Rapid eye movement sleep behavior disorder and neurodegenerative diseases

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  • Suzuki Keisuke
    Department of Neurology, Dokkyo Medical University, Tochigi, Japan
  • Miyamoto Masayuki
    School of Nursing, Dokkyo Medical University, Tochigi, Japan
  • Hirata Koichi
    Department of Neurology, Dokkyo Medical University, Tochigi, Japan
  • Miyamoto Tomoyuki
    Department of Neurology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan

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Other Title
  • レム睡眠行動異常症と神経変性疾患
  • レム スイミン コウドウ イジョウショウ ト シンケイ ヘンセイ シッカン

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<p>Rapid eye movement sleep behavior disorder （RBD） is a parasomnia characterized by abnormal, dream-enacting behavior during REM sleep associated with nightmare, often results in injury to themselves or their bed partners.　Typically, most RBD patients can recall the details of vivid dreams upon awakening.　RBD usually emerges after the age of 50 years with a male predilection and an estimated prevalence is reported to be 0.5% in the general population.　The proposed pathophysiology of human RBD is that the involvement of brainstem nuclei responsible for controlling REM sleep, including pedunculopontine nucei, laterodorsal tegmental nucleus, sublaterodorsal nuclei and locus coeruleus, and neuronal networks involving the limbic system and neocortex may contribute to the occurrence of RBD.　Detecting REM sleep without atonia by polysomnography （PSG） is required for RBD diagnosis;however, prior to PSG examination, RBD screening tools, such as RBD screening questionnaire, are useful in clinical practice.　Low-dose clonazepam before bedtime is effective in most patients with RBD.　Several follow-up studies of RBD patients demonstrated the significant number of RBD patients developed synucleinopathies such as Parkinson’s disease （PD）, dementia with Lewy bodies （DLB） and multiple system atrophy （MSA）.　In addition, RBD patients exhibit olfactory impairment, color discrimination deficits, cognitive impairment, a reduced uptake of cardiac 123I-MIBG scintigraphy and hyperechogenicity of the substantia nigra on transcranial sonography, which are observed in Lewy body diseases such as PD and DLB.　Accumulating evidence suggests that idiopathic RBD could be a prodromal phase of Lewy body diseases and idiopathic RBD patients may be ideal condidates for future neuroprotective, disease modifying therapy.　We also discuss characteristic findings of cognitive impairment in PD and RBD. </p>

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