Rapid eye movement sleep behavior disorder is characterized by dream enactment and complex motor behaviors during rapid eye movement sleep and rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia) during polysomnography. Rapid eye movement sleep behavior disorder may be idiopathic or symptomatic and in both settings is highly associated with synucleinopathy neurodegeneration, especially Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. Rapid eye movement sleep behavior disorder frequently manifests years to decades prior to overt motor, cognitive, or autonomic impairments as the presenting manifestation of synucleinopathy, along with other subtler prodromal "soft" signs of hyposmia, constipation, and orthostatic hypotension. Between 35% and 91.9% of patients initially diagnosed with idiopathic rapid eye movement sleep behavior disorder at a sleep center later develop a defined neurodegenerative disease. Less is known about the long-term prognosis of community-dwelling younger patients, especially women, and rapid eye movement sleep behavior disorder associated with antidepressant medications. Patients with rapid eye movement sleep behavior disorder are frequently prone to sleep-related injuries and should be treated to prevent injury with either melatonin 3-12 mg or clonazepam 0.5-2.0 mg to limit injury potential. Further evidence-based studies about rapid eye movement sleep behavior disorder are greatly needed, both to enable accurate prognostic prediction of end synucleinopathy phenotypes for individual patients and to support the application of symptomatic and neuroprotective therapies. Rapid eye movement sleep behavior disorder as a prodromal synucleinopathy represents a defined time point at which neuroprotective therapies could potentially be applied for the prevention of Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. © 2017 International Parkinson and Movement Disorder Society.

Music training may provide an effective mean of enhancing cognitive function in older adults. However, age-related differences in learning, vision and brain plasticity may limit traditional teaching methods effectiveness for older adult learners. The Maine Understanding Sensory Integration and Cognition Project aimed to develop an economical, older-adult-friendly music intervention. The current study presents the pilot data on the effect of music training on social, emotional, and cognitive function. Results, methodology, and challenges with solutions encountered during implementation of a group music intervention for older adults are reported. Community-based participatory research methods were used to enhance recruitment of socioeconomically diverse older adults and solicit participatory feedback. Thirty-five socioeconomically diverse older adults (M age ϭ 70, SD ϭ 5.12) completed the program. Participants took part in 12 weekly 1-hr recorder group lessons and underwent comprehensive pre-and postintervention neuropsychological assessments. Teaching manuals designed specifically for older adults were developed to overcome identified learning barriers in music learning. Results indicated improved executive function, global cognition, verbal fluency, and visual memory performance following the intervention, ps Ͻ .05. Participants universally reported the group provided valuable socialization and camaraderie. Subjective improvements in cognition, self-efficacy and emotional well-being as a result of participating in the music group were also found. Music training is a cognitively stimulating activity that has real-life applications. The Maine Understanding Sensory Integration and Cognition Project's manualized group intervention may provide an engaging and efficient method to enhance social and cognitive function in older adults.

Objectives: Adverse childhood experiences (ACE) are associated with an increased risk for dementia, but this relationship and modifying factors are poorly understood. This study is the first to our knowledge to comprehensively examine the effect of ACE on specific cognitive functions and measures associated with greater risk and resiliency to cognitive decline in independent community-dwelling older adults. Methods: Verbal/nonverbal intelligence, verbal memory, visual memory, and executive attention were assessed. Self-report measures examined depression, self-efficacy, and subjective cognitive concerns (SCC). The ACE questionnaire measured childhood experiences of abuse, neglect, and household dysfunction. Results: Over 56% of older adults reported an adverse childhood event. ACE scores were negatively associated with income and years of education and positively associated with depressive symptoms and SCC. ACE scores were a significant predictor of intellectual function and executive attention; however, these relationships were no longer significant after adjusting for education. Follow-up analyses using the PROCESS macro revealed that relationships among higher ACE scores with intellectual function and executive attention were mediated by education. Conclusions: Greater childhood adversity may increase vulnerability for cognitive impairment by impacting early education, socioeconomic status, and mental health. These findings have clinical implications for enhancing levels of cognitive reserve and addressing modifiable risk factors to prevent or attenuate cognitive decline in older adults.

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There has been no comparison of excessive daytime sleepiness (EDS) in patients with Alzheimer’s disease dementia (ADem), dementia with Lewy bodies (DLB) and behavioral variant frontotemporal dementia (bvFTD). We identified patients with mild dementia who met criteria for these disorders who also had the Epworth Sleepiness Scale (ESS) completed. The sample included 17 bvFTD, 111 AD and 31 DLB. An ESS score ≥10 was considered abnormal and consistent with EDS. Analyses with age and sex as covariates revealed higher mean ESS scores for DLB compared to the other groups (DLB 13.9 ± 5, bvFTD 9.6 ± 8, AD 8.8 ± 5, p<0.05). An ESS score ≥10 was significantly more likely to occur in DLB compared to bvFTD or AD (DLB 81% vs. bvFTD 47% vs. AD 45%, p<0.01). In patients with mild dementia, EDS is greatest in DLB and comparably lower in bvFTD and AD.