Original popular science article: Sleep disorders and Parkinson's disease

Editor: Ma Yonglan

Reviewer: Yang Pengbin

(Qi Zhengyan) Some people dance in their dreams. When they enter the dreamy rapid eye movement (REM) sleep period, this dreaming state usually indicates more serious health problems. This symptom is called rapid eye movement sleep behavior disorder (RBD). Studies have shown that 80% of people with this symptom will develop certain neurodegenerative diseases, such as Parkinson's disease, multiple system atrophy, and Lewy body dementia. Therefore, RBD is not only a sleep disorder, but also may be a pre-motor symptom of Parkinson's disease, which provides an opportunity for intervention in the early prevention of Parkinson's disease.

Dreaming about restlessness is a warning sign of Parkinson's disease

Idiopathic REM sleep behavior disorder and Parkinson's disease-related disorders are characterized by loss of normal muscle weakness during REM sleep and dreaming behavior. Clinical manifestations include vocalizations such as talking and shouting, violent, aggressive complex behaviors during REM sleep, and vivid, unpleasant, and violent dreams that cause sleep-related harm to the patient or bed partner. There is a link between RBD disease and neurodegenerative diseases, with observations showing that 38% of 29 male patients with idiopathic RBD disease developed Parkinson's disease 12.7±7.3 years after RBD onset. At 12 years of follow-up, 82% of 44 RBD patients developed neurodegenerative diseases (16 Parkinson's disease, 14 DLB disease, 1 multiple sclerosis, and 5 mild cognitive impairment). 28% of 93 patients with idiopathic RBD disease developed neurodegenerative diseases. The estimated risk of neurodegenerative diseases in RBD subjects was 17.7% at 5 years of follow-up, 40.6% at 10 years, and 52.4% at 12 years of follow-up. In addition, when mild cognitive impairment was included, the risk of neurodegenerative diseases in RBD patients was 33.1% at 5 years, 75.7% at 10 years, and 90.9% at 14 years. The risk of neurodegenerative diseases increased with the increase in follow-up time. In a clinicopathological study including 172 patients with or without neurologic diseases, the neuropathological diagnoses were Lewy body disease (n = 77), combined Lewy body disease and AD (n = 59), MSA (n = 19), AD (n = 6), progressive supranuclear palsy (n = 2), and others (n = 9), indicating that the proportion of synucleinopathy was high (94%) in patients with RBD associated with neurodegenerative diseases (n = 170) [50]. Taken together, these longitudinal studies suggest that idiopathic RBD carries a substantial risk for the development of synucleinopathies, particularly Lewy body-associated diseases such as Parkinson's disease and DLB disease, and that the absence of RBD is associated with an Alzheimer's disease-like atrophy pattern and increased phospho-tau load on magnetic resonance imaging.

Therefore, RBD, as a mental illness, is also considered to be a manifestation of potential neurodegenerative diseases. It is of great significance to identify, prevent or delay these people from developing into Parkinson's syndrome or Lewy body dementia patients.

How to identify people who have restless dreams and are prone to Parkinson's disease?

There are four main indicators for identifying early neurodegenerative diseases in patients with RBD:

1. Decreased cognitive function . The patient's attention, executive function, and verbal memory abilities are reduced, while the recommended mental status examination scale and dementia rating scale scores reflecting overall cognitive function can be normal.

2. Abnormal brain waves.

3. Decreased striatal dopamine transporters.

4. Decreased brain glucose metabolism.

Rapid eye movement sleep behavior disorder (RBD) is not only a sleep disorder, but also a possible premotor symptom of Parkinson's disease, which provides an opportunity for intervention in the early prevention of Parkinson's disease. RBD has a certain influence on the clinical symptoms of Parkinson's disease. Clinicians should pay more attention to patients with Parkinson's disease accompanied by RBD. Timely intervention of RBD can improve the quality of life of Parkinson's disease patients and reduce or reduce the economic burden.