Factors related to clinically probable REM sleep behavior disorder in Parkinson disease

https://doi.org/10.1016/j.parkreldis.2009.08.005Get rights and content

Abstract

Rapid eye movement sleep behavior disorder (RBD) is commonly accompanied in Parkinson disease (PD). However, the underlying mechanism linking RBD to PD remains unclear. We interviewed and examined 447 consecutive patients with PD to investigate factors associated with the presence of RBD in PD patients. Using the minimal diagnostic criteria for parasomnias provided in the International Classification of Sleep Disorders-Revised (ICSD-R), 164 patients (36.5%) were diagnosed with clinically probable RBD (cpRBD). PD patients with cpRBD were older, had a longer duration of PD, a more severe level of disability, a longer duration of antiparkinsonian medication, and a lower proportion of their Unified Parkinson Disease Rating Scale (UPDRS) scores accounted for by tremor than those without RBD. Multivariate and univariate logistic regression analyses revealed that patient age, PD symptom duration (and, accordingly, more severe motor disability), tremor score, and proportion of the UPDRS score accounted for by tremor were significant factors associated with the presence of RBD in PD patients. The results of the present study support previous observations that PD with RBD may result from a different underlying pattern of neurodegeneration than PD without RBD.

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Subjects and methods

The study subjects included 447 consecutive patients with PD (mean age, 63.8 ± 9.2 yrs; 207 men and 240 women) who visited our hospital from March 1 to June 30, 2007. All subjects gave their written informed consent to participate in this study after a full explanation of the purpose and a detailed description of the study procedures. This study was approved by the Institutional Review Board of our hospital. All PD diagnoses were made according to the United Kingdom Brain Bank criteria [16].

All

Results

During face-to-face interviews, 164 of 447 PD patients (36.7%) were diagnosed with cpRBD. RLS was diagnosed in 73 patients (16.3%). The demographic characteristics of the patients are shown in Table 1. Patients with cpRBD were older, had a longer duration of PD symptoms, more severe PD disability as assessed by either Hoehn and Yahr stage or UPDRS, higher bradykinesia and axial/gait scores, a lower proportion of their UPDRS score accounted for by tremor, and a longer duration of

Discussion

The present study used the minimal diagnostic criteria for parasomnias provided in the ICSD-R, which includes the presence of limb or body movements associated with dream mentation, and at least one of the following criteria: harmful or potentially harmful sleep behaviors, dreams appearing to be “acted out”, and sleep behaviors disrupting sleep continuity [17]. The latest version of ICSD criteria has added polysomnography (PSG) recording as a mandatory criteria, because PSG is the only method

Acknowledgement

This research was supported by the Brain Korea 21 Project for Medical Science, Yonsei University.

References (27)

  • J.F. Gagnon et al.

    REM sleep behavior disorder and REM sleep without atonia in Parkinson's disease

    Neurology

    (2002)
  • E. Sinforiani et al.

    REM sleep behavior disorder, hallucinations, and cognitive impairment in Parkinson's disease

    Mov Disord

    (2006)
  • M. Vendette et al.

    REM sleep behavior disorder predicts cognitive impairment in Parkinson disease without dementia

    Neurology

    (2007)
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    The review of this paper was entirely handled by an Associate Editor, En-King Tan.

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