Clinical features of Parkinson’s disease with and without rapid eye movement sleep behavior disorder

Abstract

BackgroundRapid eye movement sleep behavior disorder (RBD) and Parkinson’s disease (PD) are two distinct clinical diseases but they share some common pathological and anatomical characteristics. This study aims to confirm the clinical features of RBD in Chinese PD patients.MethodsOne hundred fifty PD patients were enrolled from the Parkinson`s disease and Movement Disorders Center in Department of Neurology, Shanghai General Hospital from January 2013 to August 2014. This study examined PD patients with or without RBD as determined by the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), assessed motor subtype by Unified PD Rating Scale (UPDRS) III at “on” state, and compared the sub-scale scores representing tremor, rigidity, appendicular and axial. Investigators also assessed the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Parkinson’s disease Sleep Scale (PDSS).ResultsOne hundred fourty one PD patients entered the final study. 30 (21.28%) PD patients had probable RBD (pRBD) diagnosed with a RBDSQ score of 6 or above. There were no significant differences for age, including age of PD onset and PD duration, gender, smoking status, alcohol or coffee use, presence of anosmia or freezing, UPDRS III, and H-Y stages between the pRBD+ and pRBD− groups. pRBD+ group had lower MMSE scores, higher PDSS scores, and pRBD+ PD patients had more prominent proportion in anxiety, depression, constipation, hallucination and a greater prevalence of orthostatic hypotension.ConclusionpRBD+ PD patients exhibited greater changes in non-motor symptoms. However, there was no increase in motor deficits.

Orthostatic hypotension and REM sleep behaviour disorder: impact on clinical outcomes in α-synucleinopathies

“…Out of the 2601 records derived from the initial search strategy, 101 studies met full eligibility criteria and underwent data extraction10–14 18–36 [s10-s86] : 41 focused on OH; 43 on RBD; three on both OH and RBD and 14 on the association between OH and RBD (online supplementary figures 1-3).…”

“…[s51-s59] An autopsy series showed an association between RBD and more aggressive progression of dementia and hallucinations in DLB. [s60] Negative data were reported in one longitudinal [s61] and seven cross-sectional studies in PD,29 30 [s62-s66] and one longitudinal study in DLB (online supplementary table 4). [s67]…”

“…Postural stability and falls . One longitudinal [s31] and four cross-sectional studies showed that RBD is associated with falls28 [s63, s68] and postural instability [s66] in PD, whereas two longitudinal and five cross-sectional studies, all based on clinical questionnaires,27 29 30 [s69-s72] yielded negative results (online supplementary table 5).…”

Freezing of gait in Parkinson’s disease: pathophysiology, risk factors and treatments

“…Although gait disorders have been found in polysomnographyconfirmed RBD patients [46,47] and it was hypothesized that FOG and RBD might share a common physiopathology [48], the relationship between RBD and FOG was not confirmed [16,18,24]. In other two studies, RBDSQ at baseline didn't show significant difference between transitional freezers and non-freezers [18,24], which was supported by a previous finding that there was no freezing difference between the patients with probable RBD and without RBD [49]. Other studies explored the relationship of insomnia or daytime sleepiness with FOG.…”

Obstructive Sleep Apnea in Neurodegenerative Disorders: Current Evidence in Support of Benefit from Sleep Apnea Treatment

“…Motor manifestations in PD with RBD seem to differ from PD without RBD, exhibiting a non-tremor predominant phenotype and perhaps more postural instability and falls [168,[176][177][178][179][180]. In most studies, a combination of RBD and PD is associated with more excessive daytime sleepiness, worse performance on neurocognitive screening tests (MMSE and MOCA), and impairments in specific neurocognitive domains, especially attention and vigilance, executive functions, and memory impairments [37,[181][182][183][184]. This is supported by one study showing that 63% of patients with PD and RBD had mild cognitive impairment (MCI) as opposed to 33% with isolated PD and 33% with idiopathic RBD [183].…”