Lost in a Dream

Neurodegenerative Disorder ◽

Lewy Bodies ◽

Behavior Disorder ◽

Sleep Behavior ◽

The Relationship ◽

Over Time

Rapid-eye-movement sleep behavior disorder (RBD) is a parasomnia that is closely associated with neurodegenerative disorders. RBD is usually caused by neurodegeneration within the brainstem that disables the system responsible for immobilizing skeletal muscles during REM sleep and thus permits motor neurons to activate these muscles during dreaming. The underlying source of the brainstem neurodegeneration spreads over time to other central nervous system regions until it has sufficiently evolved to permit clinical recognition of the underlying neurodegenerative disorder. Longitudinal follow-up of patients with RBD has demonstrated that most patients subsequently develop some neurodegenerative disorder years later, particularly the synucleinopathies. We review the relationship between RBD and dementia with Lewy bodies, which is one of the synucleinopathies. The management of RBD is reviewed with discussion of the relevant considerations in patients with dementia with Lewy bodies.

Diagnostic Value of 123-I-MIBG Cardiac Scintigraphy for the Prediction of Conversion from Idiopathic REM Sleep Behavior Disorder to Dementia with Lewy Bodies, and the Differential Diagnosis of Neurodegenerative Diseases

Alzheimers Disease & Dementia ◽

10.36959/734/373 ◽

2017 ◽

Vol 1 (2) ◽

Author(s):

Seto Makiko ◽

Nakata Ruka ◽

Yuasa Takayuki ◽

Nakao Yoko ◽

Ichinose Katsuhiro ◽

...

Keyword(s):

Differential Diagnosis ◽

Neurodegenerative Diseases ◽

Rem Sleep ◽

Lewy Bodies ◽

Behavior Disorder ◽

Diagnostic Value ◽

Severe Brain Metabolic Decreases Associated with REM Sleep Behavior Disorder in Dementia with Lewy Bodies

Journal of Alzheimer s Disease ◽

10.3233/jad-151000 ◽

2016 ◽

Vol 52 (3) ◽

pp. 989-997 ◽

Cited By ~ 9

Author(s):

Leonardo Iaccarino ◽

Sara Marelli ◽

Sandro Iannaccone ◽

Giuseppe Magnani ◽

Luigi Ferini-Strambi ◽

...

Keyword(s):

Rem Sleep ◽

Lewy Bodies ◽

Behavior Disorder ◽

REM Sleep Behavior Disorder (RBD) in Dementia with Lewy Bodies (DLB)

Behavioural Neurology ◽

10.1155/2018/9421098 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Po-Chi Chan ◽

Hsun-Hua Lee ◽

Chien-Tai Hong ◽

Chaur-Jong Hu ◽

Dean Wu

Keyword(s):

Eye Movement ◽

Rem Sleep ◽

Clinical Manifestations ◽

Lewy Bodies ◽

Behavior Disorder ◽

Rapid Eye Movement ◽

Sleep Behavior ◽

Neurologic Disorders

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia, with abnormal dream-enacting behavior during the rapid eye movement (REM) sleep. RBD is either idiopathic or secondary to other neurologic disorders and medications. Dementia with Lewy bodies (DLB) is the third most common cause of dementia, and the typical clinical presentation is rapidly progressive cognitive impairment. RBD is one of the core features of DLB and may occur either in advance or simultaneously with the onset of DLB. The association between RBD with DLB is widely studied. Evidences suggest that both DLB and RBD are possibly caused by the shared underlying synucleinopathy. This review article discusses history, clinical manifestations, possible pathophysiologies, and treatment of DLB and RBD and provides the latest updates.

Smaller pineal gland is associated with rapid eye movement sleep behavior disorder in Alzheimer’s disease

10.21203/rs.3.rs-56077/v2 ◽

2020 ◽

Author(s):

Jeongbin Park ◽

Seung Wan Suh ◽

Grace Eun Kim ◽

Subin Lee ◽

Jun Sung Kim ◽

...

Keyword(s):

Pineal Gland ◽

Eye Movement ◽

Rem Sleep ◽

Lewy Bodies ◽

Behavior Disorder ◽

Rapid Eye Movement ◽

Sleep Behavior ◽

Gland Volume

Abstract Background: To investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer’s disease (AD) patients without any feature of dementia with Lewy bodies.Methods: We enrolled 296 community-dwelling probable AD patients who did not meet the diagnostic criteria for possible or probable dementia with Lewy bodies. Among them, 93 were amyloid beta (Aβ) positive on 18F-florbetaben amyloid brain positron emission tomography. We measured RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as the RBDSQ of 5 or higher. We manually segmented pineal gland on 3T structural T1-weighted brain magnetic resonance imaging.Results: The participants with pRBD had smaller pineal parenchyma volume (VPP) than those without pRBD (p < 0.001). The smaller the VPP, the more severe the RBD symptoms (p < 0.001). VPP was inversely associated with risk of prevalent pRBD (odds ratio = 0.909, 95% confidence interval [CI] = 0.878–0.942, p < 0.001). Area under the receiver operator characteristic curve for pRBD of VPP was 0.80 (95% CI = 0.750–0.844, p < 0.0001). These results were not changed when we analyzed the 93 participants with Aβ-positive AD separately.Conclusions: In AD patients, reduced pineal gland volume may be associated with RBD.

Rapid Eye Movement Sleep Behavior Disorder Manifesting as Sign Language in a Patient with Dementia with Lewy Bodies

Movement Disorders Clinical Practice ◽

10.1002/mdc3.12486 ◽

2017 ◽

Vol 4 (4) ◽

pp. 623-624

Author(s):

Jason Margolesky ◽

Corneliu C Luca ◽

Carlos Singer

Keyword(s):

Sign Language ◽

Eye Movement ◽

Lewy Bodies ◽

Behavior Disorder ◽

Rapid Eye Movement ◽

Rapid Eye Movement Sleep ◽

REM sleep behavior disorder

10.1093/med/9780199682003.003.0038 ◽

2017 ◽

Cited By ~ 1

Author(s):

Ronald B. Postuma

Keyword(s):

Rem Sleep ◽

Lewy Bodies ◽

Behavior Disorder ◽

Clinical History ◽

Final Diagnosis ◽

Acting Out ◽

Sleep Behavior ◽

Rem Atonia

A diagnosis of REM sleep behavior disorder (RBD), a disorder characterized by “acting out” of dreams during REM sleep, has critical implications for a patient’s future. Aside from being a treatable parasomnia, usually managed with melatonin or clonazepam, RBD is the most powerful risk factor for Parkinson disease and dementia with Lewy bodies yet discovered. Over 70% of patients with idiopathic RBD will develop a neurodegenerative synucleinopathy. Moreover, the disease course is more severe in patients with RBD than those without. Numerous screens have been developed to aid detection, and clinical history can help distinguish RBD from NREM parasomnia. However, final diagnosis relies on polysomnographic documentation of REM atonia loss. Given the profound implications of idiopathic RBD, patients need careful counseling and the offer of neurological follow-up to detect and treat prodromal disease symptoms. Recognition of RBD is also a means to discover and test protective therapies against neurodegenerative disease.

Clinical and video-polysomnographic analysis of rapid eye movement sleep behavior disorder and other sleep disturbances in dementia with Lewy bodies

SLEEP ◽

10.1093/sleep/zsz086 ◽

2019 ◽

Vol 42 (7) ◽

Cited By ~ 7

Author(s):

Ana Fernández-Arcos ◽

Estrella Morenas-Rodríguez ◽

Joan Santamaria ◽

Raquel Sánchez-Valle ◽

Albert Lladó ◽

...

Keyword(s):

Eye Movement ◽

Rem Sleep ◽

Predictive Value ◽

Lewy Bodies ◽

Behavior Disorder ◽

Sleep Spindles ◽

Electromyographic Activity ◽

Rapid Eye Movement ◽

Abstract Objective The main objective of this study was to study rapid eye movement (REM) sleep behavior disorder (RBD) and other sleep disorders in dementia with Lewy bodies (DLB). Methods Consecutive patients with DLB and mild dementia severity were recruited irrespective of sleep complaints. Patients underwent clinical interview, assessment of sleep scales, and video-polysomnography (V-PSG). RBD was diagnosed with V-PSG based on electromyographic and audiovisual analysis. Results Thirty-five patients (65.7% men; mean age 77.7 ± 6.1 years) were evaluated. Poor sleep quality (54.3%), hypersomnia (37.1%), snoring (60%), and abnormal nocturnal behaviors (77.1%) were reported. Sleep–wake architecture abnormalities occurred in 75% patients and consisted of occipital slowing on awake electroencephalography (EEG; 34.4%), the absence of sleep spindles and K complexes (12.9%), slow frequency sleep spindles (12.9%), delta activity in REM sleep (19.2%), and REM sleep without atonia (44%). Three patients showed hallucinatory-like behaviors and 10 patients showed abnormal behaviors during arousals mimicking RBD. RBD was diagnosed in 50% of those patients in whom sufficient REM sleep was attained. Of these, 72.7% were not aware of displaying dream-enacting behaviors and in 63.7% RBD preceded the onset of cognitive impairment. For RBD diagnosis, the sensitivity of Mayo Sleep Questionnaire was 50%, specificity was 66.7%, positive predictive value was 83.3%, and negative predictive value was 28%. False-positive RBD cases according to clinical history had hallucinatory-like behaviors, severe obstructive sleep apnea, and prominent periodic limb movements in sleep. Occipital EEG frequency while awake and rate of electromyographic activity in REM sleep were negatively correlated, suggesting a common subcortical origin. Conclusion In DLB, RBD and sleep–wake disorders are common, heterogeneous, and complex, challenging their identification without performing V-PSG.