REM sleep behaviour disorder in Parkinson?s disease: a questionnaire-based study

Abstract

The aim of the study was to determine the clinical frequency and features of REM sleep behaviour disorder (RBD) in a large population of Parkinson's disease (PD) patients using defined diagnostic criteria both for RBD and PD. Six trained neurologists used a semistructured questionnaire based on ICSD-R diagnostic criteria for RBD to evaluate 200 PD patients and their caregivers. Interobserver reliability for the diagnosis of RBD was "substantial" (Kappa 0.65). Five patients were excluded from the study because of an MMSE lower than 25. The demographic and PD clinical features were compared in the clinically defined RBD group and in those without RBD (NRBD). Then the RBD features during the last year were analysed in the affected group. Out of 195 patients, 66 fulfilled the ICSD-R criteria for RBD; 62 patients reported RBD during the last year (frequency 31.8%). RBD features: two or more episodes per week in 35.5%; upper limb movements in 87%; lower limb movements in 79%; vocalisations during events in 85%. RBD onset was before PD in 27% of patients; 69% of the RBD group had injured themselves or their caregivers during sleep. According to multivariate analysis, RBD was associated with male gender, age and PD duration. Brief training and the use of a semistructured questionnaire may help the neurologist in dealing with sleep disturbances in PD patients. The search for RBD symptoms in PD is highly recommended, especially in patients with a long disease duration, the risk of sleep-related injuries being high.

Estrogen Actions in the Brain and the Basis for Differential Action in Men and Women: A Case for Sex-Specific Medicines

“…The precise implications of this observation are unclear, but they emphasize underlying sex differences in neurotransmission and could possibly indicate sex differences in adaptive responses, which are known to be very powerful during the early stages of PD (Bezard et al, 2003). There are also clear indicators of sex differences in the profiles and severity of PD symptoms as well as outcomes of pharmacological and surgical treatments, with implications for clinical management (Lyons et al, 1998;Fernandez et al, 2000;Rojo et al, 2003;Scaglione et al, 2005;Shulman and Bhat, 2006;Gillies and McArthur, 2010). In women, for example, PD is associated with a later onset, greater frequency of presentation with a tremor-dominant form of disease, and a slower progression compared with men (Shulman and Bhat, 2006;Haaxma et al, 2007).…”

Effects of gender on nigral gene expression and parkinson disease

“…Gender also influences the clinical features of the disease after onset, with females exhibiting more impairment of postural stability, depression, and reduced ability to conduct daily activities (Haaxma et al, 2006;Lyons et al, 1998;Rojo et al, 2003;Uitti et al, 2005). In contrast, men are more likely to exhibit REM behavior disorders and other sleep disturbances (Scaglione et al, 2005). Gender also interacts with other risk factors, attenuating the protective effect of caffeine in women (Ascherio et al, 2003) and altering the relationship between cigarette smoking, alleles of MAO B, and risk for PD (Kelada et al, 2002).…”

Sleepwalking in Parkinson’s disease: a questionnaire-based survey

“…In two series of patients with REM sleep behavior disorder (RBD) and PD, one out of 100 consecutive patients and two of 66, respectively, had SW [8,9]. We recently described SW in six out of 165 consecutive patients in a retrospective case series [10].…”

“…In questionnaire-based studies asking for sleepwalking/nighttime wandering in PD patients, frequencies ranging from 2% (4/201) [13], 3% (2/61, resp. 2/66) [9,14] to 5% (16/303) [15] can be found in the literature, however, no detailed characteristics of the phenomenon were studied. The aim of the present study was to assess frequency and characteristics of SW/nighttime wandering in patients with PD.…”