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Manifestations of Parkinson disease differ in association with REM sleep behavior disorder

Authors

  • Ronald B. Postuma MD, MSc,

    Corresponding author
    1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
    2. Centre d'etude du sommeil, Hopital du Sacre-Coeur, Montreal, Quebec, Canada
    • Department of Neurology, L7-305 Montreal General Hospital, 1650 Cedar Ave., Montreal, Quebec, Canada H3G 1A4
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  • Jean-Francois Gagnon PhD,

    1. Centre d'etude du sommeil, Hopital du Sacre-Coeur, Montreal, Quebec, Canada
    2. Department of Psychiatry, Université de Montréal, Quebec, Canada
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  • Melanie Vendette BSc,

    1. Centre d'etude du sommeil, Hopital du Sacre-Coeur, Montreal, Quebec, Canada
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  • Katia Charland MSc,

    1. Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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  • Jacques Montplaisir MD, PhD

    1. Centre d'etude du sommeil, Hopital du Sacre-Coeur, Montreal, Quebec, Canada
    2. Department of Psychiatry, Université de Montréal, Quebec, Canada
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  • Potential conflict of interest: R.B. Postuma received personal compensation from Novartis for consulting services. J.Y. Montplaisir received personal compensation as consultant (Boehringer Ingelheim, Servier, Shire Biochem), speaker (Boehringer, Shire), and received financial support for research activities from Sanofi Synthelabo, GlaxoSmithKline. J.F. Gagnon, M. Vendette and K. Charland have nothing to disclose.

Abstract

REM sleep behavior disorder (RBD) is commonly associated with Parkinson disease (PD), but it is unclear whether this association has implications for disease manifestations. We evaluated 36 PD patients for the presence of RBD by polysomnography. Patients underwent an extensive evaluation by a movement disorders specialist blinded to polysomnography results. Severity of motor manifestations, autonomic, visual, psychiatric, and olfactory dysfunctions and quality of life (QOL) were assessed, and compared using regression analysis that adjusted for disease duration, age and sex. Severity of motor manifestations did not differ between groups. However, the presence of RBD in PD was strongly associated with symptoms and signs of orthostatic hypotension (systolic blood pressure lying to standing = −25.7 ± 13.0 mmHg vs. −4.9 ±14.1, P < 0.001); and orthostatic symptom prevalence = 71% vs. 27%, P = 0.0076). There was no association between RBD and other autonomic symptoms. Color vision was worse in patients with RBD, but olfactory dysfunction did not differ between groups. The prevalence of depression, hallucinations, paranoia, and impulse disorders did not differ between groups. Emotional functioning and general health QOL measures were lower in those with RBD, but there were no differences between groups on disease-specific indices or on measures of overall physical QOL. These findings suggest that the pathophysiology of RBD and nonmotor manifestations of PD, particularly autonomic dysfunction, are linked. © 2008 Movement Disorder Society

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