REM sleep behavior as a preclinical risk factor for Synucleinopathies

Abstract

Objective: To determine the prevalence of REM behavior disorder in the synucleinopathy patient population, treatments used, and effectiveness of these treatments. Background: Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disorder characterized by loss of muscle atonia during the REM sleep stage, often manifesting in shouting, flailing, and kicking behaviors. These behaviors are generally associated with the content of the dream and patients report these dreams as unusually vivid. We have evaluated patients with Synucleinopathies (Multiple Systems Atrophy, Parkinson’s disease, and Dementia with Lewy Bodies) to examine the prevalence of RBD in this population and the presence of screening practices. In addition to the typical motor symptoms of these diseases, RBD, as a non-motor symptom, is a common precursor to these disorders. Methods: This study was conducted via a retrospective chart review and analysis of 278 patients in the movement disorders clinic at Boston Medical Center from 2011. Results: These patients had an average age of 71.6 years (± 8.4 years). Of these patients, 36.8% of those with Parkinson’s Disease, 66.6% of those with Multiple system atrophy, 61% of those with Lewy Body Dementia and 17.9% of those with Parkinsonism were comorbid for RBD. Of all charts reviewed 73.7% of the patients were screened for RBD and 46.8% of those with this disorder were undergoing treatment for it, 37.8% were taking melatonin(average 3.5mg ±1.1mg) with a 57.1% improvement, while 62% were on Clonazepam(average .5mg ±.16mg) with a 56.5% improvement. 32.9% of our RBD population was found to be on SSRIs. 72.2% of our RBD population was male. Conclusion: It is evident that RBD has a high prevalence in this population and may be able to serve as a pre-clinical risk factor and diagnostic measure. Further study of the correlation between RBD and Synucleinopathies may allow for earlier and more accurate diagnosis, thereby having implications in the treatment of these neurodegenerative disorders.