Sleep disorder associated to sooner development of Parkinson’s illness

According to a UK study, early-stage Parkinson’s patients with Rapid Eye Movement Sleep Behavior Disorder (RBD) have more severe symptoms and show faster disease progression in terms of motor, mood, and cognitive symptoms.

In addition, these patients were at higher of frequent falls, aisle freeze – when they felt their feet were “sticking” to the floor and unable to move forward – and mild cognitive impairment compared to patients without RBD.

These results underscore the importance of screening for RBD symptoms in predicting disease progression, providing better personalized treatment, and identifying patients who could benefit from previously targeted motor interventions, the researchers noted.

The study, “Longitudinal changes in Parkinson’s symptoms with and without sleep disturbance from rapid eye movements: The Oxford Discovery Cohort Study“Was published in Movement Disorders magazine.

In addition to the well-known motor symptoms, Parkinson’s disease is characterized by non-motor symptoms such as cognitive impairment, sleep disorders and depression.

RBD, a sleep state in which a person physically responds to events that occur in a dream, affects up to 42% of people with Parkinson’s disease and has been increasingly studied as a potential early marker of the disease.

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Previous research has also indicated that RBD is linked to “higher exposure to non-motor symptoms as well as more severe motor disorders,” but whether its presence in early Parkinson’s affects the rate of progression of other symptoms remains largely unclear, the researchers added.

To address this, a team of researchers from Oxford University in the UK looked at the effects of RBD on the progression of motor and non-motor symptoms over time in 923 people with early Parkinson’s.

Patients had been diagnosed within the past 3.5 years and were recruited from 2010 to 2019 to join the Discovery Cohort at Oxford Parkinson’s Disease Center, an ongoing study of early Parkinson’s disease involving 11 hospitals.

Participants’ demographic and clinical characteristics, including motor and non-motor symptoms, were assessed every 18 months through questionnaires and interventions. Since RBD rates in Parkinson’s patients had previously been shown to increase over time, their potential presence was determined over time based on the results of the RBD screening questionnaire.

The mean age of the patients was 67.1 years and the majority were men (64.1%), married (78.2%), and white (94.8%). A total of 788 (85.4%) participants completed at least one follow-up examination – with an average follow-up time of 4.8 years and up to 8.3 years – and 153 completed all examinations.

Reasons for limited follow-up data included serious illness that prevented such assessments, study discontinuation or loss of follow-up, and death.

The results showed that 307 patients (33.3%) had possible RBD either at baseline or during follow-up. These patients were significantly more likely than men to receive higher levodopa-equivalent daily doses than patients with no evidence of RBD.

The presence of RBD was not significantly associated with dopamine agonist use.

Compared to patients without RBD, those with the sleep disorder had more severe symptoms at baseline, including poor general motor skills, posture, balance, walking difficulties, sleeping problems, depression, anxiety, and cognitive function.

RBD-positive patients also showed faster progression in general non-motor and motor symptoms, as well as dexterity problems, depression, and cognitive impairment. They also had a significantly higher of frequent falls, hallway freezes, and mild cognitive impairment compared to patients without RBD.

The results were obtained after adjusting for potential influencing factors such as age, gender and levodopa-equivalent daily doses at the start of the study.

These results highlight that Parkinson’s disease patients with RBD “progress faster with motor, mood, and cognitive symptoms, which is more aggressive [Parkinson’s] Subtype that can be identified at baseline and has great clinical implications, ”the researchers wrote.

The data are consistent with previous research suggesting that RBD is linked to faster progression of Parkinson’s disease, which further supports RBD as “a key marker of faster progression in a variety of symptom areas,” the team wrote.

Therefore, “screening for symptoms of RBD at the time of Parkinson’s diagnosis could improve the assessment of later disease progression and provide better personalized treatment, information and support for patients and their carers,” they added.

Given that RBD is “associated with a higher rate of levodopa non-responsive symptoms, including cognitive impairment, [postural instability and walking difficulties]”Gait freezes and falls,” this subset of patients “could benefit from earlier targeted interventions, including proactive exercise, physical , occupational therapy, and bone health management,” the researchers write.

Among the limitations of the study, the team highlighted the lack of confirmation of RBD by polysomnography, the gold for assessing sleep disorders that would have allowed for a more accurate depiction of the condition and a reduction in potential misclassifications.

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