Background Dream content alterations in Parkinson's disease (PD) are associated with motor and cognitive dysfunction cross‐sectionally. Although recent studies suggest abnormal dream content in PD might also predict cognitive decline, the relationship between dream content and motor decline in PD remains unknown. Objective To investigate whether abnormal dream content in PD predicts both motor and cognitive decline. Methods Data were obtained from the Parkinson's Progression Markers Initiative cohort study. Patients were evaluated at baseline and at the 60‐month follow‐up, with validated clinical scales, including the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), Montreal Cognitive Assessment (MoCA), and the Movement Disorder Society–Unified Parkinson's Disease Rating Scale Part III (MDS‐UPDRS III). Patients were dichotomized using RBDSQ item 2, which inquires whether they frequently experience aggression in their dreams. Regression analyses were used to assess whether frequent aggressive dreams at baseline predicted longitudinal changes in MDS‐UPDRS III and MoCA scores as well as progression to Hoehn and Yahr stage 3 (H&Y ≥ 3) and cognitive impairment. Results Of the patients, 58/224 (25.9%) reported frequent aggressive dreams at baseline. Aggressive dreams predicted a faster increase in MDS‐UPDRS III scores (β = 4.64; P = 0.007) and a faster decrease in MoCA scores (β = −1.49; P = 0.001). Furthermore, they conferred a 6‐fold and 2‐fold risk for progressing to H&Y ≥ 3 (odds ratio [OR] = 5.82; P = 0.005) and cognitive impairment (OR, 2.35; P = 0.023) within 60 months. These associations remained robust when adjusting for potential confounders. Conclusions This study demonstrates for the first time that frequent aggressive dreams in newly diagnosed PD may independently predict early motor and cognitive decline.
Study Objectives Parkinson’s disease (PD) is associated with abnormalities of sleep macro- and microstructure as measured using polysomnography (PSG). Whether these abnormalities precede the development of PD is unknown. This study investigated the association between PSG measured sleep abnormalities in older adults and the risk of incident PD. Methods 2,770 men from the ancillary sleep study of the Osteoporotic Fractures in Men Study (MrOS), a population-based cohort from the USA, who were free from PD baseline and underwent overnight PSG, were included in this longitudinal analysis. Incident PD was based on a clinical diagnosis from a medical professional. Multivariable logistic regression was used to estimate odds ratios (OR) for incident PD by quartiles of PSG measures, with adjustment for sociodemographic characteristics, medical comorbidities, and lifestyle factors. Results During a median follow-up of 9.8 years, 70 (2.5%) cases of incident PD were identified. Longer total sleep time, lower rapid eye movement sleep (REM) percentage, a lower α/θ ratio during non-REM sleep and higher minimum oxygen saturations during REM sleep, were each associated with an increased risk of developing PD. Conversely, a higher awakening index was associated with a decreased risk of developing PD. The OR for the highest risk quartiles compared to the lowest risk quartiles, ranged from 2.1 to 3.7 (P’s < 0.05). The associations remained significant when cases occurring within the first two years of follow-up were excluded from the analyses. Conclusions Macro- and microstructural sleep abnormalities precede the development of PD by several years and can identify individuals at high risk of developing PD in the future.
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