Mild Cognitive Impairment in Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease

ArticleinAnnals of Neurology 66(1):39-47 · July 2009with9 Reads
Impact Factor: 9.98 · DOI: 10.1002/ana.21680 · Source: PubMed
Abstract

To investigate the frequency and subtypes of mild cognitive impairment (MCI) in idiopathic rapid eye movement sleep behavior disorder (RBD) and Parkinson's disease (PD) in association with RBD. One hundred and twelve subjects without dementia or major depression including 32 idiopathic RBD patients, 22 PD patients with polysomnography-confirmed RBD, 18 PD patients without RBD, and 40 healthy control subjects, underwent a comprehensive neuropsychological evaluation. We compared the proportion of patients with MCI between groups using standard diagnostic criteria. MCI was found in 50% of idiopathic RBD patients and 73% of PD patients with RBD. In contrast, only 11% of PD patients without RBD and 8% of control subjects had MCI. The presence of MCI was significantly greater in idiopathic RBD patients and PD patients with RBD than in PD patients without RBD and control subjects. PD patients with RBD also performed worse than idiopathic RBD patients on neuropsychological tests assessing visuoconstructional and visuoperceptual abilities. In both its association with PD and its idiopathic form, RBD is an important risk factor for MCI. Except for visuoconstructional and visuoperceptual problems, RBD may be an important determinant of cognitive impairment in PD. Ann Neurol 2009;66:39-47.

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    • "...ssociations with executive dysfunction and mild cognitive impairment have been frequently reported [55, 56]. Finally, autonomic functions did not differ between FOG and NF regardless of disease stage. ..."
      However, only in the early stages the RBD scores remained significantly different between the FOG and NF groups when using a multivariate approach. RBD suggest brainstem pathology [54], yet associations with executive dysfunction and mild cognitive impairment have been frequently reported [55, 56]. Finally, autonomic functions did not differ between FOG and NF regardless of disease stage.
    [Show abstract] [Hide abstract] ABSTRACT: Background: Freezing of gait is a common disabling symptom of Parkinson’s disease (PD) with limited treatment options. The pathophysiological mechanisms of freezing behaviour are still contentious. Objective: To investigate the prevalence of freezing of gait and its associations with increasing disease severity to gain a better understanding of the underlying pathophysiology. Methods: This exploratory study included 389 idiopathic PD patients, divided into four groups; early and advanced PD with freezing of gait, and early and advanced PD without freezing of gait. Motor, cognitive and affective symptoms, REM sleep behaviour disorder and autonomic function were assessed. Results: Regardless of disease stage, patients with freezing of gait had more severe motor symptoms and a predominant non-tremor phenotype. In the early stages, freezers had a selective impairment in executive function and had more marked REM sleep behaviour disorder. Autonomic disturbances were not associated with freezing of gait across early or advanced disease stages. Conclusion: These findings support the notion that impairments across the frontostriatal pathways are intricately linked to the pathophysiology underlying freezing of gait across all stages of PD. Features of REM sleep behaviour disorder suggest a contribution to freezing from brainstem pathology but this does not extend to more general autonomic dysfunction.
    Full-text · Article · Sep 2015 · Journal of Parkinson's Disease
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    • "...Also RBD in PD patients is associated with neuropsychological impairment. Gagnon et al. [15] found that MCI was present in 73% of PD patients with RBD compared to 11% of PD patents without RBD and 8% of ..."
      Also RBD in PD patients is associated with neuropsychological impairment. Gagnon et al. [15] found that MCI was present in 73% of PD patients with RBD compared to 11% of PD patents without RBD and 8% of healthy controls. Recently, Postuma et al. [17] performed a prospective follow-up study in a cohort of PD patients to assess the presence of a PSG confirmed RBD diagnosis in order to predict the future development of dementia based on neurological and neuropsychological assessment.
    [Show abstract] [Hide abstract] ABSTRACT: Rapid Eye Movement (REM) sleep Behaviour Disorder (RBD) is a REM sleep parasomnia characterized by loss of the muscle atonia that typically occurs during REM sleep, therefore allowing patients to act out their dreams. RBD manifests itself clinically as a violent behaviour occurring during the night, and is detected at the polysomnography by phasic and/or tonic muscle activity on the electromyography channel. In absence of neurological signs or central nervous system lesions, RBD is defined as idiopathic. Nevertheless, in a large number of cases the development of neurodegenerative diseases in RBD patients has been described, with the duration of the follow-up representing a fundamental aspect. A growing number of clinical, neurophysiologic and neuropsychological studies aimed to detect early markers of neurodegenerative dysfunction in RBD patients. Anyway, the evidence of impaired cortical activity, subtle neurocognitive dysfunction, olfactory and autonomic impairment and neuroimaging brain changes in RBD patients is challenging the concept of an idiopathic form of RBD, supporting the idea of RBD as an early manifestation of a more complex neurodegenerative process.
    Full-text · Article · Sep 2015 · Parkinsonism & Related Disorders
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    • "...ncreased presence of mild cognitive impairment in idiopathic RBD patients and PD patients with RBD [84] . RBD was associated with mild cognitive impairment among drug-naïve patients with PD [85]. ..."
      Gagnon et al. reported that mild cognitive impairment was found in 50 % of idiopathic RBD patients and 73 % of PD patients with RBD, while mild cognitive impairment was observed in 11 % of PD patients without RBD and 8 % of control subjects with mild cognitive impairment. These results showed an increased presence of mild cognitive impairment in idiopathic RBD patients and PD patients with RBD [84] . RBD was associated with mild cognitive impairment among drug-naïve patients with PD [85].
    [Show abstract] [Hide abstract] ABSTRACT: Sleep disturbances are a common non-motor feature in patients with Parkinson's disease (PD). Early diagnosis and appropriate management are imperative for enhancing patient quality of life. Sleep disturbances can be caused by multiple factors in addition to age-related changes in sleep, such as nocturnal motor symptoms (rigidity, resting tremor, akinesia, tardive dyskinesia, and the "wearing off" phenomenon), non-motor symptoms (pain, hallucination, and psychosis), nocturia, and medication. Disease-related pathology involving the brainstem and changes in the neurotransmitter systems (norepinephrine, serotonin, and acetylcholine) responsible for regulating sleep structure and the sleep/wake cycle play a role in emerging excessive daytime sleepiness and sleep disturbances. Additionally, screening for sleep apnea syndrome, rapid eye movement sleep behavior disorder, and restless legs syndrome is clinically important. Questionnaire-based assessment utilizing the PD Sleep Scale-2 is useful for screening PD-related nocturnal symptoms. In this review, we focus on the current understanding and management of sleep disturbances in PD.
    Full-text · Article · Mar 2015 · Current Neurology and Neuroscience Reports
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    • "...), but this remains controversial (Massicotte-Marquez et al., 2008; Terzaghi et al., 2008; Gagnon et al., 2009). In fact, the presence of visuospatial (or non-verbal learning) impairment appears to be related t..."
      In general, attention, executive functions, episodic verbal memory (mainly free recall capacities), and non-verbal learning are the most frequently affected domains in iRBD (Ferini-Strambi et al., 2004; MassicotteMarquez et al., 2008; Terzaghi et al., 2008; Gagnon et al., 2009; Marques et al., 2010; Fantini et al., 2011 ). Moreover, some studies reported the presence in iRBD patients of abnormalities in visuospatial/visuoperceptive abilities (Ferini-Strambi et al., 2004; Iranzo et al., 2010a; Marques et al., 2010; Fantini et al., 2011), but this remains controversial (Massicotte-Marquez et al., 2008; Terzaghi et al., 2008; Gagnon et al., 2009). In fact, the presence of visuospatial (or non-verbal learning) impairment appears to be related to the extent of cognitive decline in iRBD patients (Iranzo et al., 2006; Molano et al., 2010; Fantini et al., 2011 ), as reported in RBD-associated neurodegenerative disorders such as PD or LBD (Ferman et al., 2002;).
    [Show abstract] [Hide abstract] ABSTRACT: Rapid eye movement (REM) sleep behavior disorder (RBD) can occur in the absence of any other obvious associated neurologic disorder or in association with a neurodegenerative disease, in which case it is considered as symptomatic RBD. RBD is frequently associated with Parkinson's disease (PD), Lewy body dementia or multiple system atrophy (MSA), and in several cases may even antedate the occurrence of motor symptoms by decades. When no neurologic disorder is obvious, RBD can be considered as idiopathic (iRBD). Several studies have looked at neurophysiologic and neuropsychological functions in iRBD and have found evidence of CNS dysfunction during both wakefulness and sleep in a variable proportion of these patients, challenging the concept of iRBD. Identifying subjects with a high risk of developing a neurodegenerative process may be crucial in order to develop early intervention strategies. Some prospective results in iRBD showed that potential markers of neurodegeneration are the following: 1) marked EEG slowing on spectral analysis; 2) decreased striatal 123I-FPCIT; 3) impaired color vision.
    Full-text · Article · Mar 2015 · Archives italiennes de biologie
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    • "...ithout RBD. In another study 16 of 32 RBD patients referred to a sleep center met criteria for MCI [2]. MCI has also been observed in PD [3,4], and 20-25% of PD patients without dementia have MCI [5]. ..."
      After four years, 32% of RBD patients were classified as mild cognitive impairment (MCI), an intermediate state between intact cognition and dementia, compared to 15% in those without RBD. In another study 16 of 32 RBD patients referred to a sleep center met criteria for MCI [2]. MCI has also been observed in PD [3,4], and 20-25% of PD patients without dementia have MCI [5].
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Knowledge of the cognitive performance associated with REM sleep behavior disorder (RBD) in newly diagnosed Parkinson disease (PD) patients is limited. We thus wanted to explore 1) the frequency of RBD in patients with PD at a relatively early stage and 2) cognitive performance associated with RBD in PD. We hypothesized that RBD would be associated with cognitive impairment in PD. Methods: 29 non-demented patients recently diagnosed with PD (disease duration<5 years, Hoehn and Yahr stage <2.5 and no dementia) were recruited. The diagnosis of PD was supported by dopamine transporter SPECT. RBD was diagnosed based on standardized clinical interview and confirmed by polysomnography. Overall cognition was assessed by screening tests including the Mini-Mental State Examination (MMSE), and neuropsychological tests of memory, language, executive, attentional and visuospatial functions tests were performed. Results: 13 patients (45%) had probable RBD. There were no significant differences between PD with and without RBD in any of the neuropsychological tests, but a numerically lower performance was observed in the PD RBD group on memory tests Conclusions: RBD is common even in early PD without dementia, but was not found to be associated significantly with cognition.
    Full-text · Article · Dec 2014
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    • "...vodopa (P < 0.001) [11]. Some other studies, ours included, did not support this association [7,12,13]. Interestingly, a very recent study from the German group showed the presence of REM sleep behavior..."
      Only one polysomnographic study performed on a large cohort (n ¼ 351) reported that RBD in PD was determined by higher dose of levodopa (P < 0.001) [11]. Some other studies, ours included, did not support this association [7,12,13]. Interestingly, a very recent study from the German group showed the presence of REM sleep behavioral events (i.e. motor behaviors and/or vocalizations in REM sleep with a purposeful component other than comfort moves) in 81 of 158 newly diagnosed , unmedicated patients with PD [14].
    [Show abstract] [Hide abstract] ABSTRACT: Introduction The relationship between ICD and RBD is still not yet understood and the results from the current literature are contradictory in PD. We aimed to explore the association between rapid eye movement (REM) sleep behavior disorder (RBD) and impulse control disorder in Parkinson's disease. Methods Ninety-eight non-demented patients with Parkinson's disease underwent one night of video-polysomnography recording. The diagnosis of RBD was established according to clinical and polysomnographic criteria. Impulse control disorders were determined by a gold standard, semi-structured diagnostic interview. Results Half of the patients (n = 49) reported clinical history of RBD while polysomnographic diagnosis of RBD was confirmed in 31.6% of the patients (n = 31). At least one impulse control disorder was identified in 21.4% of patients, 22.6% with RBD and 20.9% without. Logistic regression controlling for potential confounders indicated that both clinical RBD (OR = 0.34, 95% CI = 0.07–1.48, P = 0.15) and polysomnographic confirmed RBD diagnoses (OR = 0.1.28, 95% CI = 0.31–5.33, P = 0.34) were not associated with impulse control disorder. Conclusion In Parkinson's disease, REM Sleep Behavior Disorder is not associated with impulse control disorder. The results of our study do not support the notion that PSG-confirmed RBD and ICD share a common pathophysiology.
    Full-text · Article · Sep 2014 · Parkinsonism & Related Disorders
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