-Hua Lee ◽  
Chien-Tai Hong ◽  
Chaur-Jong Hu ◽  
Dean Wu
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
Dementia With Lewy Bodies ◽  
Clinical Manifestations ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Rapid Eye Movement ◽  
Sleep Behavior ◽  
Neurologic Disorders

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia, with abnormal dream-enacting behavior during the rapid eye movement (REM) sleep. RBD is either idiopathic or secondary to other neurologic disorders and medications. Dementia with Lewy bodies (DLB) is the third most common cause of dementia, and the typical clinical presentation is rapidly progressive cognitive impairment. RBD is one of the core features of DLB and may occur either in advance or simultaneously with the onset of DLB. The association between RBD with DLB is widely studied. Evidences suggest that both DLB and RBD are possibly caused by the shared underlying synucleinopathy. This review article discusses history, clinical manifestations, possible pathophysiologies, and treatment of DLB and RBD and provides the latest updates.

scholarly journals Smaller pineal gland is associated with rapid eye movement sleep behavior disorder in Alzheimer’s disease

2020 ◽  
Author(s):  
Jeongbin Park ◽  
Seung Wan Suh ◽  
Grace Eun Kim ◽  
Subin Lee ◽  
Jun Sung Kim ◽  
...  
Keyword(s):  
Pineal Gland ◽  
Eye Movement ◽  
Rem Sleep ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Rapid Eye Movement ◽  
Sleep Behavior ◽  
Gland Volume

Abstract Background: To investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer’s disease (AD) patients without any feature of dementia with Lewy bodies.Methods: We enrolled 296 community-dwelling probable AD patients who did not meet the diagnostic criteria for possible or probable dementia with Lewy bodies. Among them, 93 were amyloid beta (Aβ) positive on 18F-florbetaben amyloid brain positron emission tomography. We measured RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as the RBDSQ of 5 or higher. We manually segmented pineal gland on 3T structural T1-weighted brain magnetic resonance imaging.Results: The participants with pRBD had smaller pineal parenchyma volume (VPP) than those without pRBD (p < 0.001). The smaller the VPP, the more severe the RBD symptoms (p < 0.001). VPP was inversely associated with risk of prevalent pRBD (odds ratio = 0.909, 95% confidence interval [CI] = 0.878–0.942, p < 0.001). Area under the receiver operator characteristic curve for pRBD of VPP was 0.80 (95% CI = 0.750–0.844, p < 0.0001). These results were not changed when we analyzed the 93 participants with Aβ-positive AD separately.Conclusions: In AD patients, reduced pineal gland volume may be associated with RBD.

Arousal Characteristics in Patients with Parkinson’s Disease and Isolated Rapid Eye Movement Sleep Behavior Disorder

SLEEP ◽  
2021 ◽  
Author(s):  
Andreas Brink-Kjær ◽  
Matteo Cesari ◽  
Friederike Sixel-Döring ◽  
Brit Mollenhauer ◽  
Claudia Trenkwalder ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Eye Movement ◽  
Rem Sleep ◽  
Regression Models ◽  
Muscle Tone ◽  
Behavior Disorder ◽  
Nrem Sleep ◽  
Rapid Eye Movement ◽  
Sleep Behavior

Abstract Study objectives Patients diagnosed with isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and Parkinson’s disease (PD) have altered sleep stability reflecting neurodegeneration in brainstem structures. We hypothesize that neurodegeneration alters the expression of cortical arousals in sleep. Methods We analyzed polysomnography data recorded from 88 healthy controls (HC), 22 iRBD patients, 82 de novo PD patients without RBD and 32 with RBD (PD+RBD). These patients were also investigated at a 2-year follow-up. Arousals were analyzed using a previously validated automatic system, which used a central EEG lead, electrooculography, and chin electromyography. Multiple linear regression models were fitted to compare group differences at baseline and change to follow-up for arousal index (ArI), shifts in electroencephalographic signals associated with arousals, and arousal chin muscle tone. The regression models were adjusted for known covariates affecting the nature of arousal. Results In comparison to HC, patients with iRBD and PD+RBD showed increased ArI during REM sleep and their arousals showed a significantly lower shift in α-band power at arousals and a higher muscle tone during arousals. In comparison to HC, the PD patients were characterized by a decreased ArI in NREM sleep at baseline. ArI during NREM sleep decreased further at the 2-year follow-up, although not significantly Conclusions Patients with PD and iRBD present with abnormal arousal characteristics as scored by an automated method. These abnormalities are likely to be caused by neurodegeneration of the reticular activation system due to alpha-synuclein aggregation.

scholarly journals Nonrapid eye movement sleep electroencephalographic oscillations in idiopathic rapid eye movement sleep behavior disorder: a study of sleep spindles and slow oscillations

SLEEP ◽  
2020 ◽  
Author(s):  
Jun-Sang Sunwoo ◽  
Kwang Su Cha ◽  
Jung-Ick Byun ◽  
Jin-Sun Jun ◽  
Tae-Joon Kim ◽  
...  
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Nrem Sleep ◽  
Sleep Spindles ◽  
Rapid Eye Movement ◽  
Sleep Behavior ◽  
Slow Oscillations ◽  
Lower Amplitude

Abstract Study Objectives We investigated electroencephalographic (EEG) slow oscillations (SOs), sleep spindles (SSs), and their temporal coordination during nonrapid eye movement (NREM) sleep in patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). Methods We analyzed 16 patients with video-polysomnography-confirmed iRBD (age, 65.4 ± 6.6 years; male, 87.5%) and 10 controls (age, 62.3 ± 7.5 years; male, 70%). SSs and SOs were automatically detected during stage N2 and N3. We analyzed their characteristics, including density, frequency, duration, and amplitude. We additionally identified SO-locked spindles and examined their phase distribution and phase locking with the corresponding SO. For inter-group comparisons, we used the independent samples t-test or Wilcoxon rank-sum test, as appropriate. Results The SOs of iRBD patients had significantly lower amplitude, longer duration (p = 0.005 for both), and shallower slope (p &lt; 0.001) than those of controls. The SS power of iRBD patients was significantly lower than that of controls (p = 0.002), although spindle density did not differ significantly. Furthermore, SO-locked spindles of iRBD patients prematurely occurred during the down-to-up-state transition of SOs, whereas those of controls occurred at the up-state peak of SOs (p = 0.009). The phase of SO-locked spindles showed a positive correlation with delayed recall subscores (p = 0.005) but not with tonic or phasic electromyography activity during REM sleep. Conclusions In this study, we found abnormal EEG oscillations during NREM sleep in patients with iRBD. The impaired temporal coupling between SOs and SSs may reflect early neurodegenerative changes in iRBD.

scholarly journals Clinical and video-polysomnographic analysis of rapid eye movement sleep behavior disorder and other sleep disturbances in dementia with Lewy bodies

SLEEP ◽  
2019 ◽  
Vol 42 (7) ◽  
Author(s):  
Ana Fernández-Arcos ◽  
Estrella Morenas-Rodríguez ◽  
Joan Santamaria ◽  
Raquel Sánchez-Valle ◽  
Albert Lladó ◽  
...  
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
Predictive Value ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Behavior Disorder ◽  
Sleep Spindles ◽  
Electromyographic Activity ◽  
Rapid Eye Movement ◽  
Sleep Behavior

Abstract Objective The main objective of this study was to study rapid eye movement (REM) sleep behavior disorder (RBD) and other sleep disorders in dementia with Lewy bodies (DLB). Methods Consecutive patients with DLB and mild dementia severity were recruited irrespective of sleep complaints. Patients underwent clinical interview, assessment of sleep scales, and video-polysomnography (V-PSG). RBD was diagnosed with V-PSG based on electromyographic and audiovisual analysis. Results Thirty-five patients (65.7% men; mean age 77.7 ± 6.1 years) were evaluated. Poor sleep quality (54.3%), hypersomnia (37.1%), snoring (60%), and abnormal nocturnal behaviors (77.1%) were reported. Sleep–wake architecture abnormalities occurred in 75% patients and consisted of occipital slowing on awake electroencephalography (EEG; 34.4%), the absence of sleep spindles and K complexes (12.9%), slow frequency sleep spindles (12.9%), delta activity in REM sleep (19.2%), and REM sleep without atonia (44%). Three patients showed hallucinatory-like behaviors and 10 patients showed abnormal behaviors during arousals mimicking RBD. RBD was diagnosed in 50% of those patients in whom sufficient REM sleep was attained. Of these, 72.7% were not aware of displaying dream-enacting behaviors and in 63.7% RBD preceded the onset of cognitive impairment. For RBD diagnosis, the sensitivity of Mayo Sleep Questionnaire was 50%, specificity was 66.7%, positive predictive value was 83.3%, and negative predictive value was 28%. False-positive RBD cases according to clinical history had hallucinatory-like behaviors, severe obstructive sleep apnea, and prominent periodic limb movements in sleep. Occipital EEG frequency while awake and rate of electromyographic activity in REM sleep were negatively correlated, suggesting a common subcortical origin. Conclusion In DLB, RBD and sleep–wake disorders are common, heterogeneous, and complex, challenging their identification without performing V-PSG.

scholarly journals Isolated rapid eye movement sleep behavior disorder and cyclic alternating pattern: is sleep microstructure a predictive parameter of neurodegeneration?

SLEEP ◽  
2019 ◽  
Vol 42 (10) ◽  
Author(s):  
Andrea Melpignano ◽  
Liborio Parrino ◽  
Joan Santamaria ◽  
Carles Gaig ◽  
Irene Trippi ◽  
...  
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Average Risk ◽  
Rapid Eye Movement ◽  
Sleep Behavior ◽  
Cyclic Alternating Pattern ◽  
Cap Rate ◽  
Sleep Microstructure

Abstract Objective To evaluate the role of sleep cyclic alternating pattern (CAP) in patients with isolated REM sleep behavior disorder (IRBD) and ascertain whether CAP metrics might represent a marker of phenoconversion to a defined neurodegenerative condition. Methods Sixty-seven IRBD patients were included and classified into patients who phenoconverted to a neurodegenerative disease (RBD converters: converter REM sleep behavior disorder [cRBD]; n = 34) and remained disease-free (RBD non-converters: non-converter REM sleep behavior disorder [ncRBD]; n = 33) having a similar follow-up duration. Fourteen age- and gender-balanced healthy controls were included for comparisons. Results Compared to controls, CAP rate and CAP index were significantly decreased in IRBD mainly due to a decrease of A1 phase subtypes (A1 index) despite an increase in duration of both CAP A and B phases. The cRBD group had significantly lower values of CAP rate and CAP index when compared with the ncRBD group and controls. A1 index was significantly reduced in both ncRBD and cRBD groups compared to controls. When compared to the ncRBD group, A3 index was significantly decreased in the cRBD group. The Kaplan-Meier curve applied to cRBD estimated that a value of CAP rate below 32.9% was related to an average risk of conversion of 9.2 years after baseline polysomnography. Conclusion IRBD is not exclusively a rapid eye movement (REM) sleep parasomnia, as non-rapid eye movement (non-REM) sleep microstructure can also be affected by CAP changes. Further studies are necessary to confirm that a reduction of specific CAP metrics is a marker of neurodegeneration in IRBD.

scholarly journals Subthalamic nucleus and globus pallidus internus stimulation for the treatment of Parkinson’s disease: A systematic review

2017 ◽  
Vol 45 (5) ◽  
pp. 1602-1612 ◽  
Author(s):  
Hao Xu ◽  
Feng Zheng ◽  
Boris Krischek ◽  
Wanhai Ding ◽  
Chi Xiong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Globus Pallidus ◽  
Subthalamic Nucleus ◽  
Rating Scale ◽  
Mean Difference ◽  
Globus Pallidus Internus ◽  
Motor Score ◽  
Updrs Motor Score

Objective Deep brain stimulation (DBS) for treatment of advanced Parkinson’s disease (PD) has two anatomical targets: the subthalamic nucleus (STN) and the globus pallidus internus (GPI). The clinical effectiveness of these two stimulation targets was compared in the present study. Methods A systematic review and meta-analysis was performed to evaluated the postoperative changes in the United Parkinson’s Disease Rating Scale (UPDRS) on- and off-phase, on-stimulation motor scores; activities of daily living score (ADLS); and levodopa equivalent dose (LED) after STN and GPI stimulation. Randomized and nonrandomized controlled trials of PD treated by STN and GPI stimulation were considered for inclusion. Results Eight published reports of eligible studies involving 599 patients met the inclusion criteria. No significant differences were observed between the STN and GPI groups in the on-medication, on-stimulation UPDRS motor score [mean difference, 2.15; 95% confidence interval (CI), −0.96–5.27] or ADLS (mean difference, 3.40; 95% CI, 0.95–7.76). Significant differences in favor of STN stimulation were noted in the off-medication, on-stimulation UPDRS motor score (mean difference, 1.67; 95% CI, 0.98–2.37) and LED (mean difference, 130.24; 95% CI, 28.82–231.65). Conclusion The STN may be the preferred target for DBS in consideration of medication reduction, economic efficiency, and motor function improvement in the off phase. However, treatment decisions should be made according to the individual patient’s symptoms and expectations.

scholarly journals Hormone replacement therapy use in UK general practice: Duration, discontinuation and women’s experience

2016 ◽  
Vol 22 (4) ◽  
pp. 155-164 ◽  
Author(s):  
Pippa Anderson ◽  
Caroline O’Leary ◽  
Margaret Moffat ◽  
Xuemei Luo
Keyword(s):  
Hormone Replacement Therapy ◽  
Side Effects ◽  
Replacement Therapy ◽  
Treatment Duration ◽  
Rating Scale ◽  
Hormone Replacement ◽  
Medical Advice ◽  
Health Improvement ◽  
Duration Of Treatment ◽  
Treatment Type

Objective Investigate characteristics of women treated with combined estrogen and progestogen hormone replacement therapy (study-HRT); HRT patterns; reasons and outcomes associated with HRT discontinuation. Study design Retrospective observational study using The Health Improvement Network database examining women’s characteristics and treatment patterns (Database). Postal questionnaire exploring reasons and outcomes associated with HRT discontinuation (Survey). Main outcome measures Database: Demographic and clinical characteristics. HRT patterns, time from diagnosis to treatment, duration of treatment, type of treatment and change of treatment (switch, add-on, re-start and discontinuation). Survey: HRT therapy status, menopause rating scale and reasons for discontinuation. Results Database: 8968 women prescribed study-HRT between January 2006 and January 2010 were matched 1:1 on GP practice and age with women not prescribed HRT. Women prescribed study-HRT were more likely to be a current/past smoker ( p<0.05) and experienced higher levels of co-morbidities related to menopause ( p < 0.05) versus women not prescribed HRT. Treatment duration was approximately 14 months and 95% changed treatment during the study. Survey: 116 respondents. Women on HRT had lower MRS scores ( p < 0.05) than women who discontinued HRT. Main reasons for discontinuation were medical advice, side-effects/potential side-effects. Fear of breast cancer was also stated as a reason. Conclusions Duration of HRT was relatively short, with 95% of women changing treatment. HRT discontinuation was associated with more severe menopause symptoms. Medical advice and concerns about side-effects were major reasons for the discontinuation, suggesting that there was a need for a balanced dialogue with women about risks and benefits of HRT, as emphasised by NICE guidance.

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