Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 42
Filter
1.
Arq. neuropsiquiatr ; 79(2): 156-166, Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153155

ABSTRACT

ABSTRACT Parkinson's disease (PD) has heterogeneous clinical manifestations and prognoses. It is accompanied by a group of motor and non-motor symptoms ranging from independence to total disability, limiting work and personal care activities. Currently, disease subtype markers for informing prognosis remain elusive. However, some studies have reported an association between rapid eye movement (REM) sleep behavior disorder (RBD) and faster motor and non-motor symptom progression, including autonomic dysfunction and cognitive decline. Moreover, since autonomic dysfunction has been described in idiopathic forms of RBD, and they share some central regulatory pathways, it remains unclear whether they have a primary association or if they are more severe in patients with PD and RBD, and thus are a disease subtype marker. This article aimed at critically reviewing the literature on the controversies about the prevalence of RBD in PD, the higher incidence of PD non-motor symptoms associated with RBD, the evidence of faster motor worsening in parkinsonian patients with this parasomnia, and the main pathophysiological hypotheses that support these findings.


RESUMO A doença de Parkinson (DP) apresenta variadas manifestações clínicas e distintos prognósticos. É caracterizada por um conjunto de sintomas motores e não motores que podem variar desde um quadro de independência até a completa incapacidade laborativa e de cuidados pessoais. Até o momento, não está claro quais seriam os marcadores de subtipos da doença que poderiam alertar para formas de prognóstico. Porém existem alguns estudos que mostram que a presença do transtorno comportamental do sono REM pode estar associada à progressão mais rápida dos sintomas motores e não motores, como disfunção autonômica e declínio cognitivo. Questiona-se ainda se a disautonomia está primariamente associada ao transtorno do sono REM, já que são relatadas nas formas idiopáticas deste transtorno de sono e compartilham alguns núcleos reguladores centrais. Ou se são mais graves nos pacientes com diagnóstico de DP e transtorno comportamental do sono REM, marcando assim um subtipo da doença. Esta revisão teve como objetivo revisar criticamente os principais estudos publicados envolvendo as controvérsias sobre a prevalência do transtorno comportamental do sono REM na DP, a maior incidência de sintomas não motores da DP associados ao transtorno do sono REM, as evidências de piora motora mais rápida nos pacientes parkinsonianos que apresentam este transtorno do sono e as principais hipóteses fisiopatológicas que justificam esses achados.


Subject(s)
Humans , Parkinson Disease/complications , Sleep Wake Disorders , Autonomic Nervous System Diseases/etiology , REM Sleep Behavior Disorder/etiology , Cognitive Dysfunction
2.
Chinese Journal of Neurology ; (12): 1194-1198, 2021.
Article in Chinese | WPRIM | ID: wpr-911856

ABSTRACT

Multiple system atrophy can have various forms of sleep disorders, including insomnia, rapid eye movement sleep behavior disorder, sleep-disordered breathing, periodic leg movements during sleep and excessive daytime sleepiness. This article will focus on the concept, classification, pathogenesis, clinical features, diagnosis and treatment, aiming to deepen clinicians′ understanding of the disease, which will be helpful for early diagnosis and treatment.

3.
Arq. neuropsiquiatr ; 78(10): 629-637, Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131695

ABSTRACT

ABSTRACT Introduction: A diagnosis of rapid eye movement sleep behavior disorder (RBD) currently requires confirmation with polysomnography (PSG). However, PSG may not be sufficiently available. In these situations, a clinical diagnostic measure might be useful. Objective: To validate the Brazilian Portuguese version of RBD screening questionnaire (RBDSQ) for patients with Parkinson's disease (PD). Methods: Using detailed clinical interviews and PSG analysis (diagnostic gold standard), a convenience sample of 69 subjects was divided into the following subgroups: patients with PD and RBD (PD+RBD; n=50) and patients with PD alone (PD-RBD; n=19). Results: RBDSQ-BR showed adequate internal consistency (Cronbach's α=0.809) and, except for item 8, adequate item-test correlation. The retest performed in a second sample (n=13, consecutive) showed high agreement for total score (intraclass correlation coefficient, ICC=0.863) and acceptable agreement for items 2, 3, 6.2, 6.3, 7, and 8 (K>0.60). The receiver operating characteristic (ROC) curve analysis had an area under the curve (AUC) of 0.728. A cut-off score of 4 enabled the correct diagnosis of 76.8% subjects and provided the best balance between sensitivity (84%) and specificity (57.9%), with a 2.0 likelihood ratio of a positive result (LR+) and a 0.3 likelihood ratio of a negative result (LR-). Items 2 and 6.2 had 84.2% specificity and 3.2 LR+. Combined items 1+2+6.2, 2+6.1, and 6.1+6.2 increased the specificity to 94.7%, with LR+ ranging from 6.1 to 7.6. Conclusions: RBDSQ-BR is a reliable instrument, which may be useful for RBD diagnosis of Brazilian patients with PD. The instrument is also valid and may help in a better selection of cases for a more detailed clinical evaluation or even PSG analysis.


RESUMO Introdução: O diagnóstico do transtorno comportamental do sono REM (TCSREM) implica na realização da polissonografia (PSG), mas sua disponibilidade pode não ser suficiente. Portanto, meios clínicos para o diagnóstico podem ser úteis. Objetivo: Validar para a língua portuguesa falada no Brasil o questionário de triagem do TCSREM (QT-TCSREM) em pacientes portadores de doença de Parkinson (DP). Métodos: Uma amostra por conveniência composta de 69 indivíduos foi dividida em portadores de DP com TCSREM (n=50) e DP sem TCSREM (n=19) através de entrevista clínica detalhada e análise da PSG. Resultados: QT-TCSREM-BR apresentou consistência interna adequada (α de Cronbach=0,809) e, exceto pelo item 8, correlação item-total adequada. Reteste feito em uma segunda amostra (n=13, consecutivos) evidenciou concordância elevada para o escore total (coeficiente de correlação intraclasse, CCI=0,863) e aceitável para os itens 2, 3, 6.2, 6.3, 7 e 8 (K>0,60). Análise da curva característica de operação do receptor (COR) obteve uma área sob a curva de 0,728. O corte 4 permitiu o diagnóstico correto de 76,8% dos indivíduos e apresentou o melhor equilíbrio entre sensibilidade (84%) e especificidade (57,9%), com uma razão de verossimilhança de um resultado positivo (RV+) 2,0 e de um resultado negativo (RV-) 0,3. Os itens 2 e 6.2 obtiveram especificidade 84,2% e RV+ 3,2. Itens combinados 1+2+6,2, 2+6,1 e 6,1+6,2 aumentaram a especificidade para 94,7%, com RV+ variando de 6,1 até 7,6. Conclusões: O QT-TCSREM-BR é um instrumento confiável que pode ser útil para o diagnóstico do TCSREM em pacientes com DP no Brasil. O instrumento também é válido e pode auxiliar numa melhor seleção de casos a serem submetidos a uma avaliação mais detalhada ou até mesmo a uma análise de PSG.


Subject(s)
Humans , REM Sleep Behavior Disorder , Brazil , Mass Screening , Surveys and Questionnaires , Polysomnography/methods
4.
Rev. bras. neurol ; 56(2): 35-44, abr.-jun. 2020. ilus
Article in English | LILACS | ID: biblio-1102915

ABSTRACT

Dreaming is the result of the mental activity of rapid eye movement (REM) sleep stage, and less commonly of non-REM sleep. Dreams offer unique insights into the patients' brains, minds, and emotions. Based on neurophysiological and neuroimaging studies, the biological core of dreaming stands on some brain areas activated or inactivated. Dream abnormalities in neurological disorders include a reduction / cessation of dreaming, an increase in dream frequency, changes in dream contents and accompaniments, and the occurrence of dreamlike experiences (hallucinations) mainly during the wake-sleep/sleep-wake transitions. Dream changes can be associated with several neurological conditions, and the unfolding of biological knowledge about dream experiences can also have significance in clinical practice. Regarding the dream importance in clinical neurological management, the aim of this paper encompasses a summary of sleep stages, dreams neurobiology including brain areas involved in the dreams, memory, and dreams, besides Dreams in the aging people and neurodegenerative disorders.


Sonhar é o resultado da atividade mental do estágio do sono de movimento rápido dos olhos (REM) e, menos comumente, do sono não-REM. Os sonhos oferecem informações únicas sobre o cérebro, a mente e as emoções dos pacientes. Com base em estudos neurofisiológicos e de neuroimagem, o núcleo biológico do sonho está em algumas áreas do cérebro ativadas ou inativadas. As anormalidades do sonho nos distúrbios neurológicos incluem uma redução / cessação do sonho, um aumento na frequência do sonho, alterações nos conteúdos e acompanhamentos do sonho e a ocorrência de experiências semelhantes ao sonho (alucinações), principalmente durante as transições de vigília-sono / sono-vigília. As mudanças do sonho podem estar associadas a várias condições neurológicas, e o desenvolvimento do conhecimento biológico sobre as experiências do sonho também pode ter significado na prática clínica. Com relação à importância do sonho no manejo neurológico clínico, o objetivo deste artigo é resumir os estágios do sono, a neurobiologia dos sonhos, incluindo as áreas do cérebro envolvidas nos sonhos, a memória e os sonhos, além dos sonhos nos idosos e nos distúrbios neurodegenerativos.


Subject(s)
Humans , Child , Adult , Sleep/physiology , Sleep, REM/physiology , Sleep Stages , Dreams/physiology , Polysomnography/methods , REM Sleep Behavior Disorder , Memory , Narcolepsy
5.
Article in Chinese | WPRIM | ID: wpr-828480

ABSTRACT

OBJECTIVE@#To analyze the characteristics of eye movements in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD).@*METHODS@#Twenty two patients with iRBD and 20 controls were enrolled between January 2017 and May 2019 from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Clinical data including polysomnogram (PSG) results were collected. Videonystagmography (VNG) including spontaneous nystagmus, gaze, saccade, tracking and optokinetic test were performed. The difference of VNG results between iRBD patients and controls were analyzed. The factors related to the abnormal VNG results were analyzed by using logistic regression analysis.@*RESULTS@#No significant differences were found between the iRBD and control groups in the spontaneous nystagmus, gaze nystagmus, square wave jerk, involuntary eye movement, saccade and optokinetic nystagmus (all >0.05). In smooth pursuit of 0.4-0.5 Hz and 0.6-0.7 Hz, iRBD patients had more type Ⅲ-Ⅳ curve than controls (=5.177 and 5.301, both <0.05). Logistic regression analysis indicated that less sleep time of N3 stage was related to the abnormal results in smooth pursuit of 0.4-0.5 Hz (=0.963, <0.05). iRBD patients with Ⅲ-Ⅳ type curve in smooth pursuit of 0.4-0.5 Hz had less N3 sleep time than iRBD patients with Ⅰ-Ⅱ type curve (52±28 min vs. 76±23 min, =2.197, <0.05).@*CONCLUSIONS@#Abnormal smooth pursuit was found in iRBD patients, which might be related to the pathological mechanism of iRBD.

6.
Article in English | WPRIM | ID: wpr-765851

ABSTRACT

OBJECTIVE: It is unclear whether the decline in dopamine transporters (DAT) differs among idiopathic rapid eye movement sleep behavior disorder (iRBD) patients with different levels of olfactory impairment. This study aimed to characterize DAT changes in relation to nonmotor features in iRBD patients by olfactory loss. METHODS: This prospective cohort study consisted of three age-matched groups: 30 polysomnography-confirmed iRBD patients, 30 drug-naïve Parkinson's disease patients, and 19 healthy controls without olfactory impairment. The iRBD group was divided into two groups based on olfactory testing results. Participants were evaluated for reported prodromal markers and then underwent 18F-FP-CIT positron emission tomography and 3T MRI. Tracer uptakes were analyzed in the caudate, anterior and posterior putamen, substantia nigra, and raphe nuclei. RESULTS: Olfactory impairment was defined in 38.5% of iRBD patients. Mild parkinsonian signs and cognitive functions were not different between the two iRBD subgroups; however, additional prodromal features, constipation, and urinary and sexual dysfunctions were found in iRBD patients with olfactory impairment but not in those without. Tracer uptake showed significant group differences in all brain regions, except the raphe nuclei. The iRBD patients with olfactory impairment had uptake reductions in the anterior and posterior putamen, caudate, and substantia nigra (p < 0.016 in all, adjusted for age), which ranged from 0.6 to 0.8 of age-normative values. In contrast, those without olfactory impairment had insignificant changes in all regions ranging above 0.8. CONCLUSION: There was a clear distinction in DAT loss and nonmotor profiles by olfactory status in iRBD.


Subject(s)
Brain , Cognition , Cohort Studies , Constipation , Dopamine Plasma Membrane Transport Proteins , Dopamine , Humans , Magnetic Resonance Imaging , Parkinson Disease , Positron-Emission Tomography , Prospective Studies , Putamen , Raphe Nuclei , REM Sleep Behavior Disorder , Sleep, REM , Smell , Substantia Nigra
7.
Article in Chinese | WPRIM | ID: wpr-805431

ABSTRACT

Objective@#To explore the topological abnormality of brain metabolic network in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and compare it with the topology of brain metabolic network in patients with Parkinson′s disease (PD).@*Methods@#The 18F-fluorodeoxyglucose (FDG) PET brain images of 19 patients with iRBD diagnosed with polysomnography (PSG) (iRBD group; 15 males, 4 females, average age: 64.9 years), 19 patients with PD (PD group; 12 males, 7 females, average age: 62.2 years) and 19 gender and age-matched healthy controls (HC group; 15 males, 4 females, average age: 63.1 years) in Huashan Hospital from September 2014 to June 2015 were retrospectively analyzed. According to the complex brain network method based on graph theory, the brain metabolic networks of each group was constructed and the network parameters (clustering coefficient, characteristic path length, local efficiency, global efficiency and small-world property, etc) were evaluated quantitatively. The 500 times non-parametric permutation test was used to determine the differences in network parameters between groups.@*Results@#The brain metabolic networks of iRBD group and PD group both had abnormal topological structure, which showed that the characteristic path length (for example, when sparsity=34%, HC vs iRBD vs PD groups: 1.517 vs 1.552 vs 1.561) and local efficiency (for example, when sparsity=30%, HC vs iRBD vs PD groups: 0.802 vs 0.824 vs 0.831) were significantly increased (both P<0.05), the global efficiency (for example, when sparsity=36%, HC vs iRBD vs PD groups: 0.672 vs 0.658 vs 0.656) was significantly decreased (P<0.05). The topology was more aggravated in PD group compared with that in iRBD group.@*Conclusion@#The graph-based complex brain network analysis can reveal the abnormal topological structure of the brain metabolic network in which iRBD progresses to PD.

8.
Article in Chinese | WPRIM | ID: wpr-755268

ABSTRACT

Objective To explore the topological abnormality of brain metabolic network in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and compare it with the topology of brain metabolic network in patients with Parkinson's disease (PD).Methods The 18F-fluorodeoxyglucose (FDG) PET brain images of 19 patients with iRBD diagnosed with polysomnography (PSG) (iRBD group;15 males,4 females,average age:64.9 years),19 patients with PD (PD group;12 males,7 females,average age:62.2 years) and 19 gender and age-matched healthy controls (HC group;15 males,4 females,average age:63.1 years) in Huashan Hospital from September 2014 to June 2015 were retrospectively analyzed.According to the complex brain network method based on graph theory,the brain metabolic networks of each group was constructed and the network parameters (clustering coefficient,characteristic path length,local efficiency,global efficiency and small-world property,etc) were evaluated quantitatively.The 500 times non-parametric permutation test was used to determine the differences in network parameters between groups.Results The brain metabolic networks of iRBD group and PD group both had abnormal topological structure,which showed that the characteristic path length (for example,when sparsity =34%,HC vs iRBD vs PD groups:1.517 vs 1.552 vs 1.561) and local efficiency (for example,when sparsity=30%,HC vs iRBD vs PD groups:0.802 vs 0.824 vs 0.831) were significantly increased (both P<0.05),the global efficiency (for example,when sparsity =36%,HC vs iRBD vs PD groups:0.672 vs 0.658 vs 0.656) was significantly decreased (P<0.05).The topology was more aggravated in PD group compared with that in iRBD group.Conclusion The graph-based complex brain network analysis can reveal the abnormal topological structure of the brain metabolic network in which iRBD progresses to PD.

9.
Article in Chinese | WPRIM | ID: wpr-816095

ABSTRACT

Sleep disorders are very common non-motor symptoms in Parkinson disease(PD) related to the life quality of patients, mainly including insomnia, arousal disorders, restless legs syndrome(RLS), REM sleep behavior disorder(RBD) and sleep disorders breathing(SDB). In this article, the author discusses the causes and the current state of the diagnosis and management of sleep disorders in PD, aiming to increase clinical doctors' attention to it.

10.
Chinese Journal of Neurology ; (12): 580-585, 2018.
Article in Chinese | WPRIM | ID: wpr-710988

ABSTRACT

Objective To investigate the abnormal functional connectivity (FC) between the cores (including sublaterodorsal nucleus (SLD) and ventrolateral periaqueductal gray matter (vlPAG)) and the whole brain in rapid eye movement sleep behavior disorder (RBD) by resting state functional magnetic resonance imaging (rfMRI).Methods A total of 41 subjects recruited in the Department of Neurology,the People's Hospital of Zhengzhou University were enrolled in this study according to international diagnosis criteria,including 20 with idiopathic RBD (iRBD group) and 21 age,sex-matched normal controls (control group).All subjects were examined by Hoehn-Yahr Staging,cognitive tests and rfMRI.Resluts HoehnYahr staging score was 0(0,0) in the iRBD group,which showed no significant difference from that in the control group (0 (0,0),Z =-1.820,P =0.069).The scores of Rey Auditory Verbal Learning Test (AVLT) N1,AVLT N2,Symbol Digital Modalities Test,Rey-Osterrieth Complex Figure Test-Copy were 3.80 ± 1.67,5.10 ± 1.77,33.00(31.25,34.00) and 22.00(20.25,26.00) respectively in the iRBD group,which were significantly lower than that in the control group (4.95 ± 1.28,t =2.482,P =0.017;6.43±1.16,t =2.848,P=0.007;33.00(29.50,35.50),Z=-3.792,P=0.000;35.00(33.00,36.00),Z =-2.351,P =0.019) respectively.The scores of Trail Making Test 1 (86.5 (70.0,100.0))and Trail Making Test 2 (197.0(180.5,211.5)) in the iRBD group were significantly higher than that in the control group (66.0(49.0,91.5),112.0(99.5,173.0) respectively,Z=-2.373,P=0.018;Z =-3.105,P =0.002).Compared with the control group,the FC analysis showed reduced connections from the right SLD to the bilateral cingnlate gyrus (t =-4.173) and bilateral frontal gyrus (t =-2.965(left),-3.662(right)),from the vlPAG to the left precentral-postcentral gyrus(t =3.930),and from the vlPAG to the right frontal gyrus (t =4.141) in the iRBD.There was no statistically significant difference from the left SLD to the whole brain.Conclusion There were abnormal FCs from the SLD and vlPAG to cognitive and motor areas in RBD patients,perhaps leading to clinical RBD symptoms such as cognitive deterioration and movement disorder.

11.
Article in Chinese | WPRIM | ID: wpr-708882

ABSTRACT

Rapid eye movement sleep behavior disorder (RBD) is a condition characterized by rap id eye movement sleep without atonia and with complex behaviors associated with dreams.Numerous studies have revealed that idiopathic RBD is the prodromal manifestation of neurodegenerative disorders,especially those mediated by α-synuclein.The structural and functional imaging of RBD,including transcranial sonog raphy (TCS),MRI,SPECT,PET,are increasingly becoming the hot issues.This review summarizes the radionuclide imaging in RBD,which may be one of the most promising modalities to detect the biomarkers for early diagnosis of neurodegenerative disorders.

12.
Article in Korean | WPRIM | ID: wpr-766215

ABSTRACT

OBJECTIVES: The dream recall and sleep of patients with rapid eye movement sleep behavior disorder (RBD) were not sufficiently studied. We hypothesized that RBD patients have frequent dream recall with poor sleep quality, and investigated the relationship between the dream recall frequency and sleep quality in RBD patients compared to controls. METHODS: We analyzed 81 drug naïve patients [RBD (+), 64.6±8.3 y, 57 males] and 81 age and gender matched patients with sleep disturbances without RBD [RBD (−), 63.7±7.3 y, 57 males]. All completed Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleepiness scale and Beck depression inventory. The 5-point rating scale was used to categorize dream recall frequency of most recent month (0=never, 4=very frequent). RESULTS: In RBD (+), dream recall frequency was much higher [frequent dreaming, 77.2% vs. 35.4%], and subjective sleep quality was much better [PSQI, 6.36±3.26 vs. 8.71±4.69]. Insomnia severity was much less in RBD (+) (ISI, 9.13±5.86) than RBD (−) (12.43±7.62). No significant differences were found in sleep parameters except lower N2 sleep % in RBD (+). The relationship between dream recall frequency and sleep was not significant in RBD (+), yet, a positive correlation was noted in RBD (−). CONCLUSIONS: RBD (+) had better sleep quality despite higher frequency of dream recall compared to RBD (−). Also dream recall was not related to their sleep quality in RBD (+), which suggests that RBD patients may have different sleep perception about their sleep and sleep quality.


Subject(s)
Depression , Dreams , Humans , REM Sleep Behavior Disorder , Sleep Initiation and Maintenance Disorders , Sleep, REM
13.
Article in English | WPRIM | ID: wpr-766211

ABSTRACT

Sleep disorders are commonly observed in multiple systemic atrophy (MSA). The rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of normal voluntary muscle atonia during REM sleep. It usually presents during early course, and disappears over the course of disease progression. Sleep-disordered breathing (SDB) is also common sleep disorder in MSA which can be life-threatening, and continuous positive airway pressure (CPAP) treatment is useful in these patients. A 74-year-old woman with MSA presented for nocturnal respiratory disturbance. She had a five-year history of dream enacting behaviors, which had disappeared four months prior. Polysomnography revealed frequent stridor and sleep hypopnea. During the following full nigh CPAP titration for SDB, dream enacting behavior was observed during REM sleep stage. In MSA patients with SDB, CPAP administration may lead to increase REM sleep stage. An increase in REM sleep stage, which previously had been deprived, may have trigger RBD symptoms to reappear. The CPAP treatment should be considered with great caution in these patients.


Subject(s)
Aged , Atrophy , Continuous Positive Airway Pressure , Disease Progression , Dreams , Female , Humans , Multiple System Atrophy , Muscle, Skeletal , Polysomnography , REM Sleep Behavior Disorder , Respiratory Sounds , Sleep Apnea Syndromes , Sleep Wake Disorders , Sleep, REM
14.
The Journal of Practical Medicine ; (24): 3387-3390, 2017.
Article in Chinese | WPRIM | ID: wpr-661350

ABSTRACT

Objective To investigate the relationships between the clinical and subclinical REM sleep behavior disorder(sRBD)and the cognitive function in patients with PD. Methods We enrolled 53 patients with PD from the Second Affiliated Hospital of Nanchang University. The age ,gender and education level of each patient were recorded. Patients with dementia were excluded. The correlative scales were assessed by the form of face to face,including Montreal cognitive function score(MoCA),Unified Parkinson Disease Rating Scale(UPDRS), Parkinson Disease Sleep Scale (PDSS) and so on. The sleep quality was assessed by polysomnography(PSG), meanwhile PD patients were divided into the RBD group(PD-RBD),the subclinical RBD group(PD-sRBD)and the normal REM group(PD-REM)based on the polysomnography. The cognitive function was compared among the three groups. Results (1)MoCA score of PD patients in the RBD group was lower than that in the normal REM group(P = 0.032.(2)No significant difference was observed in the cognitive function between the sRBD group and the normal REM group.(3)Length of morbidity of PD patients with RBD was longer than that of PD patients with sRBD(P=0.021). Conclusions The presence of RBD may be an important relative factor for the develop-ment of cognitive dysfunction in PD patients. We haven′t detected that the subclinical RBD was associated with the cognitive dysfunction in patients with PD. It is not clear whether the subclinical RBD in PD patients develops to RBD in all patients,which needs further investigation.

15.
The Journal of Practical Medicine ; (24): 3387-3390, 2017.
Article in Chinese | WPRIM | ID: wpr-658431

ABSTRACT

Objective To investigate the relationships between the clinical and subclinical REM sleep behavior disorder(sRBD)and the cognitive function in patients with PD. Methods We enrolled 53 patients with PD from the Second Affiliated Hospital of Nanchang University. The age ,gender and education level of each patient were recorded. Patients with dementia were excluded. The correlative scales were assessed by the form of face to face,including Montreal cognitive function score(MoCA),Unified Parkinson Disease Rating Scale(UPDRS), Parkinson Disease Sleep Scale (PDSS) and so on. The sleep quality was assessed by polysomnography(PSG), meanwhile PD patients were divided into the RBD group(PD-RBD),the subclinical RBD group(PD-sRBD)and the normal REM group(PD-REM)based on the polysomnography. The cognitive function was compared among the three groups. Results (1)MoCA score of PD patients in the RBD group was lower than that in the normal REM group(P = 0.032.(2)No significant difference was observed in the cognitive function between the sRBD group and the normal REM group.(3)Length of morbidity of PD patients with RBD was longer than that of PD patients with sRBD(P=0.021). Conclusions The presence of RBD may be an important relative factor for the develop-ment of cognitive dysfunction in PD patients. We haven′t detected that the subclinical RBD was associated with the cognitive dysfunction in patients with PD. It is not clear whether the subclinical RBD in PD patients develops to RBD in all patients,which needs further investigation.

16.
Chinese Journal of Neurology ; (12): 594-598, 2017.
Article in Chinese | WPRIM | ID: wpr-617801

ABSTRACT

Objective To investigate the abnormal functional connectivity (FC) between the substantia nigra (SN) and the brain motor area in rapid eye movement sleep behavior disorder (RBD) by Unified Parkinson′s Disease Rating Scale (UPDRS), Hoehn-Yahr Scale and resting state functional magnetic resonance imaging (rfMRI).Methods A total of 34 subjects (14 with RBD (RBD group), 12 with Parkinson′s disease (PD group), and 8 age, sex-matched normal controls (control group)) recruited in the Department of Neurology, Henan Provincial People′s Hospital from 2014 to 2015 were enrolled in this study according to international diagnosis criteria.All subjects were examined by UPDRS, Hoehn-Yahr Scale and rfMRI.Results UPDRS scores and Hoehn-Yahr staging were 0.00 (0.00, 3.75) and 0.00 (0.00, 0.50) respectively in the RBD group, which were significantly different from that in the PD group (30.5 (18.75, 33.00) and 1.75 (1.50, 2.50), respectively;Z=-3.782, P0.05 and Z=1.10, P>0.05).The FC analysis showed alterations from the right SN to bilateral cerebellum respectively among the three groups (Fright cerebellum=12.975, Fleft cerebellum=6.144;P0.05).Conclusions There was abnormal FC from the SN to motor areas in RBD patients, and partial alterations were similar as PD patients.rfMRI provided an evidence that RBD might be presymptom of PD.

17.
Chinese Journal of Neurology ; (12): 520-525, 2017.
Article in Chinese | WPRIM | ID: wpr-616513

ABSTRACT

Objective To determine the polysomnographic characteristics in idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) patients with different severity of obstructive sleep apnea (OSA).Methods A total of 206 consecutive iRBD patients (80.1% males,mean age was (66.2 ± 10.0) years) were recruited based on international classification of sleep disorders]] diagnostic criteria and confirmed by video-polysomnography.Patients were divided into three groups according to the severity of OSA,namely no OSA group (apnea-hypopnea index (AHI) ≤ 5/hour,n =48),mild to moderate OSA group (AHI 5-30/hour,n =100),and severe OSA group (AHI > 30/hour,n =58).Results When comparing the severe OSA patients with no and mild to moderate OSA patients,as expected,patients with severe OSA had higher percentage of stage Ⅰ sleep (22.9% ± 12.2% vs 13.2% ±6.4%,15.4% ± 6.0%,F =21.80,P <0.01),lower percentage of stage Ⅱ sleep (58.5% ± 10.4% vs 68.0% ±20.5%,61.8% ±10.5%,F=6.62,P<0.01),less REM sleep (16.0% ±8.2% vs 19.3% ±9.8%,20.0% ± 7.8%,F=4.24,P=0.02) as well as higher arousal index ((33.4 ± 16.2)/h vs (8.9 ±4.3)/h,(14.9 ±6.5)/h,F =94.56,P <0.01).In addition,patients with severe OSA had a lower percentage of total electromyography (EMG) activity during REM sleep than other two groups (27.2% (25.9%) vs 30.3% (25.2%),39.1% (28.0%),H =8.20,P =0.02).There were no statistically significant differences in total sleep time,sleep efficiency,sleep latency,slow wave sleep,periodic limb movement index and period limb movements during sleep.Conclusions Patients with iRBD comorbided with severe OSA have distinct polysomnographic characteristics when compared with those without OSA and those with mild-to-moderate OSA.Those patients have increased sleep time in stage Ⅰ sleep,decreased sleep time in stage Ⅱ sleep and REM sleep,and more easily awakened from total sleep.Patients with iRBD comorbided with severe OSA have a lower percentage of tonic EMG activity during REM sleep.Excessive tonic EMG activity of upper airway muscle during REM sleep in iRBD might protect patients against severe OSA.

18.
Psychiatry Investigation ; : 227-231, 2016.
Article in English | WPRIM | ID: wpr-61682

ABSTRACT

OBJECTIVE: REM sleep behavior disorder (RBD) is associated with psychiatric symptoms, such as anxiety and alexithymia. However, only a few studies on the relationship between depression and RBD have been published. In this study, we investigated the occurrence of depression and associated factors in patients with RBD. METHODS: In total 94 patients (mean age: 61.9±12.7 years, male: 70.2%) diagnosed as RBD were examined using detailed clinical histories, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and nocturnal polysomnography (PSG). RESULTS: The mean BDI score of all patients was 12.4±10.3 and 44.7% of RBD patients showed depressed mood (BDI >11 points). Depressed RBD patients were less able to recall enacted dreams than were non-depressed patients (61.9% vs. 86.5%, p=0.008). Logistic regression analysis showed that failure to recall enacted dreams was significantly associated with depression, after controlling for confounding variables including the respiratory disturbance index and a history of psychiatric disorders (odds ratio=0.323, p=0.041). CONCLUSION: In this study, 44.7% of RBD patients were found to suffer from depressed mood. And, depression was found to be associated with reduced ability to recall enacted dreams. We suggest that routine evaluation of depression be performed in RBD patients, particularly when failure to recall enacted dreams is evident. We speculate that such failure may be associated with emotional dysregulation or neurodegeneration.


Subject(s)
Affective Symptoms , Anxiety , Depression , Dreams , Humans , Logistic Models , Male , Polysomnography , REM Sleep Behavior Disorder , Sleep, REM
19.
Article in Chinese | WPRIM | ID: wpr-491638

ABSTRACT

Present data achieving from collecting showed it should be pay attention to the intimate connection between rapid eye movement sleep behavior disorder( RBD) and neurodegenerative diseases such as Parkinson’ s disease( PD) ,there is a scholar who has announced that RBD is the mark of alpha-synucle-in,and the PD patients who also have the RBD may appear some certain clinical features.To integrate exist-ing data and analyze the research progress of Parkinson's disease with REM sleep behavior disorder,it’ s ex-tremely close between PD and RBD,however,their exact mechanism and the accurate relationship remains to be further defined so that we can correspond treatment such as nerve protection as soon as possible,to help delay occurrence or progress about disease.

20.
Rev. colomb. psiquiatr ; 44(4): 251-255, oct.-dic. 2015. ilus
Article in Spanish | LILACS, COLNAL | ID: lil-779631

ABSTRACT

A un varón adulto mayor, con un cuadro clínico documentado de trastorno comportamental del sueño MOR, inicialmente se le ofreció tratamiento farmacológico con clonazepam, recomendado por la literatura, pero se obtuvo mala adherencia por intolerancia a los efectos secundarios y la persistencia sintomática. Por ese motivo, se propuso el tratamiento con trazodona y se logró control sintomático completo, sin efectos adversos reportados por el paciente. Es claro que la trazodona no tiene indicación conocida para este tipo de trastornos, pero se consideró en este caso por su perfil farmacológico y se obtuvo un resultado clínico satisfactorio. Se plantea la necesidad de realizar mayores estudios que permitan documentar de manera suficiente la acción, la eficacia y la utilidad de esta molécula en casos como el ilustrado.


This case concerns an elderly man with a REM sleep behavior disorder, who was initially offered a pharmacological treatment with clonazepam, recommended by other articles, but with poor adherence due to its adverse reactions and persistence of symptoms. He was then offered a treatment with Trazodone was offered, achieving a complete remission of symptoms, with no reported side effects. It is clear that Trazodone has no known indication for this type of disorder; nevertheless, it was considered in this case because of its pharmacological profile, obtaining satisfactory results. Further research is needed in order to document thoroughly the mechanisms of action, efficacy and utility of this molecule in cases such as the one presented.


Subject(s)
Humans , Male , Aged , Trazodone , REM Sleep Behavior Disorder , Mental Disorders , Achievement , Therapeutics , Efficacy , Clonazepam
SELECTION OF CITATIONS
SEARCH DETAIL