Sleep Disorder May Help Predict Parkinson's Decades Earlier

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Sleep Disorder May Help Predict Parkinson's Decades Earlier

WEDNESDAY, July 28 -- A certain type of sleep disorder may be an early warning

of Parkinson's disease and other neurological disorders, new research confirms.

Patients with REM sleep behavior disorder, a condition in which people violently

act out their dreams during the rapid eye movement cycle of sleep, have been

found to develop Parkinson's and related neurological disorders as much as a

half century later.

The findings suggest that these neurological disorders may start developing much

earlier than previously suspected.

Once researchers can identify which patients with REM sleep behavior disorder

(RBD) will go on to develop a neurodegenerative disease -- something that is not

yet possible -- they may be able to intervene earlier.

" It just makes sense that we're not going to really impact diseases like this

unless we intervene early, " said Dr. Bradley F. Boeve, senior author of a paper

released online July 28 in advance of publication in the Aug. 10 print issue of

Neurology.

" If you can intervene when the disease is still at the brain stem and not

affecting some other critical structure in the brain, hopefully at the very

least we can slow it down, " he said.

Another expert, Dr. Thorpy, agrees. " This is important for us

understanding the progression of the disease because this RBD obviously precedes

other clinical manifestations of Parkinson's by many years, " said Thorpy,

director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New

York City. " In the future, should we ever have something that can modify the

disease process of Parkinson's, then very early diagnosis may be critical. "

A connection between Parkinson's and RBD was first noticed a couple of decades

ago by researchers at the Mayo Clinic, said Boeve, a professor of neurology at

the Mayo Clinic in Rochester, Minn. Until now, the median interval noted between

the two was about 10 years.

" Some people tell us that their wedding night -- that was the first time couples

slept together back in those days " -- was the first indication of a problem,

Boeve said. " Wives would report 'I got punched. I didn't know what I would be

enduring for decades to come.' "

Boeve and his co-authors reviewed Mayo Clinic records to identify 27 patients

who had RBD and went on to develop Parkinson's, dementia with Lewy bodies or

multiple system atrophy, all neurodegenerative diseases, 15 or more years later.

Thirteen of the patients were diagnosed with dementia, another 13 with

Parkinson's and one with multiple system atrophy.

Among the entire database of hundreds of patients (this included people with

shorter intervals between the two diagnoses), only one with the sleep disorder

had autopsy-confirmed Alzheimer's, Boeve said.

The average time elapsing between RBD and one of the other diseases was 25

years, the researchers found.

Eighty-nine percent of the patients in the sample were men, although it's not

clear why, as neurological disorders affect both genders, noted the authors of

an accompanying editorial.

Boeve cautions that " not everybody that acts out dreams at night has RBD. " They

may have another sleep disorder producing similar symptoms, he said.

And it's unlikely that everyone with RBD will go on to develop Parkinson's or a

kindred disorder, if they live long enough, he said.

The new findings, while informative, aren't enough by themselves to make a

difference in patients' lives, experts said.

Dr. Singer, professor of neurology at the University of Miami

School of Medicine, said clinicians won't be able to identify candidates for

early intervention " unless we find another clue how to distinguish [those who do

progress and those who don't] at an early stage. "

More information

Visit the National Sleep Foundation for more on REM sleep behavior disorder.

Source:

http://tinyurl.com/27h2jel