Brief CommunicationRelation between subtype of Parkinson’s disease and REM sleep behavior disorder☆
Introduction
Parkinson’s disease (PD) has been classified into different clinical subtypes depending upon the predominance of the various cardinal symptoms of the disease. Several studies suggest that the different subtypes may have different patterns of disease progression: whereas motor function deteriorates more rapidly in cases with predominant akinesia and rigidity, it has a more benign course in tremor-predominant cases [1], [2], [3]. A different neuropathological substrate for these subtypes of PD has also been described [4]. In addition, patients with predominant tremor have been reported to have less depression and cognitive deterioration. The incidence of other non-motor symptoms such as sleep disorders, including rapid eye movement (REM) sleep behavior disorder (RBD), in patients with the tremor-predominant and non-tremor-predominant forms of PD has not been documented. We have looked here at RBD, a parasomnia that is frequently observed in PD [5].
Section snippets
Methods
Consecutive PD patients seen at the movement disorders clinic of our institution, with clinically suspected RBD confirmed by audiovisual-polysomnography (PSG), were included in this study. Diagnosis of PD was made according to UK Brain Bank criteria [6]. Diagnosis of RBD in all the patients required not only a long-standing history of vigorous sleep behavior, but also the following: (1) audiovisual-PSG confirmation of abnormal motor behaviors during REM sleep and (2) evidence for tonic and/or
Results
There were 65 PD patients (46 men and 19 women; mean age 65.8 ± 7.5), with a mean age at onset of parkinsonism of 56.1 ± 9.6 years and a mean PD duration of 9.6 ± 6 years (Table 1). The mean age of reported onset of RBD was 61.7 ± 7.8 years, with a mean duration of 4.9 ± 6.5 years. Fifty-four had the non-tremor-predominant type of PD (83%), seven had the tremor-predominant type (10.8%), and in the remaining four patients (6.2%) the subtype could not be determined due to insufficient data. Therefore, for
Discussion
We have shown in this study that (1) most PD patients diagnosed with RBD in our sleep laboratory had the non-tremor-predominant form of PD, and in 20.4% of these patients RBD preceded the onset of the waking motor symptoms; (2) when RBD occurred in the tremor-predominant type of PD, it took longer to appear than in the non-tremor-predominant form and it did not precede parkinsonism; and (3) regardless of PD subtype, RBD in our patients preceded parkinsonism only when the motor symptoms of the
Acknowledgements
This project was supported by Grant 2001SRG00387 Generalitad de Catalunya, Spain, by the award “Distinció per la promoció de la Recerca Universitaria Generalitat de Catalunya”, Spain and by Red CIEN IDIBAPS-ISCIII RTIC C03/06 to Dr. Tolosa.
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2018, Sleep MedicineCitation Excerpt :PD patients with RBD tend to be older aged males with long disease duration, although none of these factors had a significant difference [35]. PD patients with RBD tend to be non-tremor-dominant motor subtype or a kinetic-rigid motor phenotype [36–38]. However, reports of difference of HY stage [36,39], fall and freezing [36,40,41] are not always uniform.
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This work has not received financial support and includes no descriptions of off-label or investigational use of any drugs or devices.