Objective To validate a questionnaire focused on REM sleep behavior disorder (RBD) among participants in an aging and dementia cohort. Background RBD is a parasomnia that can develop in otherwise neurologically-normal adults as well as in those with a neurodegenerative disease. Confirmation of RBD requires polysomnography (PSG). A simple screening measure for RBD would be desirable for clinical and research purposes. Methods We had previously developed the Mayo Sleep Questionnaire (MSQ), a 16 item measure, to screen for the presence of RBD and other sleep disorders. We assessed the validity of the MSQ by comparing the responses of patients’ bed partners with the findings on PSG. All subjects recruited in the Mayo Alzheimer’s Disease Research Center at Mayo Clinic Rochester and Mayo Clinic Jacksonville from 1/00 to 7/08 who had also undergone a PSG were the focus of this analysis. Results The study sample was comprised of 176 subjects [150 male; median age 71 years (range 39–90)], with the following clinical diagnoses: normal (n=8), mild cognitive impairment (n=44), Alzheimer’s disease (n=23), dementia with Lewy bodies (n=74), as well as other dementia and/or parkinsonian syndromes (n=27). The core question on recurrent dream enactment behavior yielded a sensitivity (SN) of 98% and specificity (SP) of 74% for the diagnosis of RBD. The profile of responses on four additional subquestions on RBD and one on obstructive sleep apnea improved specificity. Conclusions These data suggest that among aged subjects with cognitive impairment and/or parkinsonism, the MSQ has adequate SN and SP for the diagnosis of RBD. The utility of this scale in other patient populations will require further study.

DPPX-IgG is a biomarker for an immunotherapy-responsive multifocal neurologic disorder of the central and autonomic nervous systems.

Background: Idiopathic REM sleep behavior disorder (RBD) may be the initial manifestation of

Objective REM sleep behavior disorder (RBD) is usually characterized by potentially injurious dream enactment behaviors (DEB). RBD treatment aims to reduce DEBs and prevent injury, but outcomes require further elucidation. We surveyed RBD patients to describe longitudinal treatment outcomes with melatonin and clonazepam. Methods We surveyed and reviewed records of consecutive RBD patients seen at Mayo Clinic between 2008–2010 to describe RBD-related injury frequency/severity as well as RBD Visual Analog Scale (VAS) ratings, medication dosage, and side effects. Statistical analyses were performed with appropriate non-parametric matched pairs tests before and after treatment, and with comparative group analyses for continuous and categorical variables between treatment groups. The primary outcome variables were RBD VAS ratings and injury frequency. Results Forty-five (84.9%) of 53 respondent surveys were analyzed. Mean age was 65.8 years and 35 (77.8%) patients were men. Neurodegenerative disorders were seen in 24 (53%) patients, and 25 (56%) received antidepressants. Twenty-five patients received melatonin, 18 received clonazepam, and 2 received both as initial treatment. Before treatment, 27 patients (60%) reported an RBD associated injury. Median dosages were melatonin 6 mg and clonazepam 0.5 mg. RBD VAS ratings were significantly improved following both treatments (pm=.0001, pc=.0005). Melatonin-treated patients reported significantly reduced injuries (pm=.001, pc=.06) and fewer adverse effects (p=0.07). Mean durations of treatment were no different between groups (for clonazepam 53.9 +/− 29.5 months, and for melatonin 27.4 +/− 24 months, p=0.13) and there were no differences in treatment retention, with 28% of melatonin and 22% of clonazepam-treated patients discontinuing treatment (p=0.43). Conclusions Melatonin and clonazepam were each reported to reduce RBD behaviors and injuries and appeared comparably effective in our naturalistic practice experience. Melatonin-treated patients reported less frequent adverse effects than those treated with clonazepam. More effective treatments that would eliminate injury potential and evidence-based treatment outcomes from prospective clinical trials for RBD are needed.

Objective: To validate a questionnaire focused on REM sleep behavior disorder (RBD) in a community-based sample. Background: RBD is a parasomnia manifested by recurrent dream enactment behavior during REM sleep. While confi rmation of RBD requires the presence of REM sleep without atonia on polysomnography (PSG), a screening measure for RBD validated in older adults would be desirable for clinical and research purposes. Methods: We had previously developed the Mayo Sleep Questionnaire (MSQ) to screen for the presence of RBD and other sleep disorders. We assessed the validity of the MSQ by comparing the responses of subjects' bed partners with the fi ndings on PSG. All subjects recruited from 10/04 to 12/08 in the Mayo Clinic Study of Aging-a population-based study of aging in Olmsted County, Minnesota-who had also undergone a previous PSG were the focus of this analysis. Results: The study sample included 128 subjects (104 male; median age 77 years [range 67-90]), with the following clinical diagnoses at baseline assessment: normal (n = 95), mild cognitive impairment (n = 30), and mild Alzheimer disease (n = 3). Nine (5%) subjects had RBD based on history and PSG evidence of REM sleep without atonia. The core question on recurrent dream enactment behavior yielded sensitivity (SN) of 100% and specifi city (SP) of 95% for the diagnosis of RBD. The profi le of responses on four additional subquestions on RBD improved specifi city. Conclusions: These data suggest that the MSQ has adequate SN and SP for the diagnosis of RBD among elderly subjects in a community-based sample. S C I E N T I F I C I N V E S T I G A T I O N SS leep disorders such as rapid eye movement (REM) sleep behavior disorder (RBD), periodic limb movements during sleep (PLMS), restless legs syndrome (RLS), sleepwalking (SW), obstructive sleep apnea (OSA), sleep related leg cramps (SRLC), and insomnia can result in adverse effects on mood, cognitive functioning, and quality of life, especially in those with a neurological disorder. Treatment of these disorders often results in improved quality of life. The presence of RBD also has diagnostic relevance in those with a neurodegenerative disease, as RBD is far more common in the synucleinopathies such as Parkinson disease, dementia with Lewy bodies, multiple system atrophy, or primary autonomic failure.1 Polysomnography (PSG) is necessary to establish the diagnoses of RBD, PLMS, and OSA, but may not be practical in some settings due to expense, limited availability, scheduling diffi culties, incomplete coverage by third-party payers, or other factors.A validated screening measure for key sleep disorders could assist in identifying patients who would benefi t from a formal sleep medicine evaluation and PSG. Such a screening measure could also be useful for research purposes, particularly in epidemiologic studies of sleep disorders. by comparing the responses of subjects' bed partners with the fi ndings on PSG in a community-based sample (n = 128). Study Impact: The core question on recurrent dream enact...

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Pathologic gambling is an impulse control disorder previously reported to complicate dopamine agonist therapy in patients with Parkinson disease. It has not been described in association with dopamine agonist therapy of other conditions. We report three patients treated in our sleep disorders center who developed pathologic gambling while receiving treatment with dopamine agonists for restless legs syndrome.

Objective: To identify the spectrum of sleep disorders associated with autoantibodies reactive with voltagegated potassium channel (VGKC) complexes.Design: Case series of all patients with neurologic disorders of VGKC autoimmunity evaluated in the Mayo Clinic Center for Sleep Medicine (Rochester, Minnesota) between Setting: Academic referral center.Patients: Fifteen consecutive patients were identified with limbic encephalitis (n=5), Morvan syndrome (n=4), and overlapping features (n = 6).Intervention: Ten patients received immunotherapy (corticosteroids, cyclophosphamide, or mycophenolate mofetil).Main Outcome Measure: Response to immunotherapy. Results:The median VGKC autoantibody value at presentation was 1.51 nmol/L (range, 0.09-4.86 nmol/L). Neoplasms were discovered in 5 patients (33%) (thy-