Abstract
Objective: REM sleep Behaviour Disorder (RBD) in Dementia with Lewy bodies (DLB) may be attributed to a decrease in dopaminergic neurotransmission. Thus, we studied the therapeutic efficacy of the pre and postsynaptic D2 and D3 receptor antagonist tiapride, which at a low dosage preferentially blocks presynaptic dopamine receptors and consequently leads to feedback activation of dopamine synthesis and to increased extracellular levels of dopamine. Methods: Six consecutive patients presenting at our memory clinic with RBD in DLB, in whom melatonin had been ineffective and clonazepam was found inappropriate for clinical reasons, were treated with triapride at dosages between 50 and 150 mg for twelve weeks. Results: Tiapride was well tolerated by all patients. Five of the six patients, reported was a decrease of the self-perceived frequency of bad dreams and the intensity and severity of motor and vocal enactments during sleep. In four of these six patients, this was also the case in the view of the patients’ bed partners. Conclusion: Tiapride may by an effective and well-tolerated treatment for RBD in patients with DLB.
Highlights
REM sleep Behaviour Disorder (RBD), a parasomnia with repeated episodes of dream-enactment behaviour [1], is frequent in neurodegenerative diseases [2], in Dementia with Lewy Bodies (DLB) [3]
The trial was performed in six consecutive patients with probable mild to moderate DLB [4] and RBD, in whom treatment with clonazepam was considered inappropriate because of the risk of falls, cognitive impairment, or sleep apnea and treatment with melatonin at dosages between 2 and 8 mg had had little or no effect
The patients were asked to score the frequency of unpleasant dreams according to Item 5 (h) of the Pittsburgh Sleep Quality Index (PSQI) [20] as either “0”, “1”, “2”, or “3” before and twelve weeks after the initiation of tiapride treatment
Summary
REM sleep Behaviour Disorder (RBD), a parasomnia with repeated episodes of dream-enactment behaviour [1], is frequent in neurodegenerative diseases [2], in Dementia with Lewy Bodies (DLB) [3]. It has been given increased diagnostic weight as a core clinical feature in the revised criteria for the clinical diagnosis of probable and possible DLB [4]. The two best established drugs for the treatment of RBD are melatonin and clonazepam [5] Both have been found to be modestly effective. The majority of the authors found modest improvements in RBD symptom severity and frequency [12 - 14], while others did not [15]
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