REM Sleep Behavior Disorder and REM Sleep Without Atonia in Probable Alzheimer Disease

Gagnon, Jean‐François; Petit, Dominique; Fantini, María Livia; Rompré, Sylvie; Gauthier, Serge; Panisset, Michel; Robillard, Alain; Montplaisir, Jacques

doi:10.1093/sleep/29.10.1321

Cited by 128 publications

(74 citation statements)

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“…The results range from sustained benefit without dose escalation to others with a high incidence of dose escalation and treatment failure [138,216,[237][238][239]. In 1 series, 58% of patients on clonazepam reported clinically significant adverse effects with 50% either stopping the agent or reducing the dose [239].…”

Section: Clonazepammentioning

confidence: 99%

Parasomnias: An Updated Review

2012

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Parasomnias are abnormal behaviors emanating from or associated with sleep. Sleepwalking and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, or promote sleep inertia lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after an arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications; in particular, the widely prescribed benzodiazepine receptor agonists. Recently, compelling evidence suggests that nocturnal eating may in some cases be a nonmotor manifestation of Restless Legs Syndrome (RLS). rapid eye movement (REM) Sleep Behavior Disorder (RBD) is characterized by a loss of REM paralysis leading to potentially injurious dream enactment. The loss of atonia in RBD often predates the development of Parkinson's disease and other disorders of synuclein pathology. Parasomnia behaviors are related to an activation (in NREM parasomnias) or a disinhibition (in RBD) of central pattern generators (CPGs). Initial management should focus on decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders. Clonazepam and melatonin appear to be effective therapies in RBD, whereas paroxetine has been reported effective in some cases of sleep terrors. At this point, pharmacotherapy for other parasomnias is less certain, and further investigations are necessary.Keywords Parasomnia . Sleepwalking . Sleep terrors . REM sleep behavior disorder . Restless legs syndrome Classification of ParasomniasParasomnias are typically classified by the sleep state from which they arise: non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM) (see Table 1 NREM parasomnias include: confusional arousals, sleepwalking disorder, and sleep terrors. These behaviors arise when the cortex incompletely arouses from deep NREM sleep, often due to comorbid conditions that provoke repeated arousal or promote sleep inertia. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking and related disorders [3].Sleep-related eating disorder (SRED) is currently classified in the International Classification of Sleep Disorders, 2nd edition (ICSD-2) under "Other Parasomnia" [1]. However the vast majority of SRED cases emanate from NREM [4], and the complex amnestic behaviors with ambulation are striking similar to sleepwalking [5]. Furthermore, both SRED and sleepwalking are frequently triggered by sedating agents in the setting of underlying motor restlessness [6]. Thus, considering these similarities, SRED will be reviewed immediately after NREM parasomnias.REM sleep behavior disorder is the most clinically relevant REM parasomnia. The loss of atoni...

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Section: Clonazepammentioning

confidence: 99%

Parasomnias: An Updated Review

2012

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“…However, RBD occurs in 40-60% of PD patients [5], and 80% or more of patients with idiopathic RBD eventually develop PD or DLB [3][4][5][6][7]. Likewise, almost all patients with MSA, a synucleinopathy, have RBD, whereas the presence of RBD in degenerative diseases such as supranuclear palsy [42] and Alzheimer's disease [43] is extremely rare. RBD with PD tends to occur in males [4,44], in agreement with the prevalence of PD in males [45]; research on the possibility of gender-related effects on synucleinopathies underlying RBD pathology is needed to clarify this association.…”

Section: Rbd and Neurodegenerative Disordersmentioning

confidence: 99%

Rapid-Eye-Movement Sleep Behavior Disorder

Schenck

Mahowald

2019

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Rapid eye movement (REM) sleep behavior disorder (RBD) is a failure of the circuitry regulating motor atonia during REM sleep. In REM sleep, neurons of the sublaterodorsal tegmental nucleus (SLD) project to interneurons in the ventromedial medulla (VMM) and spinal cord that in turn inhibit spinal motoneurons. In RBD, degeneration of this circuitry disinhibits phasic motor commands originating from motor generators. The resulting behavior ranges from simple twitches or jerks to complex behavior. Simple behaviors in RBD may originate from cortical, brainstem and spinal cord motor generators, while complex behavior may originate from cortical motor generators, possibly related to dream content in REM sleep. While RBD can occur idiopathically, it is usually comorbid with or a precursor to a synucleinopathy such as Parkinson's disease (PD). RBD can precede the onset of PD by decades, suggesting a an underlying pathology that can progressively afflict REM atonia and midbrain dopaminergic centers. The relative recovery of motor function during REM sleep in some cases of PD with RBD emphasizes the complexity of motor pathway control during wakefulness and REM sleep.

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“…There are several timely articles are there to get an deep insight into the pathophysiology of sleeping disturbance in PD. Chronologically, studies by Factor et al is the pioneer work relating PD pathology with sleep disturbance [148] while, Gagnon and colleagues have highlighted the REM sleep behaviors in PD [149].…”

Section: Sleeping Disturbancementioning

confidence: 99%

Cognitive and Psychological Anomalies in Parkinsons Disease: An Insight into Non-Motor Characteristic Features

Choudhury¹,

Rao²,

R³

et al. 2017

Neuropsychiatry

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While most of the clinical concerns for Parkinson's disease (PD) are limited to the cardinal motor abnormalities, non-motor features like cognitive and psychological anomalies are also acquired ample of importance in last few decades. Progressive research has showcased several obvious incidences of cognitive and psychological anomalies in the pathophysiology of PD. It has been reported that, almost 30% PD sufferers show different degree of cognitive impairment but lack of awareness or negligence makes it difficult to diagnose it, at the initial stage of the disease. As a result, cognitive and psychological impairments continue to increases progressively and deteriorate the quality of life of the patient. It is presumable that, early detection of PD can be achieved by the identification of specific set of cognitive and psychological anomalies and the similar scope might open up new avenue in the non-invasive diagnosis of PD. In the present review, we have accumulated all the timely documentation on cognitive and psychological anomalies in PD and highlighted most of the non-motor features with rational justification for the relevance of their study in the early diagnosis of PD.

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REM Sleep Behavior Disorder and REM Sleep Without Atonia in Probable Alzheimer Disease

Abstract: RBD is rare, but REM sleep without atonia is relatively fre-quent in patients with probable Alzheimer disease, a tauopathy.

Cited by 128 publications

References 0 publications

Parasomnias: An Updated Review

Parasomnias: An Updated Review

Rapid-Eye-Movement Sleep Behavior Disorder

Cognitive and Psychological Anomalies in Parkinsons Disease: An Insight into Non-Motor Characteristic Features

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