REM Sleep Without Atonia and Gait Impairment in People with Mild-to-Moderate Parkinson’s Disease

Abstract

Background: Subtle gait deficits can be seen in people with idiopathic rapid eye movement (REM) sleep behavior disorder (RBD), a prodromal stage of Parkinson’s disease (PD) and related alpha-synucleinopathies. It is unknown if the presence and level of REM sleep without atonia (RSWA, the electromyographic hallmark of RBD) is related to the severity of gait disturbances in people with PD. Objective: We hypothesized that gait disturbances in people with mild to moderate PD would be greater in participants with RSWA compared to those without RSWA and matched controls, and that gait impairment would correlate with measures of RSWA. Methods: Spatiotemporal characteristics of gait were obtained from 41 people with PD and 21 age-matched controls. Overnight sleep studies were used to quantify muscle activity during REM sleep and group participants with PD into those with RSWA (PD-RSWA+, n = 22) and normal REM sleep muscle tone (PD-RSWA-, n = 19). Gait characteristics were compared between groups and correlated to RSWA. Results: The PD-RSWA+ group demonstrated significantly reduced gait speed and step lengths and increased stance and double support times compared to controls, and decreased speed and cadence and increased stride velocity variability compared to PD-RSWA- group. Larger RSWA scores were correlated with worse gait impairment in the PD group. Conclusion: The presence and level of muscle tone during REM sleep is associated with the severity of gait disturbances in PD. Pathophysiological processes contributing to disordered gait may occur earlier and/or progress more rapidly in people with PD and RBD.

Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson's Disease

“…They are also at a higher risk of non-motor symptoms, including constipation, hallucination, depression, and cognitive impairment [ 93 - 97 ]. All of these factors make RBD patients have a relatively lower QOL, and emphasize the importance of controlling RBD in PD patients [ 98 ].…”

Early detection of diseases causing dementia using digital navigation and gait measures: A systematic review of evidence

“…The most frequently encountered measure in the pace subdomain was gait speed (n = 39), found to discriminate between individuals at risk of developing dementias across the spectrum (asymptomatic and symptomatic at risk of AD, symptomatic at risk of AD/FTD, asymptomatic and symptomatic at risk of dementia, asymptomatic at risk of DLB, symptomatic at risk of PDD and symptomatic at risk of VaD/DLB) and their respective control groups. 14,[23][24][25][26]80,87,88,91,96,98,101,105,106,[108][109][110]117,133,[135][136][137][138][139][140][141][142]144,145,147,150 In the only study that compared individuals across the preclinical and prodromal stages of different diseases, two pace measures, namely, gait speed and step length, were shown to differentiate symptomatic individuals who progressed to VaD/DLB from those who progressed to AD/FTD. 23 In the rhythm subdomain, the most common measures were cadence (n = 4), double support time (n = 4), swing time (n = 4), stance time (n = 3), and step time (n = 3).…”

“…Most studies investigated gait in association with risk of AD (n = 35), 26,27, DLB (n = 16), 11,28,[30][31][32][113][114][115][116][117][118][119][120][121][122][123] and PDD (n = 9). 13,24,[124][125][126][127][128][129][130] Very few studies were conducted in relation to FTD (n = 1) or VaD (n = 2) risk, with one combining asymptomatic and symptomatic individuals who progressed to FTD with those who later developed AD (AD/FTD group), and asymptomatic and symptomatic cases of future VaD with individuals who later progressed to DLB diagnosis (VaD/DLB group), as the two groups in each pair were similar in their gait characteristics. 23,131 Finally, 22 studies utilized the term "dementia," combining different dementia etiologies.…”

Multimodal Imaging of Substantia Nigra in Parkinson's Disease with Levodopa‐Induced Dyskinesia

“…In the patients with PD, we defined the "more affected side" of the SN and putamen as the side contralateral to the more affected body side, ie, the side that exhibited higher MDS-UPDRS Part III (items 3.3-3.8 and 3.15-3.17) scores in the medication off state. 29,30 We used only the QSM, NM values of the "more affected side" of the SNpc, the values of diffusion metrics of the "more affected side" of the pSN, and the FC between ipsilateral SNpc and the putamen of the "more affected side" in PD. The mean values of these metrics of the bilateral SNpc and pSN were analyzed in HCs.…”