Wednesday, November 6, 2024

A little-understood sleep disorder affects millions and has clear links to dementia – 4 questions answered

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A little-understood sleep disorder affects millions and has clear links to dementia – 4 questions answered

What is REM Sleep Behavior Disorder?

REM sleep behavior disorder, or RBD, is a sleep disorder that occurs during the rapid eye movement, or REM, stage of sleep. It is characterized by acting out dreams, which can result in injuries to the individual or their bed partner. The disorder is poorly understood, but it is known to be associated with neurodegenerative brain diseases such as Parkinson’s disease and dementia with Lewy bodies.

REM sleep behavior disorder affects around 1% of the general population worldwide and about 2% of adults over 65. The disorder can occur at any age, but symptoms usually start with people in their 40s and 50s. For those younger than 40, antidepressants are the most common cause of REM sleep behavior disorder; in these younger patients, it affects biological males and females about equally, but past age 50, it’s more common in biological males.

What Causes REM Sleep Behavior Disorder?

The disease mechanism of REM sleep behavior disorder is not well understood. In some cases, a clear cause cannot be identified. In other cases, the disorder may be caused by something specific, such as obstructive sleep apnea, narcolepsy, psychiatric disorders, use of antidepressants, autoimmune disorders, and brain lesions.

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In both situations, REM sleep behavior disorder may be associated with synucleinopathies, a group of neurodegenerative disorders in which aggregates of the protein α-synuclein accumulate in brain cells. The most common of these neurodegenerative disorders is Parkinson’s disease. Others are dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. REM sleep behavior disorder may precede these diseases or occur at any time during the disease process.

REM sleep behavior disorder may be the first symptom of Parkinson’s disease or dementia with Lewy bodies. It is observed in 25% to 58% of patients diagnosed with Parkinson’s, 70% to 80% of patients with dementia with Lewy bodies, and 90% to 100% of those with multiple system atrophy.

In a long-term study of 1,280 patients with REM sleep behavior disorder who didn’t have parkinsonism or dementia, researchers followed participants to find out how many would develop these disorders. After 12 years, 73.5% of those with REM sleep behavior disorder had developed a related neurodegenerative disorder.

Some of the factors that independently increased the risk of developing a neurodegenerative disorder were the presence of irregular motor symptoms, abnormal dopamine levels, loss of sense of smell, cognitive impairment, abnormal color vision, erectile dysfunction, constipation, and older age.

Does an Early Diagnosis Help?

For most neurodegenerative disorders, there is a phase that may last for decades in which brain changes are taking place but the patient either remains asymptomatic or develops symptoms without the full expression of the disease. RBD, in that scenario, is an early sign of those disorders. This provides an opportunity to study how the disease progresses in the brain and to develop therapies that could either slow this process or prevent it from happening.

At this time, there are no approved therapies to prevent the onset of these neurodegenerative diseases in those with REM sleep behavior disorder. There are, however, medications such as melatonin and clonazepam that may improve the symptoms. We also recommend measures to avoid injury, such as removing breakable objects from the room, protecting windows, and padding floors.

Patients who are affected by REM sleep behavior disorder may choose to participate in research. Proper treatment of the disease can help prevent injury and improve quality of life.

Conclusion

REM sleep behavior disorder is a little-understood sleep disorder that affects millions of people worldwide. It is characterized by acting out dreams, which can result in injuries to the individual or their bed partner. The disorder is associated with neurodegenerative brain diseases such as Parkinson’s disease and dementia with Lewy bodies. Early diagnosis and treatment of the disorder may help prevent injury and improve quality of life.

FAQs

Q: What is REM sleep behavior disorder?

A: REM sleep behavior disorder, or RBD, is a sleep disorder that occurs during the rapid eye movement, or REM, stage of sleep. It is characterized by acting out dreams, which can result in injuries to the individual or their bed partner.

Q: What causes REM sleep behavior disorder?

A: The disease mechanism of REM sleep behavior disorder is not well understood. In some cases, a clear cause cannot be identified. In other cases, the disorder may be caused by something specific, such as obstructive sleep apnea, narcolepsy, psychiatric disorders, use of antidepressants, autoimmune disorders, and brain lesions.

Q: What are the links between the sleep disorder and dementia?

A: REM sleep behavior disorder may be the first symptom of Parkinson’s disease or dementia with Lewy bodies. It is observed in 25% to 58% of patients diagnosed with Parkinson’s, 70% to 80% of patients with dementia with Lewy bodies, and 90% to 100% of those with multiple system atrophy.

Q: Does an early diagnosis help?

A: For most neurodegenerative disorders, there is a phase that may last for decades in which brain changes are taking place but the patient either remains asymptomatic or develops symptoms without the full expression of the disease. RBD, in that scenario, is an early sign of those disorders. This provides an opportunity to study how the disease progresses in the brain and to develop therapies that could either slow this process or prevent it from happening.

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