The Motor Dysfunction Seen in Isolated REM Sleep Behavior Disorder.

BACKGROUND: Isolated Rapid Eye Movement (REM) sleep Behavior Disorder (iRBD) requires quantitative tools to detect incipient Parkinson's disease (PD). METHODS: A motor battery was designed and compared with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) in people with iRBD and controls. This included two keyboard-based tests (BRadykinesia Akinesia INcoordination tap test and Distal Finger Tapping) and two dual tasking tests (walking and finger tapping). RESULTS: We included 33 iRBD patients and 29 controls. The iRBD group performed both keyboard-based tapping tests more slowly (P < 0.001, P = 0.020) and less rhythmically (P < 0.001, P = 0.006) than controls. Unlike controls, the iRBD group increased their walking duration (P < 0.001) and had a smaller amplitude (P = 0.001) and slower (P = 0.007) finger tapping with dual task. The combination of the most salient motor markers showed 90.3% sensitivity for 89.3% specificity (area under the ROC curve [AUC], 0.94), which was higher than the MDS-UPDRS-III (minus action tremor) (69.7% sensitivity, 72.4% specificity; AUC, 0.81) for detecting motor dysfunction. CONCLUSION: Speed, rhythm, and dual task motor deterioration might be accurate indicators of incipient PD in iRBD. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

REM sleep and neurodegeneration.

Several brainstem, subcortical and cortical areas are involved in the generation of rapid eye movement (REM) sleep. The alteration of these structures as a result of a neurodegenerative process may therefore lead to REM sleep anomalies. REM sleep behaviour disorder is associated with nightmares, dream-enacting behaviours and increased electromyographic activity in REM sleep. Its isolated form is a harbinger of synucleinopathies such as Parkinson's disease or dementia with Lewy bodies, and neuroprotective interventions are advocated. This link might also be present in patients taking antidepressants, with post-traumatic stress disorder, or with a history of repeated traumatic head injury. REM sleep likely contributes to normal memory processes. Its alteration has also been proposed to be part of the neuropathological changes occurring in Alzheimer's disease.

Sleep and sleep disorders in people with Parkinson's disease.

Sleep disorders are common in people with Parkinson's disease. These disorders, which increase in frequency throughout the course of the neurodegenerative disease and impair quality of life, include insomnia, excessive daytime sleepiness, circadian disorders, obstructive sleep apnoea, restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder. The causes of these sleep disorders are complex and multifactorial, including the degeneration of the neural structures that modulate sleep, the detrimental effect of some medications on sleep, the parkinsonian symptoms that interfere with mobility and comfort in bed, and comorbidities that disrupt sleep quality and quantity. The clinical evaluation of sleep disorders include both subjective (eg, questionnaires or diaries) and objective (eg, actigraphy or video polysomnography) assessments. The management of patients with Parkinson's disease and a sleep disorder is challenging and should be individualised. Treatment can include education aiming at changes in behaviour (ie, sleep hygiene), cognitive behavioural therapy, continuous dopaminergic stimulation at night, and specific medications. REM sleep behaviour disorder can occur several years before the onset of parkinsonism, suggesting that the implementation of trials of neuroprotective therapies should focus on people with this sleep disorder.

Alteraciones respiratorias durante el sueño a consecuencia de la estimulación del nervio vago / Sleep-disordered breathing as a consequence of vagus nerve stimulation

INTRODUCCIÓN: La estimulación del nervio vago (ENV) es una terapia utilizada en casos de epilepsia refractaria. Sus efectos secundarios son, con frecuencia, leves; sin embargo, se han descrito previamente alteraciones respiratorias durante el sueño. Casos clínicos. Los tres casos incluidos son representativos de alteraciones respiratorias durante el sueño (apnea del sueño y estridor) que surgen a consecuencia de la actividad de la ENV. CONCLUSIONES: Dada la elevada prevalencia del síndrome de apnea/hipopnea durante el sueño en pacientes con epilepsia refractaria, debería estudiarse su posible preexistencia en candidatos a ENV y considerarse su potencial aparición como consecuencia de la ENV en el seguimiento de pacientes con ENV activa

INTRODUCTION: Vagus nerve stimulation (VNS) is indicated in cases of refractory epilepsy. Its side effects are frequently minor, however, breathing disturbances during sleep have been previously reported. CASE REPORTS. Our three cases are representative of sleep-disordered breathing that occurred as a consequence of VNS activity in patients with refractory epilepsy. Sleep apnoea was observed in two patients and stridor in one patient. CONCLUSIONS: Given the high prevalence of sleep apnoea-hypopnoea syndrome in patients with refractory epilepsy, implantation of VNS should be ideally preceded by an assessment of the breathing during sleep. Furthermore, sleep-disordered breathing should be considered as a rare complication of VNS, and sleep apnoea should be investigated alongside data regarding VNS firing

Trastornos del movimiento y de la conducta durante el sueño en el adulto / Sleep-related movement and behavioural disorders in adults

Los trastornos del movimiento y de la conducta durante el sueño pueden tener un impacto en la calidad del sueño del paciente y dar lugar a síntomas diurnos. En estos grupos de enfermedades se incluyen entidades como el síndrome de piernas inquietas, los movimientos periódicos de las piernas y las parasomnias del sueño de movimientos oculares rápidos (REM) y no REM. El conocimiento de sus características clínicas y nociones sobre su manejo es de gran importancia para el neurólogo y especialista en sueño por su frecuencia e impacto en la calidad del sujeto. Con frecuencia, estos pacientes son referidos a dichos especialistas, y es relevante conocer que ciertos trastornos del sueño pueden asociarse a otras enfermedades neurológicas

Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as restless legs syndrome, periodic leg movements, and REM and NREM parasomnias. The knowledge of their clinical features and management is of utmost importance for the neurologist and sleep specialist. Frequently, these patients are referred to such specialists and it is relevant to know that certain sleep disorders may be associated with other neurological conditions

¿Qué saben sobre la demencia los cuidadores de nuestros pacientes? / Caregivers of our patients, what know about dementia?

Objetivo: determinar si el hecho de ser cuidador principal de un paciente con demencia supone un mayor conocimiento de esta patología. Material y métodos: estudio transversal, llevado a cabo mediante una encuesta autoadministrada de 14 preguntas relacionadas con aspectos generales de la demencia (conceptos, clínica, diagnóstico, tratamiento), realizada a un grupo de cuidadores y a otro de población general, externa al ámbito asistencial. Se analiza la proporción de aciertos y fallos, considerando los factores incluidos en el estudio (grupo, edad, sexo, nivel de estudios). Resultados: el porcentaje de aciertos del grupo de cuidadores (n = 40) y el de la población general (n = 40) fue similar (70 % frente a 72 %; NS). Se ha detectado una mayor proporción de aciertos en los encuestados jóvenes y con estudios superiores (86 % y 76 %; p < 0,01). En el grupo de cuidadores, los bloques con más aciertos fueron el de clínica y tratamiento (77 % y 70 %; p < 0,01), con una tendencia positiva al mayor conocimiento en aquellos que pertenecían a una asociación, sin alcanzar la significación estadística (74 % frente a 71 %; NS). Conclusiones: un mayor conocimiento sobre la demencia parece independiente de ser cuidador de estos pacientes y está más relacionado con el nivel de estudios y la edad. Sería importante facilitar más información relacionada con la enfermedad para evitar la sobrecarga del cuidador y conseguir una mejor atención del paciente (AU)

Objective: To determine whether caregivers of patients with dementia are more familiar with the disease than the general population. Method: Cross-sectional study carried out via a 14-question survey related to general aspects of dementia (concepts, clinical presentation, diagnosis, treatment), filled out by two groups: caregivers and general population, unrelated to the clinical field. The proportion of correct and wrong answers is analysed considering the variables included in the study (group, age, sex, education level). Results: A similar proportion of right answers was found in both groups, caregivers (n = 40) and general population (n = 40) (70% vs. 72%; NSS). However, a higher proportion of correct answers was detected amongst younger individuals and those with a higher education level (86% and 76%; p < 0.01). Regarding the caregivers’ group, questions related to clinical presentation and treatment were answered more successfully (77% and 70% were right; p < 0.01). A positive tendency to greater knowledge was found amongst caregivers who belonged to an association without, however, reaching statistical significance for the results (74% vs. 71%; NSS). Conclusions: Caregivers have a similar level of knowledge about dementia compared to the general population. However, a better understanding of the disease seems directly related to age and level of education. Didactic and supportive interventions could help alleviate the caregiver’s burden and would result in better care for the patient (AU)