Clinical features of 35 patients with Parkinson's disease displaying REM behavior disorder

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Abstract

Objective:

To assess and compare the disease severity, the treatment properties and the frequency of motor complications in the patients with Parkinson's disease (PD) having and not having REM sleep behavior disorder (RBD).

Patients and methods:

Based on chart review, patients with Parkinson's disease whose bed partners have reported prominent motor activity while dreaming were identified. Standard questionnaires assessing the presence of RBD have been addressed to these patients and their informants. Obtained data fulfilled clinical diagnostic criteria of probable RBD in 35 patients (RBD group) with the mean age at symptom onset was 61.8 years. Of them 77% were men. Clinical features of these patients concerning Hoehn-Yahr stage of PD, the severity of PD according to the Unified Parkinson's disease rating scale (UPDRS), the mean dose and duration of levodopa (LD) therapy, the presence of motor complications were compared with those of gender and age at PD-onset matched 35 PD patients without RBD (NRBD group).

Results:

The mean values of PD duration, Hoehn-Yahr stage and UPDRS scores did not differ between groups. The duration of LD therapy was significantly longer in RBD group in comparison to NRBD group (6.2 years versus 3.05 years, respectively, P < 0.005) and also mean actual dose of LD was higher (460.3 mg/day versus 320.3 mg/day respectively, P < 0.02). The dose and duration of dopamine agonists did not differ between groups. In RBD group, wearing-off phenomenon was significantly common (P < 0.01), its duration was longer (P < 0.005), and LD-related dyskinesias were more frequent (P < 0.01).

Conclusion:

In the current study, when compared with NRBD group, the patients with RBD required higher doses of LD treatment at an earlier stage of PD which eventually led to motor complications. In these patients, dopaminergic treatment restored UPDRS scores, but did not prevent the occurrence of RBD.

Introduction

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of normal skeletal muscle atonia during REM sleep with prominent motor activity which may result in falling down bed as well as causing harm to bed partner while dreaming [1]. Minimal diagnostic criteria for RBD defined by the International Classification of Sleep Disorders in 1997 includes movement of limbs or body associated with dream mentation, and at least one of the following: potentially harmful sleep behaviors, dreams that appear to be “acted out”, or sleep behaviors that disrupt sleep continuity [2]. Eliciting a careful history from informants often allows identification of the disorder [3], [4]. Based on clinicopathological data, Boeve et al. reported that RBD predominantly manifests in neurodegenerative diseases including Parkinson's disease (PD) known as synucleinopathies compared with the nonsynucleinopathies [5], [6]. In the present study, the presence of probable RBD among patients with PD was investigated by using chart review and standard sleep questionnaire and their several clinical data were compared to those of without RBD.

Section snippets

Patients and methods

Among the patients with idiopathic PD admitted to our movement disorders outpatient clinic between June 2002 and February 2003, who have experienced violent or injurious behavior during sleep associated with dream mentation being harmful for themselves and/or bed partners were identified by review of the medical records. The patients who had an accompanying caregiver or informants were invited to the hospital to fill out separately a standard sleep questionnaire [7]. Generally, spouses

Results

Demographic and clinical data for patients with (n = 35) and without RBD (n = 35) were summarized in Table 1. The mean age was 67.2 ± 8.6 years in RBD group and 67.6 ± 9.2 years in NRBD group. In both groups, the mean age of symptom-onset was 61.8 ± 6.41 and 61.88 ± 8.96 years, respectively. Although the disease duration was a bit longer in the former group, the difference was not significant (7.5 years versus 5.7 years, respectively). There were not any differences for the mean values of Hoehn-Yahr stage

Discussion

In the current study, we used clinical criteria [2] for the diagnosis of RBD. Of 35 PD patients with clinically probable RBD, 77% were men. The male predominancy and older age in these patients having RBD were similar to previous reported results in which more than 85% were older men [3], [10], [11], [12], [13], [14]. As patients with idiopathic PD have an approximately equal sex ratio, the reason of male predominancy in PD patients having RBD is yet unknown [4]. We noted that duration of PD

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