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12 results

  • Case 4 - “I Am Tired All the Time”

  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book:
    Clinical Case Studies in Long-Term Care Psychiatry
    Published online:
    31 October 2024
    Print publication:
    14 November 2024, pp 16-19

  • Summary

    Dementia with Lewy bodies (DLB) is a neurodegenerative disorder characterized by the presence of Lewy bodies, which are abnormal protein deposits, in certain areas of the brain. The symptoms of DLB can be variable and fluctuate from day to day, making it challenging to diagnose. The most common symptom is cognitive impairment. There are central features, core features, suggestive features, and supportive features that can be used to aid in the diagnosis of DLB. REM sleep behavior disorder is common in DLB and Parkinson-related dementia.

  • Rapid Eye Movement Sleep Behavior Disorder in Parkinson’s Disease: A Survey-Based Study

  • Veronica Bruno, Marta Ruiz-Lopez, Cinthia Terroba-Chambi, Maria Eliza Freitas, Rajasumi Rajalingam, Anna Chang, Susan Helen Fox, Anthony Edward Lang
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 50 / Issue 5 / September 2023
    Published online by Cambridge University Press:
    26 August 2022, pp. 703-709
    • Article
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      • Open access
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  • Objective:

    To characterize Parkinson’s disease (PD) symptoms based on the presence, onset time, and severity of rapid eye movement sleep behavior disorder (RBD) and their association with impulse control disorders (ICD).

    Background:

    RBD is a frequent non-motor symptom in PD, usually described as prodromal. The severity of RBD according to the start time and its relationship with ICD in PD needs further clarification.

    Methods:

    A survey-based study was performed to determine the presence of RBD symptoms, their severity, and the temporal relationship with the PD onset. The survey included RBD1Q, the Mayo Sleep, and the RBDQ-HK questionnaires and questions about clinical characteristics, including ICD. Only PD patients with care partners spending night hours in the same room were included.

    Results:

    410 PD patients were included: 206 with RBD (50.2%) and 204 non-RBD (49.8%). The PD-RBD patients were younger and their daily levodopa dose was higher than the non-RBD group. Most of these patients developed RBD symptoms after the onset of clinical PD were younger at motor symptom onset and had higher scores in the hallucinations and psychosis subsection of MDS-UPDRS-I. RBD group had a more severe non-motor phenotype, including more ICD than those without RBD, mainly due to higher compulsive eating.

    Conclusions:

    In our study, most patients recognized RBD symptoms after the onset of the PD motor symptoms and the clinical features of PD with and without RBD were distinctive, supporting the hypothesis that PD-RBD might represent a variant pattern of neurodegeneration.

  • 34 - The Role of Sleep in Cognitive Aging

  • from Part V - Later Life and Interventions
  • Edited by Ayanna K. Thomas, Tufts University, Massachusetts, Angela Gutchess, Brandeis University, Massachusetts
  • Book:
    The Cambridge Handbook of Cognitive Aging
    Published online:
    28 May 2020
    Print publication:
    28 May 2020, pp 628-644

  • Summary

    Aging is marked by cognitive decline, which in the case of Alzheimer’s disease is associated with tremendous global economic burden. Identifying modifiable risk factors for cognitive decline is therefore of paramount importance. In this chapter, we describe how aging compromises sleep quality and sleep architecture at a rate that parallels normal age-related cognitive decline. We argue that understanding the neurocognitive functions of sleep – frontal lobe restoration, memory consolidation, and metabolite clearance – and how such functions change in later life will be key to informing why some older individuals maintain healthy cognitive functioning and other older individuals do not. Critically, by investigating how sleep, cognition, and aging interact, researchers and clinicians can develop sleep-related treatments that target preventing, or at least ameliorating, pathologies such as Alzheimer’s disease.

  • Rapid Eye Movement (REM) Sleep Behavior Disorder and REM Sleep with Atonia in the Young

  • Garima Shukla, Anupama Gupta, Kamalesh Chakravarty, Angela Ann Joseph, Aathira Ravindranath, Manju Mehta, Sheffali Gulati, Madhulika Kabra, Afsar Mohammed, Shivani Poornima
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 47 / Issue 1 / January 2020
    Published online by Cambridge University Press:
    31 October 2019, pp. 100-108
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  • Background:

    Rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RWA) have assumed much clinical importance with long-term data showing progression into neurodegenerative conditions among older adults. However, much less is known about RBD and RWA in younger populations. This study aims at comparing clinical and polysomnographic (PSG) characteristics of young patients presenting with RBD, young patients with other neurological conditions, and normal age-matched subjects.

    Methods:

    A retrospective chart review was carried out for consecutive young patients (<25 years) presenting with clinical features of RBD; and data were compared to data from patients with epilepsy, attention deficit hyperactivity disorder (ADHD), and autism, as well as normal subjects who underwent PSG during a 2-year-period.

    Results:

    Twelve patients fulfilling RBD diagnostic criteria, 22 autism patients, 10 with ADHD, 30 with epilepsy, and 14 normal subjects were included. Eight patients with autism (30%), three with ADHD (30%), one with epilepsy (3.3%), and six patients who had presented with RBD like symptoms (50%) had abnormal movements and behaviors during REM sleep. Excessive transient muscle activity and/or sustained muscle activity during REM epochs was found in all patients who had presented with RBD, in 16/22 (72%) autistic patients, 6/10 (60%) ADHD patients compared to only 6/30 (20%) patients with epilepsy and in none of the normal subjects.

    Conclusion:

    We observed that a large percentage of young patients with autism and ADHD and some with epilepsy demonstrate loss of REM-associated atonia and some RBD-like behaviors on polysomnography similar to young patients presenting with RBD.

  • Chapter 53 - Zolpidem-induced parasomnias

  • from Section 5 - Neuroimaging of sleep disorders
  • Edited by Eric Nofzinger, University of Pittsburgh, Pierre Maquet, Université de Liège, Belgium, Michael J. Thorpy
  • Book:
    Neuroimaging of Sleep and Sleep Disorders
    Published online:
    05 March 2013
    Print publication:
    07 March 2013, pp 414-415

  • Summary

    This chapter reviews the usefulness of Meta-iodobenzylguanidine (123I-MIBG) in neurology-specific sleep disorders with a particular focus on rapid eye movement (REM) sleep behavior disorder (RBD). Several studies demonstrated the diagnostic reliability of reduced cardiac 123I-MIBG uptake in Parkinson's disease (PD) patients. In general, 123I-MIBG scintigraphy is regarded as an assessment of autonomic function. Autonomic dysfunction is common in α-synucleinopathies, and particularly marked in multiple system atrophy (MSA). Most patients with idiopathic RBD (iRBD) have reduced 123I-MIBG uptake, and an abnormal 123I-MIBG finding supports the diagnosis of RBD. Although an abnormal 123I-MIBG finding cannot predict the development of α-synucleinopathies among iRBD patients, the existence of RBD might be predictive of developing PD with dementia (PDD) in patients with PD. In the near future, 123I-MIBG findings might help predict the development of PDD among PD patients affected with RBD.

  • Chapter 9 - Sexsomnias

  • from Section 1 - Introduction
  • Edited by Michael J. Thorpy, Giuseppe Plazzi, Università di Bologna
  • Book:
    The Parasomnias and Other Sleep-Related Movement Disorders
    Published online:
    10 November 2010
    Print publication:
    10 June 2010, pp 70-80

  • Summary

    If the notions of dream and nightmare are centuries old, going back to ancient Egyptian and Jewish civilizations, the distinction between nightmares and parasomnias is recent. As parasomnias became distinguishable from nightmares, a possible link between such episodic nocturnal phenomena and seizure disorders was proposed. In 1999, Ohayon et al. in their epidemiological studies on sleepwalking and sleep terrors found that obstructive sleep apnea syndrome was the most common sleep disorder associated with parasomnias between the ages of 15 and 24 years. Epileptic disorders were shown to be rarely involved in abnormal behavior during non-rapid eye movement (NREM) sleep, but when sleep-related seizure disorders are present, specific seizure entities are implicated. Nocturnal polysomnography has allowed the dissociation of NREM from REM sleep abnormal behavior. The initial description of what is now known as REM sleep behavior disorder (RBD) came from Japanese researchers.

  • Chapter 18 - Sleep enuresis

  • from Section 4 - Other parasomnias
  • Edited by Michael J. Thorpy, Giuseppe Plazzi, Università di Bologna
  • Book:
    The Parasomnias and Other Sleep-Related Movement Disorders
    Published online:
    10 November 2010
    Print publication:
    10 June 2010, pp 175-183

  • Summary

    The parasomnias most frequently associated with forensic consequences are the disorders of arousal (confusional arousals, sleepwalking/sleep terrors) and their variant sexsomnia, parasomnia due to drug or substance and REM sleep behavior disorder (RBD). There are numerous historical cases documenting sleep-related crimes dating back to the seventeenth century. The insanity defense and automatism remain relevant to criminal liability today, but the Model Penal Code (MPC) definitions still rely on ideas that have not kept up to date with developments in neuroscience. It is important that experts providing evidence for apparent sleep-related forensic cases be acutely aware of and follow guidelines laid down by their respective professional and regulatory bodies in their particular jurisdictions. The assessment of a person accused of a violent act that may have arisen from sleep requires a systematic and thorough evaluation of all possible diagnoses.

  • Chapter 15 - Recurrent isolated sleep paralysis

  • from Section 3 - Parasomnias usually associated with REM sleep
  • Edited by Michael J. Thorpy, Giuseppe Plazzi, Università di Bologna
  • Book:
    The Parasomnias and Other Sleep-Related Movement Disorders
    Published online:
    10 November 2010
    Print publication:
    10 June 2010, pp 142-152

  • Summary

    The REM sleep behavior disorder (RBD) is the parasomnia most commonly associated with an underlying neurological condition (the so-called symptomatic RBD). RBD usually occurs in setting of neurodegenerative diseases such as Lewy body dementia (LBD), Parkinson's disease (PD), and multiple system atrophy (MSA), and it may precede the development of Parkinsonism by many years. The disorders of arousal are the most frequent of the NREM sleep parasomnias. They may be triggered by prior sleep deprivation, alcohol, emotional stress and febrile illness. Different medications have been associated with RBD or REM sleep without atonia (RSWA), particularly psychotrophic and antihypertensive drugs. In the last two decades, some studies have demonstrated that arousals secondary to apneas, hypopneas and irregular breathing can be the trigger for sleepwalking and related disorders in children and adults. Hallucinations, both diurnal and nocturnal, have been described in PD associated with cognitive decline and RBD.

  • 30 - Sleep medication and traffic safety in the elderly

  • from Part 3 - Sleepdisorders in the elderly
  • Edited by S. R. Pandi-Perumal, Jaime M. Monti, Universidad de la República, Uruguay, Andrew A. Monjan, National Institute on Aging, Bethesda, Maryland
  • Book:
    Principles and Practice of Geriatric Sleep Medicine
    Published online:
    04 August 2010
    Print publication:
    26 November 2009, pp 319-324

  • Summary

    This chapter reviews the nocturnal sleep disorders associated with Parkinson's disease (PD). The most common sleep disorders in PD include insomnia, REM sleep behavior disorder (RBD), sleep apnea, restless legs syndrome (RLS), and periodic limb movement disorder (PLMD). The diagnosis of RLS in PD patients may be confounded by akathisia and nocturnal motor symptoms. The presence of diurnal variations of symptoms in RLS, and the feeling of inner restlessness without a sensory component in akathisia, may help to differentiate akathisia from RLS. The primary neurodegenerative process of PD, complex medication regimens, age-related changes in the sleep architecture, and co-existent sleep disturbances play an important role in the development of excessive daytime somnolence (EDS). Several objective and subjective diagnostic tools have been used for the diagnosis of EDS in PD patients. Deep brain stimulation (DBS) has become an important treatment option for PD patients with disabling motor complications and dyskinesias.

  • 14 - Forensic sleep medicine issues: violent parasomnias

  • from SECTION 3 - SLEEP IN SPECIALTY AREAS
  • Edited by Harold R. Smith, University of California, Irvine, Cynthia L. Comella, Birgit Högl
  • Book:
    Sleep Medicine
    Published online:
    08 August 2009
    Print publication:
    10 April 2008, pp 240-255

  • Summary

    Violent behaviors during sleep may result in events which have forensic science implications. The apparent suicide (for example, leap to death from a second-storey window), assault or murder (for example, molestation, strangulation, stabbing, shooting) may be the unintentional, non-culpable but catastrophic result of disorders of arousal, sleep-related seizures, REM sleep behavior disorder (RBD), or psychogenic dissociative states. Violent sleep-related behaviors have been reviewed in the context of automatic behavior in general, with many well-documented cases resulting from a wide variety of disorders. Conditions associated with sleep-period-related violence fall into two major categories: neurologic and psychiatric. Psychogenic dissociative disorders may arise exclusively or predominantly from the sleep period. Recent interest in the forensic aspects of parasomnias provides sleep medicine professionals with an opportunity to educate and assist the legal profession in cases of sleep-related violence. One infrequently used tactic to improve scientific testimony is to use a court-appointed impartial expert.

  • SECTION 2 - SLEEP DISORDERS

  • Edited by Harold R. Smith, University of California, Irvine, Cynthia L. Comella, Birgit Högl
  • Book:
    Sleep Medicine
    Published online:
    08 August 2009
    Print publication:
    10 April 2008, pp -

  • Summary

    Parasomnias involve automatic behavior, i.e., seemingly goal-directed, complex purposeful behaviors enacted without the conscious awareness and volition of the individual, who cannot exercise conscious deliberate control over his or her behaviors and sleep-related experiences. It could be subdivided by taking into account the motoric versus autonomic/ sensory activation. This chapter deals with the most common disorders, covering the appropriate diagnostic and therapeutic strategies. Disorders of arousal include sleepwalking or somnambulism, sleep terrors, and confusional arousals. The pathophysiology of REM sleep behavior disorder (RBD) lies in a dysfunction of the brainstem structures modulating REM sleep. Enuresis consists of recurrent involuntary urination during sleep. It includes primary forms, where bladder control has never been achieved, and secondary variants occurring after a period of bladder control. Catathrenia, also known as nocturnal groaning or expiratory vocalization during sleep, consists of the emission of an unusual expiratory noise occurring in bursts without associated motor phenomena.

  • Dementia with Lewy bodies may present as dementia and REM sleep behavior disorder without parkinsonism or hallucinations

  • TANIS J. FERMAN, BRADLEY F. BOEVE, GLENN E. SMITH, MICHAEL H. SILBER, JOHN A. LUCAS, NEILL R. GRAFF-RADFORD, DENNIS W. DICKSON, JOSEPH E. PARISI, RONALD C. PETERSEN, ROBERT J. IVNIK
  • Journal:
    Journal of the International Neuropsychological Society / Volume 8 / Issue 7 / November 2002
    Published online by Cambridge University Press:
    13 November 2002, pp. 907-914

  • Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disturbance that commonly occurs in Dementia with Lewy bodies (DLB). Retrospective examination of DLB course has shown that RBD and cognitive decline may precede the onset of parkinsonism and visual hallucinations. Therefore, some patients with DLB may initially present with dementia and RBD, but would not meet current formal criteria for probable DLB at that time. The purpose of this study is to determine whether patients with dementia and RBD, who do not have parkinsonism or visual hallucinations, have cognitive profiles that can be distinguished from autopsy-confirmed definite AD, but not from clinically probable DLB. If so, this would support the hypothesis that the presence of RBD and dementia, as the only presenting symptoms, reflects the early manifestation of DLB. Results show that early dementia in probable DLB and dementia with RBD are neuropsychologically indistinguishable. Both groups differ from definite AD of a similar early stage with significantly worse visual perceptual organization, sequencing and letter fluency but significantly better confrontation naming and verbal memory. In addition, follow-up data from a subset of patients with dementia and RBD reveal the subsequent development of parkinsonism or hallucinations 1 to 6 years later. Results indicate that the presentation of dementia and RBD is suggestive of underlying Lewy body disease and not Alzheimer's disease. This provides further evidence in support of including RBD as one of the core diagnostic features of DLB. (JINS, 2002, 8, 907–914.)