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Mayo Clinic researchers and a group of international collaborators have
discovered a correlation between an extreme form of sleep disorder and
eventual onset of parkinsonism or dementia. The findings appear in the
current issue of the journal Brain.

Clinical observations and pathology studies, as well as research in animal
models, led to the findings that patients with the violent rapid eye
movement sleep (REM) behavior disorder (RBD) have a high probability of
later developing Lewy body dementia, Parkinson's disease or multiple system
atrophy (a Parkinson's-like disorder), because all of these conditions
appear to stem from a similar neurodegenerative origin.

"Our data suggest that many patients with idiopathic (not associated with
any other neurologic symptoms) RBD may be exhibiting early signs of an
evolving neurodegenerative disease, which in most cases appear to be caused
by some mishap of the synuclein protein," says Bradley Boeve, M.D., Mayo
Clinic neurologist and lead author of the study. Synuclein proteins are
associated with synapses in the brain, and clumps of abnormal
alpha-synuclein protein are present in some forms of dementia. "The problem
does not seem to be present in the synuclein gene itself, but it's something
that happens to the protein following gene expression. Just what happens to
it to cause the conditions isn't clear."

The result, however, is quite clear. The patients -- usually older males --  
strike out violently, often yelling, when they enter REM sleep. Mayo
researchers following these individuals over many years saw many of them
develop symptoms of dementia. Postmortems showed they all had developed Lewy
bodies but not the pathology of Alzheimer's disease. Earlier studies by two
of the co-authors on this paper (from the University of Minnesota) had
described this sleep disorder and associated it with eventual onset of
Parkinson's disease or Parkinson's disease-like disorder in some patients.
This Mayo study builds on that work and makes the connection to onset of a
non-Alzheimer's dementia.

Dr. Boeve says many cases may go unreported because the individual sleeps
alone, the activity is tolerated or the condition is misdiagnosed. Violent
movements during sleep do not always mean someone has this condition.
Sometimes the behavior is due to untreated sleep apnea and the condition
resolves with regular sleep apnea treatment -- use of a CPAP breathing
machine. In those cases, the cause is sleep apnea. It's the idiopathic RBD
findings on sleep studies that may precede dementia or parkinsonism by years
or decades -- underscoring the need for patients with suspected RBD to
undergo a sleep study... Cont.

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