Rapid eye movement sleep behavior disorder and subtypes of Parkinson's disease

• Published in: Movement disorders Vol. 27; no. 8; pp. 996 - 1003
• Main Authors: Romenets, Silvia Rios, Gagnon, Jean-Francois, Latreille, Véronique, Panniset, Michel, Chouinard, Sylvain, Montplaisir, Jacques, Postuma, Ronald B.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.07.2012; Wiley
• Subjects: Aged; Antiparkinson Agents - therapeutic use; Autonomic Nervous System Diseases - etiology; Autonomic Nervous System Diseases - physiopathology; Biological and medical sciences; Cohort Studies; Color Perception; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Female; Hallucinations - etiology; Hallucinations - psychology; Humans; Levodopa - therapeutic use; Male; Medical sciences; Mental Disorders - etiology; Mental Disorders - psychology; Middle Aged; motor manifestation; Movement; Neurologic Examination; Neurology; nonmotor manifestation; orthostatic hypotension; Parkinson Disease - classification; Parkinson Disease - complications; Parkinson Disease - psychology; Parkinson's disease; Polysomnography; Psychomotor Performance; REM sleep behavior disorder; REM Sleep Behavior Disorder - complications; REM Sleep Behavior Disorder - psychology; Smell; Socioeconomic Factors; orthostatic hypotension; Nervous system diseases; Parkinson's disease; nonmotor manifestation; Parkinson disease; Sleep disorder; Cardiovascular disease; Rapid eye movement sleep; motor manifestation; Cerebral disorder; REM sleep behavior disorder; Postural hypotension; Arterial hypotension; Diseases of the autonomic nervous system; Central nervous system disease; Degenerative disease; Sleep wake cycle; Behavior; Neurological disorder; Subtype; Extrapyramidal syndrome
• ISSN: 0885-3185; 1531-8257; 1531-8257
• DOI: 10.1002/mds.25086

Numerous studies have explored the potential relationship between rapid eye movement sleep behavior disorder (RBD) and manifestations of PD. Our aim was to perform an expanded extensive assessment of motor and nonmotor manifestations in PD to identify whether RBD was associated with differences in the nature and severity of these manifestations. PD patients underwent polysomnography (PSG) to diagnose the presence of RBD. Participants then underwent an extensive evaluation by a movement disorders specialist blinded to PSG results. Measures of disease severity, quantitative motor indices, motor subtypes, therapy complications, and autonomic, psychiatric, visual, and olfactory dysfunction were assessed and compared using regression analysis, adjusting for disease duration, age, and sex. Of 98 included patients, 54 had RBD and 44 did not. PD patients with RBD were older (P = 0.034) and were more likely to be male (P < 0.001). On regression analysis, the most consistent links between RBD and PD were a higher systolic blood pressure (BP) change while standing (−23.9 ± 13.9 versus −3.5 ± 10.9; P < 0.001), a higher orthostatic symptom score (0.89 ± 0.82 versus 0.44 ± 0.66; P = 0.003), and a higher frequency of freezing (43% versus14%; P = 0.011). A systolic BP drop >10 could identify PD patients with RBD with 81% sensitivity and 86% specificity. In addition, there was a probable relationship between RBD and nontremor predominant subtype of PD (P = 0.04), increased frequency of falls (P = 0.009), and depression (P = 0.009). Our results support previous findings that RBD is a multifaceted phenomenon in PD. Patients with PD who have RBD tend to have specific motor and nonmotor manifestations, especially orthostatic hypotension. © 2012 Movement Disorder Society