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Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson's disease: A prospective study

Authors

  • Ronald B. Postuma MD, MSc,

    1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Québec, Canada
    2. Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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    • These authors contributed equally to this work.

  • Josie-Anne Bertrand MPs,

    1. Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
    2. Department of Psychology, Université de Montréal, Montreal, Québec, Canada
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  • Jacques Montplaisir MD, PhD,

    1. Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
    2. Department of Psychiatry, Université de Montréal, Montreal, Québec, Canada
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  • Catherine Desjardins MPs,

    1. Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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  • Mélanie Vendette MSc,

    1. Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
    2. Department of Psychology, Université de Montréal, Montreal, Québec, Canada
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  • Silvia Rios Romenets MD,

    1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Québec, Canada
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  • Michel Panisset MD,

    1. Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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  • Jean-François Gagnon PhD

    Corresponding author
    1. Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
    2. Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
    • Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, 5400 boulevard Gouin ouest, Montréal, Québec H4J 1C5, Canada
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    • These authors contributed equally to this work.


  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

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

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