Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder

Abstract

We report longitudinal data on a group of 29 male patients 50 years of age or older who were initially diagnosed as having idiopathic REM sleep behavior disorder (RBD) after extensive polysomnographic and neurologic evaluations. Thirty-eight percent (11/29) were eventually diagnosed as having a parkinsonian disorder (presumably Parkinson's disease) at a mean interval of 3.7 +/- 1.4 (SD) years after the diagnosis of RBD+, and at a mean interval of 12.7 +/- 7.3 years after the onset of RBD. To date, only 7% (2/29) of patients have developed any other neurologic disorder. At the time of RBD diagnosis, data from the RBD group with eventual Parkinson's disease (n = 11) and the current idiopathic RBD group (n = 16) were indistinguishable, with two exceptions: the RBD-Parkinson's disease group had a significantly elevated hourly index of periodic limb movements of non-REM sleep and an elevated REM sleep percentage. RBD was fully or substantially controlled with nightly clonazepam treatment in 89% (24/27) of patients in both groups. Thus, RBD can be the heralding manifestation of Parkinson's disease in a substantial subgroup of older male RBD patients. However, a number of presumed Parkinson's disease patients may eventually be diagnosed with multiple system atrophy (striatonigral degeneration subtype). Our findings indicate the importance of serial neurologic evaluations after RBD is diagnosed and implicate the pedunculopontine nucleus as a likely site of pathology in combined RBD-Parkinson's disease, based on experimental and theoretical considerations rather than on autopsy data.

Epidemiology and etiology of Parkinson’s disease: a review of the evidence

“…Imaging and autopsy studies suggest an association with neuropathological changes in the brainstem, such as neuronal loss and Lewy bodies in the locus coeruleus and the substantia nigra [520]. In a case series of 29 patients with RBD, 11 (38%) were diagnosed with PD about 13 years after the onset of RBD symptoms [521]. Another study reported that of 44 RBD patients followed prospectively, 9…”

Sleep stability and transitions in patients with idiopathic REM sleep behavior disorder and patients with Parkinson's disease

“…RBD is closely associated with PD (Munhoz and Teive, 2014), and patients suffering from idiopathic RBD (iRBD) are at great risk of subsequently developing Parkinsonism or dementia (Schenck et al, 2013(Schenck et al, , 2003(Schenck et al, , 1996. Several studies have focused on analysis of sleep data in the search for PD biomarkers (Dos Santos et al, 2014).…”

Impaired GABA and Glycine Transmission Triggers Cardinal Features of Rapid Eye Movement Sleep Behavior Disorder in Mice

“…First, REM motor activation and repetitive NREM muscle jerks disrupt sleep continuity, and violent dream enactment often results in bodily injuries-lacerations, fractures, and hospital visits are common in RBD (Schenck et al, 1986). Second, a majority of RBD patients develop Parkinson's, multiple system atrophy, or dementia with Lewy bodies within 12 years of initial diagnosis (Schenck et al, 1996;Iranzo et al, 2006). RBD is therefore a harbinger of neurodegenerative disease, particularly those stemming from synucleinopathies.…”