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Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson's disease: A prospective study
Author(s) -
Postuma Ronald B.,
Bertrand JosieAnne,
Montplaisir Jacques,
Desjardins Catherine,
Vendette Mélanie,
Rios Romenets Silvia,
Panisset Michel,
Gag JeanFrançois
Publication year - 2012
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.24939
Subject(s) - dementia , prospective cohort study , rapid eye movement sleep , parkinson's disease , rem sleep behavior disorder , medicine , dementia with lewy bodies , psychology , disease , eye movement , ophthalmology
Abstract One of the most devastating nonmotor manifestations of PD is dementia. There are few established predictors of dementia in PD. In numerous cross‐sectional studies, patients with rapid eye movement (REM) sleep behavior disorder (RBD) have increased cognitive impairment on neuropsychological testing, but no prospective studies have assessed whether RBD can predict Parkinson's dementia. PD patients who were free of dementia were enrolled in a prospective follow‐up of a previously published cross‐sectional study. All patients had a polysomnogram at baseline. Over a mean 4‐year follow‐up, the incidence of dementia was assessed in those with or without RBD at baseline using regression analysis, adjusting for age, sex, disease duration, and follow‐up duration. Of 61 eligible patients, 45 (74%) were assessed and 42 were included in a full analysis. Twenty‐seven patients had baseline RBD, and 15 did not. Four years after the initial evaluation, 48% with RBD developed dementia, compared to 0% of those without ( P ‐adjusted = 0.014). All 13 patients who developed dementia had mild cognitive impairment on baseline examination. Baseline REM sleep atonia loss predicted development of dementia (% tonic REM = 73.2 ± 26.7 with dementia, 40.8 ± 34.5 without; P = 0.029). RBD at baseline also predicted the new development of hallucinations and cognitive fluctuations. In this prospective study, RBD was associated with increased risk of dementia. This indicates that RBD may be a marker of a relatively diffuse, complex subtype of PD. © 2012 Movement Disorder Society