Abstract
Background: The prevalence of dream enactment behavior and other risk factors for a parkinsonian disorder is not well documented. Methods: A survey on prevalence of parkinsonism risk factors was designed using two validated instruments (REM behavior disorder single item question, bowel movement frequency for constipation) and three exploratory instruments (for hallucinations, cognitive and olfactory complaints.) It was sent by mail and email to patients aged 50 and over at two University of Utah community clinics in Salt Lake City. A total of 7888 unique patients were sent the survey, and 1607 responses were recorded (response rate 20%). Those whose age was missing (n = 117) or less than 50 years (n = 10) were excluded from the analysis. Results: Of the 1406 without personal diagnosis of neurodegenerative disease 62.7% were female, and median age was 63. Family history (FH) of Parkinson’s disease was endorsed by 9%, constipation (defined as a bowel movement less than once per day) by 19%, mild cognitive complaints (MCI) 15.8%, dream enactment 13.7%, subjective hyposmia or anosmia 18.2%, and at least one potential psychotic symptom in 37.6%. Multivariable logistic regression showed male gender, mild cognitive complaints, hearing voices, and at least one potentially psychotic symptom to be significantly associated with dream enactment. Conclusions: This survey shows that dream enactment, a strong predictor of risk for synucleinopathy, is relatively common in the older population; because such individuals rarely come to medical attention of a sleep clinic, such survey research may be useful to identify and recruit at-risk individuals for trials aimed at preventing neurodegenerative disease.
Highlights
Dementia with Lewy bodies (DLB) and Parkinson’s disease (PD) dementia, collectively known as Lewy body dementia (LBD), are the leading causes of neurodegenerative parkinsonism and the second-leading cause of age-associated neurodegenerative dementia [1,2]
Dream enactment was assessed using a validated single item question for probable RBD, [16] constipation with a bowel movement frequency question adapted from a validated instrument, [17] and potential psychotic symptoms with questions modeled from a validated instrument for PD psychosis, mild cognitive complaints (MCI), and anosmia with novel questions
When we combined all predictors, male gender, mild cognitive complaints, and psychotic symptoms were associated with RBD
Summary
Dementia with Lewy bodies (DLB) and Parkinson’s disease (PD) dementia, collectively known as Lewy body dementia (LBD), are the leading causes of neurodegenerative parkinsonism and the second-leading cause of age-associated neurodegenerative dementia [1,2]. Robust clinical and epidemiological evidence has shown idiopathic REM sleep behavior disorder (iRBD) to be the strongest known clinical predictor of neurodegenerative alpha-synucleinopathy (DLB, PD, or multiple system atrophy), LBD [3,4,5]. This parasomnia, characterized by dream enactment behavior with loss of REM-related muscle atonia, has been associated with an 80–91%. Methods: A survey on prevalence of parkinsonism risk factors was designed using two validated instruments (REM behavior disorder single item question, bowel movement frequency for constipation) and three exploratory instruments (for hallucinations, cognitive and olfactory complaints.) It was sent by mail and email to patients aged 50 and over at two University of Utah community clinics in Salt Lake City. Conclusions: This survey shows that dream enactment, a strong predictor of risk for synucleinopathy, is relatively common in the older population; because such individuals rarely come to medical attention of a sleep clinic, such survey research may be useful to identify and recruit at-risk individuals for trials aimed at preventing neurodegenerative disease
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