Associations between probable REM sleep behavior disorder, olfactory disturbance, and clinical symptoms in Parkinson’s disease: A multicenter cross-sectional study

Background Rapid eye movement sleep behavior disorder (RBD) and olfactory dysfunction are useful for early diagnosis of Parkinson’s disease (PD). RBD and severe olfactory dysfunction are also regarded as risk factors for cognitive impairment in PD. This study aimed to assess the associations between RBD, olfactory function, and clinical symptoms in patients with PD. Methods The participants were 404 patients with non-demented PD. Probable RBD (pRBD) was determined using the Japanese version of the RBD screening questionnaire (RBDSQ-J) and the RBD Single-Question Screen (RBD1Q). Olfactory function was evaluated using the odor identification test for Japanese. Clinical symptoms were evaluated using the Movement Disorder Society Revision of the Unified PD Rating Scale (MDS-UPDRS) parts I–IV. Results In total, 134 (33.2%) patients indicated a history of pRBD as determined by the RBD1Q and 136 (33.7%) by the RBDSQ-J based on a cutoff value of 6 points. Moreover, 101 patients were diagnosed as pRBD by both questionnaires, 35 by the RBDSQ-J only, and 33 by the RBD1Q only. The MDS-UPDRS parts I–III scores were significantly higher and disease duration significantly longer in the pRBD group. pRBD was significantly associated with male gender and the MDS-UPDRS part I score. The olfactory identification function was significantly reduced in the pRBD group. Conclusions About 33% of the patients with PD had pRBD based on the questionnaires, and both motor and non-motor functions were significantly decreased in these patients. These results suggest that more extensive degeneration occurred in patients with non-demented PD with RBD.

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Preliminary finding of a randomized, double-blind, placebo-controlled, crossover study to evaluate the safety and efficacy of 5-hydroxytryptophan on REM sleep behavior disorder in Parkinson’s disease

Sleep And Breathing ◽

10.1007/s11325-021-02417-w ◽

2021 ◽

Author(s):

Mario Meloni ◽

Michela Figorilli ◽

Manolo Carta ◽

Ludovica Tamburrino ◽

Antonino Cannas ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rem Sleep ◽

Rating Scale ◽

Sleep Onset ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Double Blind ◽

Sleep Behavior ◽

Double Blind Placebo

Abstract Purpose Altered serotonergic neurotransmission may contribute to the non-motor features commonly associated with Parkinson’s disease (PD) such as sleep disorders. The 5-hydroxytryptophan (5-HTP) is the intermediate metabolite of l-tryptophan in the production of serotonin and melatonin. The purpose of this study was to compare the effects of 5-HTP to placebo on REM sleep behavior disorder (RBD) status in patients with PD. Methods A single-center, randomized, double-blind placebo-controlled crossover trial was performed in a selected population of 18 patients with PD and RBD. The patients received a placebo and 50 mg of 5-HTP daily in a crossover design over a period of 4 weeks. Results 5-HTP produced an increase in the total percentage of stage REM sleep without a related increase of RBD episodes, as well as a marginal, non-significant reduction in both arousal index and wake after sleep onset. The self-reported RBD frequency and clinical global impression (CGI) were improved during 5-HTP and placebo treatment in comparison to baseline. 5-HTP significantly improved our patients’ motor experiences of daily living as rated by the Unified Parkinson’s Disease Rating Scale (UPDRS) part II. Conclusions This study provides evidence that 5-HTP is safe and effective in improving sleep stability in PD, contributing to ameliorate patients’ global sleep quality. Larger studies with higher doses and longer treatment duration are needed to corroborate these preliminary findings.

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Olfactory function deteriorates in patients with Parkinson's disease complicated with REM sleep behavior disorder

eNeurologicalSci ◽

10.1016/j.ensci.2020.100261 ◽

2020 ◽

Vol 20 ◽

pp. 100261

Author(s):

Takashi Nomura ◽

Yuki Nomura ◽

Masayoshi Oguri ◽

Yasuaki Hirooka ◽

Ritsuko Hanajima

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rem Sleep ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Olfactory Function ◽

Sleep Behavior

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Probable REM Sleep Behavior Disorder Is a Risk Factor for Symptom Progression in Parkinson Disease

Frontiers in Neurology ◽

10.3389/fneur.2021.651157 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ashley Barasa ◽

Jijia Wang ◽

Richard B. Dewey

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Parkinson Disease ◽

Rating Scale ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Rate Of Change ◽

Rapid Progression ◽

Sleep Behavior ◽

Updrs Part

Background: The literature is conflicting on whether rapid eye movement sleep behavior disorder (RBD) is associated with more rapid progression of Parkinson disease (PD).Objective: We aimed to determine (1) how stable probable RBD (pRBD) is over time and (2) whether it predicts faster PD progression.Methods: We evaluated participants in the Parkinson's Disease Biomarker Project (PDBP) who were prospectively assessed every 6–12 months with a series of motor, non-motor, disability, and health status scales. For aim 1, we calculated the incidence and disappearance rates of pRBD and compared stability of pRBD in PD with control subjects. For aim 2, we developed multiple regression models to determine if pRBD at baseline influenced the rate of change or average value at 48 months of 10 outcome variables.Results: We found that pRBD was a less stable diagnosis for PD than controls. In pRBD+ subjects, the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score progressed 2.78 points per year faster (p < 0.01), MDS-UPDRS total score progressed 3.98 points per year faster (p < 0.01), a global composite outcome (GCO) worsened by 0.09 points per year faster (p = 0.02), and Parkinson's Disease Questionnaire (PDQ-39) mobility score progressed 2.57 percentage points per year faster (p < 0.01). The average scores at 48 months were 8.89 (p = 0.02) and 14.3 (p = 0.01) points higher for pRBD+ in MDS-UPDRS part III and total scores, respectively.Conclusions: Our study confirms that pRBD detected at the start of a study portends more rapid progression of PD. Knowing this could be useful for enriching clinical trials with fast progressors to accelerate discovery of a disease modifying agent.

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