Non-Motor Symptoms Associated with Sleep Disorder in PARKINSON’S DISEASE
A study done in Great Britain found that patients who reported more severe non-motor symptoms such as depression, constipation, or hallucinations also reported having serious sleep behavior problems. While it is impossible to say that the sleep disorder is causative of the other non-motor symptoms, it appears that there are some common underlying pathologies shared between them.
Rapid Eye Movement Sleep Behavior Disorder (RBD) is usually experienced by men and often is present for many years before any other symptoms of PARKINSON’S DISEASE become apparent. They have frequent terrifying nightmares, such as being chased by wild animals or being pursued by armed thugs and they violently act out their defense, often hurting themselves in the process or actually injuring their bed partners. They may yell or scream, punch or kick and actually jump out of bed during the nightmare. What causes RBD is not really well understood, but it often foreshadows the development of neurodegenerative diseases such as Lewy body dementia or PARKINSON’S DISEASE.
When the study done at the Oxford Parkinson’s Disease Center by researcher Michele Hu, M.D., Ph.D., looked at 475 patients who had been diagnosed with PARKINSON’S DISEASE in the last 3 and a half years, they found that almost half of them had probable RBD based on responses to questionnaires. These same patients also reported more problems with non-motor symptoms and had more orthostatic hypotension (low blood pressure on rising from a sitting or lying position) as well as more depression. They scored lower on Mini-Mental State Examination and while there was no significant difference in cognitive testing scores in the early stages, patients with RBD did show earlier cognitive decline as the disease progressed than non RBD patients. They also reported more problems with swallowing, chewing, turning in bed and walking and balance earlier than patients without RBD.
Patients with RBD saw themselves as having more difficulties with their motor functions and also as having a poorer quality of life. Fortunately, there is a medication that helps at least 90% of the patients affected by RBD. Clonazepam is the drug that has shown effectiveness within less than a week of beginning the medication. It needs to be taken continuously. The advice of a skilled movement disorder specialist is need to determine which medication is appropriate, as some medications can actually cause the condition to develop or worsen over time.
REM Sleep behavior disorder is associated with worse quality of life and other non-motor features in early Parkinson’s disease; Michele Hu et al; J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2013-306104
Review by Marcia McCall