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REM Sleep Behavior Disorder

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Disorders of Sleep and Circadian Rhythms in Parkinson's Disease

Abstract

REM sleep behavior disorder (RBD), a condition of dream enactment, often predates Parkinson’s disease (PD) and is the result of early neurodegenerative processes in the brainstem. Normally, REM sleep is characterized by vivid mentation combined with skeletal muscle paralysis. This REM atonia is diminished or absent in RBD, which enables patients to act out their dreams with violent, injurious nocturnal behaviors. Consistent with an impending neurodegenerative disorder, patients with RBD demonstrate subtle motor, autonomic, and cognitive changes frequently seen in synucleinopathies. These disorders include PD as well as multiple system atrophy (MSA) and dementia with Lewy bodies (DLB). In PD, RBD is linked with the akinetic–rigid predominant subtype, gait freezing, and predicts aggressive cognitive impairment. Clinical management is focused upon decreasing the potential for sleep-related injuries (SRIs), treating comorbid sleep disorders, and eliminating exacerbating agents. High-dose melatonin, low-dose clonazepam, and combined melatonin–clonazepam appear to be effective therapies.

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Authors and Affiliations

  1. Department of Neurology, University of Minnesota, Minneapolis, USA

    Michael J. Howell MD

  2. Department of Psychiatry, University of Minnesota, Minneapolis, USA

    Carlos H. Schenck MD

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  1. Michael J. Howell MD
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  2. Carlos H. Schenck MD
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Correspondence to Michael J. Howell MD .

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Editors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Aleksandar Videnovic

  2. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    Birgit Högl

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Howell, M.J., Schenck, C.H. (2015). REM Sleep Behavior Disorder. In: Videnovic, A., Högl, B. (eds) Disorders of Sleep and Circadian Rhythms in Parkinson's Disease. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1631-9_10

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  • DOI: https://doi.org/10.1007/978-3-7091-1631-9_10

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1630-2

  • Online ISBN: 978-3-7091-1631-9

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