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