Abstract
BackgroundIncreasing evidence provides a clear association between rapid eye movement sleep behavior disorders (RBD) and Parkinson’s disease (PD), but the clinical features that determine the co-morbidity of RBD and PD are not yet fully understood.MethodsWe evaluated the characteristics of nocturnal disturbances and other motor and non-motor features related to RBD in patients with PD and the impact of RBD on their quality of life. Probable RBD (pRBD) was evaluated using the Japanese version of the RBD screening questionnaire (RBDSQ-J).ResultsA significantly higher frequency of pRBD was observed in PD patients than in the controls (RBDSQ-J ≥ 5 or ≥ 6: 29.0% vs. 8.6%; 17.2% vs. 2.2%, respectively). After excluding restless legs syndrome and snorers in the PD patients, the pRBD group (RBDSQ-J≥5) showed higher scores compared with the non-pRBD group on the Parkinson’s disease sleep scale-2 (PDSS-2) total and three-domain scores. Early morning dystonia was more frequent in the pRBD group. The Parkinson’s Disease Questionnaire (PDQ-39) domain scores for cognition and emotional well-being were higher in the patients with pRBD than in the patients without pRBD. There were no differences between these two groups with respect to the clinical subtype, disease severity or motor function. When using a cut-off of RBDSQ-J = 6, a similar trend was observed for the PDSS-2 and PDQ-39 scores. Patients with PD and pRBD had frequent sleep onset insomnia, distressing dreams and hallucinations. The stepwise linear regression analysis showed that the PDSS-2 domain “motor symptoms at night”, particularly the PDSS sub-item 6 “distressing dreams”, was the only predictor of RBDSQ-J in PD.ConclusionOur results indicate a significant impact of RBD co-morbidity on night-time disturbances and quality of life in PD, particularly on cognition and emotional well-being. RBDSQ may be a useful tool for not only screening RBD in PD patients but also predicting diffuse and complex clinical PD phenotypes associated with RBD, cognitive impairment and hallucinations.
Highlights
Increasing evidence provides a clear association between rapid eye movement sleep behavior disorders (RBD) and Parkinson’s disease (PD), but the clinical features that determine the co-morbidity of RBD and PD are not yet fully understood
The PD patients exhibited a significant increase in the frequency of Probable RBD (pRBD) compared with the controls (RBDSQ-J ≥ 5 or ≥ 6: 29.0% vs. 8.6%; 17.2% vs. 2.2%, respectively)
The Epworth sleepiness scale (ESS), Beck Depression Inventory (BDI)-II and Parkinson fatigue scale (PFS) scores were significantly different in the PD patients compared with the controls, and the mean Parkinson’s disease sleep scale-2 (PDSS-2) total and domain scores in the PD patients were higher than in the controls
Summary
Increasing evidence provides a clear association between rapid eye movement sleep behavior disorders (RBD) and Parkinson’s disease (PD), but the clinical features that determine the co-morbidity of RBD and PD are not yet fully understood. The Braak staging system for PD [10], which is based on the temporal sequence of alpha synuclein pathology, shows that pathologic changes begin in the medulla and olfactory bulb (stage 1) and ascend to the rostral regions (stage 2), including the sublaterodorsal nucleus, magnocellular reticular formation and peri-locus coeruleus structures, which are associated with RBD [11]; the changes reach the midbrain (stage 3) and eventually the cortical structures (stages 4 and 5) This staging may help explain how RBD can precede parkinsonism and cognitive decline in PD; whether RBD and PD co-morbidity results in more severe or extensive brain involvement than PD alone remains unknown, and whether differences exist between these two groups (RBD and non-RBD groups) in disease severity and motor score is still controversial [6,9,12,13,14,15,16]. Despite a number of studies that have evaluated daytime motor and non-motor features of RBD in PD, the characteristics of RBD-mediated nocturnal problems remain poorly studied in PD patients
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