Quantifying the risk of Neurodegenerative Disease in Idiopathic REM sleep behavior disorder

Department of Neurology, L7-305 Montreal General Hospital, 1650 Cedar Ave., Montreal, Quebec, Canada.
Neurology (Impact Factor: 8.29). 04/2009; 72(15):1296-300. DOI: 10.1212/01.wnl.0000340980.19702.6e
Source: PubMed


Idiopathic REM sleep behavior disorder (RBD) is a potential preclinical marker for the development of neurodegenerative diseases, particularly Parkinson disease (PD) and Lewy body dementia. However, the long-term risk of developing neurodegeneration in patients with idiopathic RBD has not been established. Obtaining an accurate picture of this risk is essential for counseling patients and for development of potential neuroprotective therapies.
We conducted a follow-up study of all patients seen at the sleep disorders laboratory at the Hôpital du Sacré Coeur with a diagnosis of idiopathic RBD. Diagnoses of parkinsonism and dementia were defined according to standard criteria. Survival curves were constructed to estimate the 5-, 10-, and 12-year risk of developing neurodegenerative disease.
Of 113 patients, 93 (82%) met inclusion criteria. The mean age of participants was 65.4 years and 75 patients (80.4%) were men. Over the follow-up period, 26/93 patients developed a neurodegenerative disorder. A total of 14 patients developed PD, 7 developed Lewy body dementia, 4 developed dementia that met clinical criteria for AD, and 1 developed multiple system atrophy. The estimated 5-year risk of neurodegenerative disease was 17.7%, the 10-year risk was 40.6%, and the 12-year risk was 52.4%.
Although we have found a slightly lower risk than other reports, the risk of developing neurodegenerative disease in idiopathic REM sleep behavior disorder is substantial, with the majority of patients developing Parkinson disease and Lewy body dementia.

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Available from: Maria Livia Fantini, May 27, 2014
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    • "RBD is usually a chronic parasomnia affecting older males, but can emerge acutely, triggered by medications, drug/alcohol withdrawal states, relapsing multiple sclerosis, and severe stress. RBD is frequently reported in the synucleinopathies , such as PD, dementia with Lewy bodies (DLB), and multiple system atrophy, considered it as a marker of these diseases, than in nonsynucleinopathies , such as AD [56]. In accordance with this, clinicopathologic analyses led to the hypothesis that MCI patients with RBD very likely reflect evolving DLB. "
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    ABSTRACT: Sleep disorders are frequently reported in Alzheimer's disease (AD), with a significant impact on patients and caregivers and a major risk factor for early institutionalization. Although changes in sleep organization are a hallmark of the normal aging processes, sleep macro- and micro-architectural alterations are more evident in patients affected by AD. Degeneration of neural pathways regulating sleep-wake patterns and sleep architecture may contribute to sleep alterations. In return, several recent studies suggested that common sleep disorders may precede clinical symptoms of dementia and represent risk factors for cognitive decline, through impairment of sleep-dependent memory consolidation processes. Thus, a close relationship between sleep disorders and AD has been largely hypothesized. Here, sleep alterations in AD and its pre-dementia stage, mild cognitive impairment, and their complex interactions are reviewed.
    Journal of Alzheimer's disease: JAD 04/2015; 46(3). DOI:10.3233/JAD-150138 · 4.15 Impact Factor
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    • "This abnormal behavior result from disorder of the deep nuclei and brainstem neurons involved in the integration of the sleep–wake cycle and the locomotor system [21]. A lot of researches found a link between RBD and synucleinopathies such as Parkinson disease (PD), Lewy body dementia (LBD) and multiple system atrophy [41] [42] and are even considered to be early marker for these diseases [43]. In the consensus criteria for LBD, RBD are considered to be suggestive features of the disease [44]. "
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    ABSTRACT: Objective: Mild cognitive impaired (MCI) is viewed as a transitional stage from normal to dementia. The aim of this study is analyze the sleep disturbances in subjects diagnosed as carries MCI. Methods: A review of the literature was conducted in order to document sleeps problems in the context of MCI. Results: Among the studies that compares the prevalence of sleep disturbances between subjects with MCI and those with normal cognition demonstrated that night time behaviors are more common in MCI patients (18.3-45.5%) than in normal population (10.9-23.3%). Conclusions: Sleep disturbance is prevalent and predictive of cognitive decline in older people and in those with neurodegenerative disorders. The sleep problems have to be identified and treat to preserve the cognition and the MCI subjects with sleep disturbances have to be follow more closely to identify the initial signs of dementia.
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    • "Parkinson's disease (PD) is a neurodegenerative disorder with a multifactorial etiology, but it is primarily suggested to be due to a loss of dopaminergic function, which produces multiple neurological and psychiatric symptoms, including motor, cognitive, and emotional dysfunction. Additionally, most patients with PD experience sleep-related symptoms, including difficulty in initiating and maintaining sleep, excessive daytime sleepiness (EDS), and parasomnias such as rapid eye movement (REM) sleep behavior disorder (Kumar et al. 2002; Brotini and Gigli 2004; Postuma et al. 2009). Most studies point out that the prevalence of sleep disturbance in PD is nearly 100% (Lees et al. 1988; Kumar et al. 2002; Poryazova and Zacchariev 2005). "
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