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Chen ZK, Liu YY, Zhou JC, Chen GH, Liu CF, Qu WM, Huang ZL. Insomnia-related rodent models in drug discovery. Acta Pharmacol Sin 2024; 45:1777-1792. [PMID: 38671193 PMCID: PMC11335876 DOI: 10.1038/s41401-024-01269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the widespread prevalence and important medical impact of insomnia, effective agents with few side effects are lacking in clinics. This is most likely due to relatively poor understanding of the etiology and pathophysiology of insomnia, and the lack of appropriate animal models for screening new compounds. As the main homeostatic, circadian, and neurochemical modulations of sleep remain essentially similar between humans and rodents, rodent models are often used to elucidate the mechanisms of insomnia and to develop novel therapeutic targets. In this article, we focus on several rodent models of insomnia induced by stress, diseases, drugs, disruption of the circadian clock, and other means such as genetic manipulation of specific neuronal activity, respectively, which could be used to screen for novel hypnotics. Moreover, important advantages and constraints of some animal models are discussed. Finally, this review highlights that the rodent models of insomnia may play a crucial role in novel drug development to optimize the management of insomnia.
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Affiliation(s)
- Ze-Ka Chen
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Yuan-Yuan Liu
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ji-Chuan Zhou
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Gui-Hai Chen
- Department of Neurology (Sleep Disorders), the Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, China
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Wei-Min Qu
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Zhi-Li Huang
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Liu Y, Xue L, Zhao J, Dou K, Wang G, Xie A. Clinical characteristics in early Parkinson's disease with excessive daytime sleepiness: A cross-sectional and longitudinal study. Clin Transl Sci 2023; 16:2033-2045. [PMID: 37551840 PMCID: PMC10582661 DOI: 10.1111/cts.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/10/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
We aimed to explore excessive daytime sleepiness (EDS) and correlates of clinical characteristics by using cross-sectional and longitudinal analyses from the Parkinson's Progression Markers Initiative database. Four hundred twenty-three patients with Parkinson's disease (PD; EDS: non-EDS = 357:66) and 195 healthy controls (HCs; EDS: nEDS = 171:24) were enrolled in our study at baseline. Multiple linear and linear mixed-effects models were used to research the relationships between EDS/daytime sleepiness severity and clinical characteristics. Relationships between the change rates of clinical characteristics and daytime sleepiness severity were further investigated through multiple linear regression models. Mediating effect analysis was used to determine whether autonomic dysfunction was the mediator between cognition assessments and daytime sleepiness severity. Patients with PD with EDS and greater daytime sleepiness severity presented faster cognitive decline, high possibility for rapid eye movement sleep behavior disorder, autonomic dysfunction, depression, and anxiety from cross-sectional and longitudinal analyses. Furthermore, HC individuals with EDS showed a higher striatal binding ratio of the right putamen, right striatum, and mean striatum. Autonomic dysfunction may act as a mediator between PD and cognitive decline. In early PD, EDS and daytime sleepiness severity were related to several clinical variables, suggesting that EDS might play an essential role in regulating PD progression.
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Affiliation(s)
- Yumei Liu
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Ling Xue
- Brain DepartmentAffiliated Taian City Central Hospital of Qingdao UniversityTaianChina
| | - Jun Zhao
- Brain DepartmentAffiliated Taian City Central Hospital of Qingdao UniversityTaianChina
| | - Kaixin Dou
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Guojun Wang
- Department of NeurosurgeryAffiliated Taian City Central Hospital of Qingdao UniversityTaianChina
| | - Anmu Xie
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdaoChina
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Lin W, Lin YK, Yang FC, Chung CH, Hu JM, Tsao CH, Weng ZX, Ko CA, Chien WC. Risk of neurodegenerative diseases in patients with sleep disorders: A nationwide population-based case-control study. Sleep Med 2023; 107:289-299. [PMID: 37269705 DOI: 10.1016/j.sleep.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Our study aimed to explore the associative relationship between neurodegenerative diseases and sleep disorders. PATIENTS This 15-year retrospective longitudinal nationwide population-based matched case-control study used data extracted from the National Health Insurance Research Database. We evaluated 25,589 patients diagnosed with neurodegenerative diseases between 2000 and 2015 and a matched control of 102,356 patients without neurodegenerative diseases. RESULTS Sleep disorders were an independent risk factor for the development of neurodegenerative diseases (adjusted odds ratio (OR): 1.794, 95% confidence interval (CI): 1.235-2.268, P < 0.001), with a positive dose-effect relationship (adjusted OR (95% CI): <1 year: 1.638 (1.093-2.872), P < 0.001; 1-5 years: 1.897 (1.260-3.135), P < 0.001; >5 years: 2.381 (1.467-3.681), P < 0.001. Moreover, patients with sleep disorder and comorbid depression had a significantly higher risk of neurodegenerative disorders (adjusted OR: 5.874). Subgroup analysis showed that insomnia was associated with Alzheimer's disease, Pick's disease and essential tremor (adjusted OR (95% CI): 1.555 (1.069-1.965), 1.934 (1.331-2.445) and 2.089 (1.439-2.648), respectively). Obstructive sleep apnea was associated with Parkinson's disease, essential tremor, and primary dystonia (adjusted OR (95% CI): 1.801 (1.239-2.275), 5.523 (3.802-6.977), and 4.892 (3.365-6.178), respectively). Other specific sleep disorders were associated with Pick's disease, Parkinson's disease, essential tremor, and primary dystonia (adjusted OR (95% CI): 8.901 (6.101-11.010), 1.549 (1.075-1.986), 2.791 (1.924-3.531), and 9.114 (6.283-10.506), respectively). CONCLUSION Sleep disorders are associated with the subsequent development of neurodegenerative disorders. Moreover, sleep disorder patients with comorbid depression have a higher risk of neurodegenerative diseases.
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Affiliation(s)
- Wei Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taiwan
| | - Je-Ming Hu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Zi-Xeng Weng
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Ko
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 114, Taiwan.
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Verma AK, Yu Y, Acosta-Lenis SF, Havel T, Sanabria DE, Molnar GF, MacKinnon CD, Howell MJ, Vitek JL, Johnson LA. Parkinsonian daytime sleep-wake classification using deep brain stimulation lead recordings. Neurobiol Dis 2023; 176:105963. [PMID: 36521781 PMCID: PMC9869648 DOI: 10.1016/j.nbd.2022.105963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/01/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Excessive daytime sleepiness is a recognized non-motor symptom that adversely impacts the quality of life of people with Parkinson's disease (PD), yet effective treatment options remain limited. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for PD motor signs. Reliable daytime sleep-wake classification using local field potentials (LFPs) recorded from DBS leads implanted in STN can inform the development of closed-loop DBS approaches for prompt detection and disruption of sleep-related neural oscillations. We performed STN DBS lead recordings in three nonhuman primates rendered parkinsonian by administrating neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Reference sleep-wake states were determined on a second-by-second basis by video monitoring of eyes (eyes-open, wake and eyes-closed, sleep). The spectral power in delta (1-4 Hz), theta (4-8 Hz), low-beta (8-20 Hz), high-beta (20-35 Hz), gamma (35-90 Hz), and high-frequency (200-400 Hz) bands were extracted from each wake and sleep epochs for training (70% data) and testing (30% data) a support vector machines classifier for each subject independently. The spectral features yielded reasonable daytime sleep-wake classification (sensitivity: 90.68 ± 1.28; specificity: 88.16 ± 1.08; accuracy: 89.42 ± 0.68; positive predictive value; 88.70 ± 0.89, n = 3). Our findings support the plausibility of monitoring daytime sleep-wake states using DBS lead recordings. These results could have future clinical implications in informing the development of closed-loop DBS approaches for automatic detection and disruption of sleep-related neural oscillations in people with PD to promote wakefulness.
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Affiliation(s)
- Ajay K Verma
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Ying Yu
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Sergio F Acosta-Lenis
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Tyler Havel
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | | | - Gregory F Molnar
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Michael J Howell
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Luke A Johnson
- Department of Neurology, University of Minnesota, Minneapolis, United States of America.
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Effects of melatonin prolonged-release on both sleep and motor symptoms in Parkinson’s disease: a preliminary evidence. Neurol Sci 2022; 43:5355-5362. [PMID: 35536495 PMCID: PMC9385777 DOI: 10.1007/s10072-022-06111-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022]
Abstract
Background Sleep-related symptoms, especially insomnia, are frequently reported by patients with Parkinson’s disease (PD) and can markedly affect motor symptoms and impair patients’ quality of life. Melatonin has been shown to improve sleep in PD patients. This pilot study aimed at evaluating the effects of a 3-month treatment with 2 mg melatonin prolonged-release (PR) on sleep and motor disability in PD patients. Materials and methods Twelve PD patients under stable antiparkinsonian treatment were enrolled in the study. Before treatment (T0), motor dysfunction was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS-III) and sleep architecture with polysomnography. Subjective sleep quality was also assessed through Pittsburgh Sleep Quality Index (PSQI) and daytime somnolence with Epworth Sleepiness Scale (ESS). Patients then started melatonin PR and all measures were repeated at the end of treatment after 3 months (T1). Results Sleep latency significantly decreased from T0 to T1, but no other significant differences were found in PSG parameters. Melatonin PR treatment significantly reduced the ESS scores from T0 to T1, while the PSQI scores presented a trend of improvement from T0 to T1. Motor dysfunction was not improved by melatonin PR, although there was a trend in decreasing UPDRS-III. Both clinical global improvement and patient clinical global impression documented an improvement in insomnia symptoms at T1. Conclusions These findings suggest that melatonin may improve sleep symptoms in PD patients, although further evidence is needed in larger controlled studies to confirm these results and explore the possible direct and indirect influence of sleep improvement on motor dysfunction.
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吉田 正. [Management for lower urinary tract dysfunction in the elderly according to guidelines]. Nihon Ronen Igakkai Zasshi 2022; 59:115-130. [PMID: 35650043 DOI: 10.3143/geriatrics.59.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Meng Z, Sun B, Chen W, Zhang X, Huang M, Xu J. Depression of Non-Neuronal Cholinergic System May Play a Role in Co-Occurrence of Subjective Daytime Sleepiness and Hypertension in Patients with Obstructive Sleep Apnea Syndrome. Nat Sci Sleep 2021; 13:2153-2163. [PMID: 34934375 PMCID: PMC8684399 DOI: 10.2147/nss.s339038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Simultaneous occurrence of hypertension and excessive daytime sleepiness (EDS) is very common in obstructive sleep apnea syndrome (OSAS), although no study has specifically addressed this issue. The present study explored the risk factors for co-occurrence of OSAS-related EDS and hypertension. PATIENTS AND METHODS A total of 161 OSAS patients were studied after undergoing an eight-hour in-laboratory polysomnography for one night. The OSAS severity assessment depends on the number of breathing disturbances per hour of sleep. EDS was defined using the Epworth Sleepiness Scale (ESS) scores of ≥13. Hypertension was defined according to direct cuff blood pressure (BP) measurements. Beat-to-beat R-R interval data were incorporated in polysomnography for heart rate variability analysis. The low-frequency/high-frequency band ratio was used to reflect sympathovagal balance. The study participants were divided into four groups based on the presence of EDS and/or hypertension: EDS with hypertension (n = 53), EDS without hypertension (n = 27), no EDS with hypertension (n = 38), and no EDS or hypertension (n = 43). Clinical, polysomnographic and heart rate data were compared and studied among the four groups. Plasma acetylcholine (ACh) levels were assessed to explore the effects of the non-neuronal cholinergic system and the co-occurrence of EDS and hypertension. RESULTS Patients with EDS and hypertension had more severe OSAS severity indices compared to control patients. Increased cardiac sympathovagal imbalance and nocturnal hypoxemia regulated the presence of EDS and hypertension. Further plasma biomarker analysis revealed that both ESS scores and BP levels were associated with significantly elevated plasma norepinephrine, interleukin-6 and superoxide dismutase levels and significantly decreased ACh levels. Logistic regression analyses showed that ACh was the only factor significantly associated with co-occurrence of EDS and hypertension after controlling for confounders using odds ratio of 0.932, with a 95% confidence interval of 0.868 to 1.000 (P = 0.049). CONCLUSION The results suggested that OSAS coupled with both EDS and hypertension is a more severe phenotype of the respiratory disorder. The presence of EDS and hypertension was accompanied by sympathovagal imbalance, and co-occurrence of these two conditions may be related to decreased plasma ACh levels.
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Affiliation(s)
- Zili Meng
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, People’s Republic of China
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, People’s Republic of China
| | - Wei Chen
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, People’s Republic of China
| | - Xilong Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Mao Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Jing Xu
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, People’s Republic of China
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Fernández-Pajarín G, Sesar Á, Ares B, Jiménez-Martín I, Gelabert M, Arán-Echabe E, Relova JL, Castro A. Continuous Subcutaneous Apomorphine Infusion before Subthalamic Deep Brain Stimulation: A Prospective, Comparative Study in 20 Patients. Mov Disord Clin Pract 2021; 8:1216-1224. [PMID: 34761055 PMCID: PMC8564815 DOI: 10.1002/mdc3.13338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/15/2021] [Accepted: 08/15/2021] [Indexed: 11/07/2022] Open
Abstract
Background Studies comparing the clinical efficacy of apomorphine infusion (APO) with subsequent subthalamic deep brain stimulation (STN-DBS) in advanced Parkinson's disease (aPD) are currently lacking. Retrospective data have shown that patients treated with APO are usually older, have a more prolonged disease, and a more severe phenotype. Objective To compare the benefit of APO with that of STN-DBS on motor, non-motor, cognitive, and quality of life in the same patient when given sequentially. Methods We prospectively analyzed 20 aPD patients over 3 different treatment phases: baseline (optimized medical treatment), during APO treatment, and during subsequent STN-DBS treatment. The APO and STN-DBS phases were stable for 6 months, and evaluation of the different treatments was separated by 6 months. Results Compared to baseline, APO, and STN-DBS reduced mean daily off time by 70.5% and 89.3% (P = 0.012), respectively, and scores for Unified Parkinson's Disease Rating Scale (UPDRS) IV by 27.5% and 80.5% (P ≤ 0.001), Non-motor symptoms scale (NMSS) by 24.6% and 49.3% (P ≤ 0.001), Montgomery Asberg depression scale (MADRS) by 7.4% and 39.0% (P = 0.27), Starkstein apathy scale (SAS) by 51.1% and 39.9% (P = 0.734), Parkinson's disease sleep scale 2 (PDSS-2) by 25.7% and 56.7% (P ≤ 0.001), and Parkinson's disease questionnaire 39 item (PDQ-39) by 39.6% and 64.9% (P ≤ 0.001). Global cognition did not change with either therapy, but phonetic fluency worsened after STN-DBS compared to APO (P = 0.022). Conclusions Both APO and STN-DBS improved motor and non-motor symptoms and quality of life compared to optimized medical treatment in aPD. Overall, STN-DBS was the most effective treatment, but APO showed a pronounced benefit on motor symptoms. Effective treatment for aPD should not be delayed, even when waiting for surgery.
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Affiliation(s)
- Gustavo Fernández-Pajarín
- Department of Neurology Hospital Clínico Universitario de Santiago Santiago Spain.,Grupo Clínico de Trastornos del Movimiento Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago Spain
| | - Ángel Sesar
- Department of Neurology Hospital Clínico Universitario de Santiago Santiago Spain.,Grupo Clínico de Trastornos del Movimiento Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago Spain
| | - Begoña Ares
- Department of Neurology Hospital Clínico Universitario de Santiago Santiago Spain.,Grupo Clínico de Trastornos del Movimiento Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago Spain
| | - Isabel Jiménez-Martín
- Department of Neurology Hospital Clínico Universitario de Santiago Santiago Spain.,Grupo Clínico de Trastornos del Movimiento Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago Spain
| | - Miguel Gelabert
- Department of Neurosurgery Hospital Clínico Universitario de Santiago Santiago Spain
| | - Eduardo Arán-Echabe
- Grupo Clínico de Trastornos del Movimiento Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Santiago Spain.,Department of Neurosurgery Hospital Clínico Universitario de Santiago Santiago Spain
| | - José Luis Relova
- Department of Clinical Neurophysiology Hospital Clínico Universitario de Santiago Santiago Spain
| | - Alfonso Castro
- Department of Neurology Hospital Clínico Universitario de Santiago Santiago Spain
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Matsumoto S, Tsunematsu T. Association between Sleep, Alzheimer's, and Parkinson's Disease. BIOLOGY 2021; 10:1127. [PMID: 34827122 PMCID: PMC8614785 DOI: 10.3390/biology10111127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 01/09/2023]
Abstract
The majority of neurodegenerative diseases are pathologically associated with protein misfolding and aggregation. Alzheimer's disease (AD) is a type of dementia that slowly affects memory and cognitive function, and is characterized by the aggregation of the β-amyloid protein and tau neurofibrillary tangles in the brain. Parkinson's disease (PD) is a movement disorder typically resulting in rigidity and tremor, which is pathologically linked to the aggregation of α-synuclein, particularly in dopaminergic neurons in the midbrain. Sleep disorders commonly occur in AD and PD patients, and it can precede the onset of these diseases. For example, cognitively normal older individuals who have highly fragmented sleep had a 1.5-fold increased risk of subsequently developing AD. This suggests that sleep abnormalities may be a potential biomarker of these diseases. In this review, we describe the alterations of sleep in AD and PD, and discuss their potential in the early diagnosis of these diseases. We further discuss whether sleep disturbance could be a target for the treatment of these diseases.
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Affiliation(s)
- Sumire Matsumoto
- Advanced Interdisciplinary Research Division, Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan;
| | - Tomomi Tsunematsu
- Advanced Interdisciplinary Research Division, Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan;
- Super-Network Brain Physiology, Graduate School of Life Sciences, Tohoku University, Sendai 980-8577, Japan
- Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Kawaguchi 332-0012, Japan
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Suzuki K. Current Update on Clinically Relevant Sleep Issues in Parkinson's Disease: A Narrative Review. JOURNAL OF PARKINSONS DISEASE 2021; 11:971-992. [PMID: 33896849 PMCID: PMC8461662 DOI: 10.3233/jpd-202425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sleep disturbances are among the common nonmotor symptoms in patients with Parkinson’s disease (PD). Sleep can be disrupted by nocturnal motor and nonmotor symptoms and other comorbid sleep disorders. Rapid eye movement sleep behavior disorder (RBD) causes sleep-related injury, has important clinical implications as a harbinger of PD and predicts a progressive clinical phenotype. Restless legs syndrome (RLS) and its related symptoms can impair sleep initiation. Excessive daytime sleepiness (EDS) is a refractory problem affecting patients’ daytime activities. In particular, during the COVID-19 era, special attention should be paid to monitoring sleep problems, as infection-prevention procedures for COVID-19 can affect patients’ motor symptoms, psychiatric symptoms and sleep. Therefore, screening for and managing sleep problems is important in clinical practice, and the maintenance of good sleep conditions may improve the quality of life of PD patients. This narrative review focused on the literature published in the past 10 years, providing a current update of various sleep disturbances in PD patients and their management, including RBD, RLS, EDS, sleep apnea and circadian abnormalities.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
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Antiparkinsonian drugs as potent contributors to nocturnal sleep in patients with Parkinson's disease. PLoS One 2021; 16:e0255274. [PMID: 34320022 PMCID: PMC8318227 DOI: 10.1371/journal.pone.0255274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To clarify whether antiparkinsonian drugs contribute to nocturnal sleep disturbances in patients with Parkinson’s disease (PD). Background Although the major antiparkinsonian drugs L-dopa and dopamine agonists (DAs) have been found to affect sleep, little is known about the effects of specific drugs on sleep in PD patients. Methods The study participants consisted of 112 PD patients (median age 72.5 years [inter-quartile range: IQR 65–79]; mean disease duration 8.44 years [standard deviation: 7.33]; median Hoehn and Yahr stage 3 [IQR 2–3.75]) taking one of three types of non-ergot extended-release DAs (rotigotine 32; pramipexole 44; ropinirole 36) with or without L-dopa (median daily total dosage of antiparkinsonian drugs 525.5 mg [IQR 376.25–658] levodopa equivalent dose [LED]). Participants were assessed using the PD Sleep Scale-2 (PDSS-2). Results For the whole PD patient cohort, the PDSS-2 sleep disturbance domain score and the scores for item 1 assessing sleep quality and item 8 assessing nocturia were positively correlated with daily total dosage of antiparkinsonian drugs and dosage of L-dopa, but not with the dosage of DAs. Sub-analysis according to DA treatment revealed that DA dosage was not correlated with item 1 or 8 score in any of the subgroups. The LED ratio of rotigotine to the total dosage of antiparkinsonian drugs was inversely correlated with the item 1 score. Conclusions These data suggest that antiparkinsonian drugs, in particular L-dopa, adversely affect nocturnal sleep in PD patients, especially in terms of sleep quality and nocturia. Thus, adjusting both the total dosage of antiparkinsonian drugs and the dose-ratio of L-dopa might be key actions for alleviating poor sleep quality in patients with PD. Among DAs, we found a clear positive correlation between the dose-ratio of rotigotine and sleep quality. Thus, partial L-dopa replacement with rotigotine could improve sleep quality in patients with PD.
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Ren Y, Suzuki K, Hirata K, Yang W, Wu J. Changes in efficiencies and interactions of attentional networks in Parkinson's disease with sleep disturbance. Neurosci Res 2021; 170:236-244. [PMID: 33992661 DOI: 10.1016/j.neures.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Attention is composed of three distinct attentional networks: alerting, orienting, and executive control. Previous studies have confirmed that Parkinson's disease (PD) is associated with executive control deficits; however, the interactions among the three attentional networks and the influence of sleep disturbance in PD patients have not been investigated. Herein, the efficiencies for the three attentional networks and their interactions were evaluated using the revised attention network test. The results showed a significantly slower response and lower accuracy in the PD group than in the normal control group and a significantly slower response and lower accuracy in PD patients with sleep disturbance (PDS) than in PD patients without sleep disturbance (PDnS), which indicates a response deficit in PD and worsening in PDS. Additionally, the executive control efficiency was reduced in both PDS and PDnS, and significantly higher alerting efficiency and lower orienting efficiency were found in PDS. Furthermore, largely changed interactions and correlation patterns of attentional networks were found in PDS but not in PDnS. These results suggested that attentional networks were impaired in PD patients, particularly in those affected by sleep disturbances, and that PDS might establish special connections between attentional networks to compensate for cognitive dysfunction.
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Affiliation(s)
- Yanna Ren
- Department of Psychology, College of Humanities and Management, Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, China
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, 3210293, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, 3210293, Japan
| | - Weiping Yang
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, 430062, China.
| | - Jinglong Wu
- Cognitive Neuroscience Laboratory, Graduate School of Natural Science and Technology, Okayama University, Okayama, 7008530, Japan.
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13
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Dhingra A, Janjua AU, Hack L, Waserstein G, Palanci J, Hermida AP. Exploring Nonmotor Neuropsychiatric Manifestations of Parkinson Disease in a Comprehensive Care Setting. J Geriatr Psychiatry Neurol 2021; 34:181-195. [PMID: 32242493 DOI: 10.1177/0891988720915525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a debilitating neurological condition that includes both motor symptoms and nonmotor symptoms (NMS). Psychiatric complaints comprise NMS and are collectively referred to as neuropsychiatric manifestations. Common findings include atypical depressive symptoms, anxiety, psychosis, impulse control disorder, deterioration of cognition, and sleep disturbances. Quality of life (QoL) of patients suffering from NMS is greatly impacted and many times can be more debilitating than motor symptoms of PD. We expand on knowledge gained from treatment models within a comprehensive care model that incorporates multidisciplinary specialists working alongside psychiatrists to treat PD. Insight into background, clinical presentations, and treatment options for patients suffering from neuropsychiatric manifestations of PD are discussed. Identifying symptoms early can help improve QoL, provide early symptom relief, and can assist tailoring treatment plans that limit neuropsychiatric manifestations.
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Affiliation(s)
- Amitha Dhingra
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Hack
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriella Waserstein
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
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14
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Ivy CC, Lockmiller MC, McKay M, Landess K, Manning J, Denney L. The impact of exercise on sleep in people with Parkinson's disease a scoping review. J Clin Neurosci 2021; 86:223-229. [PMID: 33775332 DOI: 10.1016/j.jocn.2021.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
While high intensity exercise is associated with improvement of both motor and non-motor symptoms in Parkinson's disease (PD), there is limited evidence on its impact on sleep disturbances in PD. This scoping review aims to provide a preliminary statement of the potential size and scope of available evidence for the interaction between exercise and sleep in people with PD. Research to date on non-motor symptoms of PD is broad, with scarce information regarding specific effects of exercise on sleep. A systematic literature search was conducted through three phases. Fifteen articles met the inclusion criteria for this study. Resistive exercise and multimodal exercise programs were frequently studied and found to improve sleep and decrease sleep-related disorders. These findings suggest that exercise programs may improve sleep and other non-motor symptoms of PD. The research was inconclusive when comparing the effects of high and low intensity exercises. Further research on the interaction between exercise and sleep in PD may have implications for rehabilitative therapy interventions.
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Affiliation(s)
- Cynthia C Ivy
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th St, Phoenix, AZ 85004, USA.
| | | | - Michelle McKay
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th St, Phoenix, AZ 85004, USA
| | - Kaitlyn Landess
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th St, Phoenix, AZ 85004, USA
| | - John Manning
- Department of Occupational Therapy, Northern Arizona University, 435 N 5th St, Phoenix, AZ 85004, USA
| | - Linda Denney
- Cline Library, Northern Arizona University, 435 N 5th St, Phoenix, AZ 85004, USA
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15
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The rate of decrease in oxygen desaturation during severe obstructive sleep apnea syndrome is correlated with subjective excessive daytime sleepiness. Sleep Breath 2020; 25:1285-1291. [PMID: 33099726 DOI: 10.1007/s11325-020-02223-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore factors that influence subjective excessive daytime sleepiness (EDS) in patients with severe obstructive sleep apnea syndrome (OSAS). METHODS Patients with snoring seen at the Sleep Medicine Center of The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University between October 2018 and November 2019 were included in this study. All patients underwent polysomnography (PSG). Noninvasive frequency-domain analysis was used to assess the autonomic nervous system regulation of the heart, with the low frequency (LF)/high frequency (HF) power ratio used to represent the sympathetic-parasympathetic balance. Daytime sleepiness was evaluated by the Epworth sleepiness scale (ESS). Overnight apnea episodes were included for analyses. The rate of pulse oxyhemoglobin saturation (SpO2) decrease was measured as the change in the percentage of SpO2 per second after obstructive apnea and was expressed as the oxygen desaturation rate (ODR). RESULTS A total of 101 patients with severe OSAS were enrolled in this study and were further divided into two groups: the EDS group (ESS > 10, n = 52) and the non-EDS group (ESS ≤ 10, n = 49). The apnea-hypopnea index (AHI), respiratory effort-related arousals (RERAs), and LF/HF power ratio were significantly higher in the EDS group than in the non-EDS group (AHI: 69.9 ± 14.5 vs. 57.9 ± 16.1 events/h; RERAs: 42.2 ± 16.7 vs. 30.4 ± 13.7 events/h; LF/HF power ratio: 2.9 ± 0.8% vs. 2.4 ± 0.9%, all p < 0.001). Multiple linear regression analyses revealed that after adjusting for covariates expected to affect this relationship, ESS scores were correlated with ODR (β = 0.520, p < 0.001) and LF/HF power ratio (β = 0.155, p = 0.028), rather than with the traditional sleep-disordered breathing parameters. CONCLUSIONS Compared with the traditional PSG parameters, both ODR and an increased LF/HF power ratio were more closely related to daytime sleepiness, especially ODR.
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Long K, Wan C, Xiang Y, Liu J, Xu Q, Sun Q, Wang Z, Tian Y, Fang L, Yang Y, Yan X, Tang B, Guo J. Study on the Clinical Features of Parkinson's Disease With Probable Rapid Eye Movement Sleep Behavior Disorder. Front Neurol 2020; 11:979. [PMID: 33041969 PMCID: PMC7517295 DOI: 10.3389/fneur.2020.00979] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/27/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: To investigate the clinical features and factors associated with Parkinson's disease (PD) patients with probable rapid eye movement sleep behavior disorder (PD-pRBD). Methods: A total of 2,440 patients with clinically established or clinically probable PD were divided into two groups: PD-pRBD and PD without pRBD (PD-NRBD), according to the RBD questionnaire—Hong Kong. Data collection included demographic data, basic clinical history, and motor and non-motor symptoms. Based on the onset time of pRBD and the motor symptoms in PD, PD-pRBD patients were further divided into the pRBD prior to PD (PD-prRBD) group and the pRBD posterior to PD (PD-poRBD) group. Clinical features were compared between the PD-pRBD and PD-NRBD groups, as well as the PD-prRBD and PD-poRBD groups. The associated factors of pRBD were also explored. Results: The prevalence of pRBD was 41.4% (1,010 out of the total of 2,440) in our PD cohort. Further, compared with the PD-NRBD group, the PD-pRBD group had longer disease duration and more severe motor symptoms. Moreover, the PD-pRBD group had significantly higher levodopa equivalent daily dose and a higher ratio of dyskinesia, wearing-off, and offset of the Hoehn–Yahr stage. The scores on the non-motor symptom rating scale (NMSS), cognitive impairment, Parkinson's disease sleep scale (PDSS), excessive daytime sleepiness, constipation, hyposmia, depression, and the 39-item Parkinson's disease questionnaire also appeared worse in the PD-pRBD group. Significant differences in the educational level, disease duration, disease progression, Unified Parkinson's Disease Rating Scale (UPDRS)-II, UPDRS-III, tremor, rigidity, bradykinesia, posture gait, frozen gait, levodopa equivalent daily dose, dyskinesia, wearing-off, Hoehn–Yahr stage, NMSS-6, PDSS, and communication score widely existed between the PD-prRBD and PD-poRBD groups. Late-onset PD, long disease duration, high UPDRS-I score, high NMSS-4 score, low PDSS score, constipation, and hyposmia were all identified as the risk factors for PD-pRBD. Conclusions: Compared with the PD-NRBD group, the PD-pRBD group may have more severe motor symptoms, motor complications, and non-motor symptoms as well as a substandard quality of life. Further, late-onset PD, long disease duration, high UPDRS-I score, high NMSS-4 score, low PDSS score, constipation, and hyposmia can be risk factors for RBD in PD. Differences also occurred between the PD-prRBD and PD-poRBD groups.
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Affiliation(s)
- Kexin Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Changmin Wan
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Yaqin Xiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiabin Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiying Sun
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiqin Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Tian
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
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17
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Wade R, Pachana NA, Dissanayaka N. Management of Sleep Disturbances in Parkinson's Disease Patients, Carers and the Patient and Carer Dyadic Relationship: A Scoping Review. Clin Gerontol 2020; 43:499-507. [PMID: 30422081 DOI: 10.1080/07317115.2018.1539424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Sleep disturbances are a debilitating non-motor symptom in Parkinson's disease (PD) and negatively impact patients, their carers and the patient-carer dyadic relationship. This review outlines the phenomenology, as well as factors associated with and treatment of sleep disturbances, in PD patients and their informal carers. METHODS The following terms were used in four databases: Parkinson*, sleep* disturbance*, carer*, dyad*, intervention* and treatment*. RESULTS Across the articles reviewed, the frequency of reported sleep disturbances in PD ranged between 60% and 98%. Common sleep problems in PD included insomnia, excessive day time sleepiness, REM sleep behavior disorder (RBD), sleep apnoea, periodic limb movements and sleep attacks. Within dyads, significant correlations were found with depression, anxiety and carer burden relating to night time care in particular. Despite the negative impact of sleep disturbance in PD, the evidence-base for treatment remains limited. CONCLUSIONS While addressing individual factors associated with sleep disturbances, it is also important to emphasize the needs arising from the patient-carer dyadic relationship. While a number of non-pharmacological interventions were suggested in the literature, further well-controlled trials are still required. CLINICAL IMPLICATIONS Multiple approaches are required to reduce sleep disturbances and associated burden in PD.
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Affiliation(s)
- Rachael Wade
- School of Psychology, The University of Queensland , Brisbane, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland , Brisbane, Australia
| | - Nadeeka Dissanayaka
- School of Psychology, The University of Queensland , Brisbane, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital , Brisbane, Australia
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18
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Memon AA, Coleman JJ, Amara AW. Effects of exercise on sleep in neurodegenerative disease. Neurobiol Dis 2020; 140:104859. [PMID: 32243913 PMCID: PMC7497904 DOI: 10.1016/j.nbd.2020.104859] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/22/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
As the population ages, the incidence and prevalence of neurodegenerative disorders will continue to increase. Persons with neurodegenerative disease frequently experience sleep disorders, which not only affect quality of life, but potentially accelerate progression of the disease. Unfortunately, pharmacological interventions are often futile or have adverse effects. Therefore, investigation of non-pharmacological interventions has the potential to expand the treatment landscape for these disorders. The last decade has observed increasing recognition of the beneficial role of exercise in brain diseases, and neurodegenerative disorders in particular. In this review, we will focus on the therapeutic role of exercise for sleep dysfunction in four neurodegenerative diseases, namely Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. Available data suggest that exercise may have the potential to improve sleep disorders and attenuate neurodegeneration, particularly in Alzheimer's disease and Parkinson's disease. However, additional research is required in order to understand the most effective exercise therapy for these indications; the best way to monitor the response to interventions; the influence of exercise on sleep dysfunction in Huntington's disease and amyotrophic lateral sclerosis; and the mechanisms underlying exercise-induced sleep modifications.
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Affiliation(s)
- Adeel A Memon
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Juliana J Coleman
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, United States of America; UAB Center for Exercise Medicine, Birmingham, AL 35205, United States of America; UAB Sleep and Circadian Research Core, United States of America.
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19
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Kataoka H, Saeki K, Kurumatani N, Sugie K, Obayashi K. Objective sleep measures between patients with Parkinson's disease and community-based older adults. Sleep Med 2020; 68:110-114. [PMID: 32035300 DOI: 10.1016/j.sleep.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Previous studies comparing objective sleep measures between patients with Parkinson's disease (PD) and control participants were limited by their small sample size. The purpose of this study was to compare objective sleep measures between large-scale cohorts of PD outpatients and community-based older adults. METHODS In this cross-sectional study, we measured sleep parameters for 157 PD patients using an actigraph on the non-dominant wrist for six consecutive nights (95 Hoehn-Yahr stage I/II; 62 Hoehn-Yahr stage III-V). Moreover, two consecutive nights of actigraphy were performed on 1101 community-based control participants aged ≥60 years. RESULTS In multivariable analysis, sleep efficiency (SE) was significantly lower in patients with late-stage PD by 17.5% [95% confidence interval: 15.3%-19.7%] and early-stage PD by 9.4% [7.6%-11.1%] compared to the controls (67.1% and 75.3% vs. 84.6%, respectively). Similar results were observed for wake after sleep onset (WASO) and fragmentation index (FI). Total sleep time and sleep onset latency (SOL) were significantly shorter in patients with late- and early-stage PD stage compared to the controls. Among PD patients, significant association trends between advancement of individual Hoehn-Yahr stages and worsened sleep measures of SE, WASO, and FI were observed independently of age, gender, levodopa equivalent dose, and motor function parameter. CONCLUSION This study demonstrated significant and quantitative differences in objective sleep quality and quantity between PD patients and control participants. Furthermore, with advancement of disease stages, objectively measured sleep quality worsened in PD patients.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan.
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Norio Kurumatani
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan.
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20
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Cunha AM, Teixeira FG, Guimarães MR, Esteves M, Pereira-Mendes J, Soares AR, Almeida A, Sousa N, Salgado AJ, Leite-Almeida H. Unilateral accumbal dopamine depletion affects decision-making in a side-specific manner. Exp Neurol 2020; 327:113221. [PMID: 32027930 DOI: 10.1016/j.expneurol.2020.113221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 01/16/2023]
Abstract
Mechanisms underlying affective and cognitive deficits in Parkinson's disease (PD) remain less studied than motor symptoms. Nucleus accumbens (NAc) is affected in PD and due to its well-known involvement in motivation is an interesting target in this context. Furthermore, PD is frequently asymmetrical, with side-specific deficits aligning with evidences of accumbal laterality. We therefore used a 6-hydroxydopamine (6-OHDA) model to study the role of left and right NAc dopamine depletion in a battery of behavioral tasks. 2 months old male rats were used in all experiments. Habitual-based and goal-directed decision-making, impulsivity, anxiety- and depressive-like behavior and motor performance were tested 3 weeks after left (6-OHDA L) or right (6-OHDA R) NAc lesion was induced. Upon contingency degradation, 6-OHDA R decrease their lever press rate less than Sham and 6-OHDA L, indicating an impairment in the shift from habit-based to goal-directed strategies. On the other hand, 6-OHDA L lesions lead to increased rates of premature responding when delays where increased in the variable delay-to-signal test. Importantly, in both paradigms task acquisition was similar between groups. In the same line we found no differences in the amount of sugared pellets eaten when freely available as well as in both general and fine motor behaviors. In conclusion, left and right NAc play distinct roles in the contingency degradation and impulsivity. More studies are needed to understand the mechanisms behind this functional lateralization and its implications for PD patients.
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Affiliation(s)
- A M Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - F G Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - M R Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - M Esteves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - J Pereira-Mendes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A R Soares
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - N Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - H Leite-Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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21
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Tada S, Nomoto M, Yamanishi Y, Miyaue N, Ando R, Yabe H, Nagai M. The marked decrease in cardiac MIBG-uptake correlates with the severity of sleep disturbance in patients with Parkinson’s disease. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Suzuki K, Fujita H, Watanabe Y, Matsubara T, Kadowaki T, Sakuramoto H, Hamaguchi M, Nozawa N, Hirata K. Leg restlessness preceding the onset of motor symptoms of Parkinson disease: A case series of 5 patients. Medicine (Baltimore) 2019; 98:e16892. [PMID: 31415433 PMCID: PMC6831196 DOI: 10.1097/md.0000000000016892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with Parkinson disease (PD) often show restless legs syndrome (RLS), leg motor restlessness (LMR) and other leg restlessness (OLR) related to sensorimotor symptoms.Here, we describe 5 patients who presented with leg restlessness as an early manifestation of PD.In case 1, the patient had leg restlessness that was not LMR or RLS and preceded the onset of motor symptoms by 1 year. In case 2, LMR preceded motor symptoms by 2 years. Case 3 had unilateral RLS symptoms on the left side of the body for 33 years. Two and a half years after the spread of RLS symptoms to the right leg with increased frequency of left-sided RLS symptoms, the patient developed PD at the age of 58 years. In cases 4 and 5, RLS symptoms preceded motor symptoms by 3 months and 1 month, respectively. All patients developed Parkinsonism within 3 years (median, 1.0 year; range 0.083-2.5 years) after initial onset or exacerbation of leg restlessness. All patients had frequent leg restlessness symptoms (6-7 days per week). In our series, the preceding leg restlessness was unilateral and confined to the dominant side of the subsequent Parkinsonism, or preceding leg restlessness was bilateral but dominant on the dominant side of the subsequent Parkinsonism.Clinicians should be aware that late-onset leg restlessness (>50 years of age) including RLS, LMR, and OLR, particularly if frequent and asymmetrical, can be an early nonmotor manifestation of PD.
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23
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Lewis AS, van Schalkwyk GI, Lopez MO, Volkmar FR, Picciotto MR, Sukhodolsky DG. An Exploratory Trial of Transdermal Nicotine for Aggression and Irritability in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2019. [PMID: 29536216 DOI: 10.1007/s10803-018-3536-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nicotinic acetylcholine receptors (nAChRs), particularly the α7 nAChR, are implicated in the pathophysiology of both autism spectrum disorder (ASD) and aggressive behavior. We explored the feasibility, tolerability, and preliminary efficacy of targeting nAChRs using transdermal nicotine to reduce aggressive symptoms in adults with ASD. Eight subjects were randomized in a double-blind crossover trial of 7 mg transdermal nicotine or placebo, each for 1 week. All participants tolerated nicotine treatment well. Five subjects contributed data to the primary outcome, Aberrant Behavior Checklist-Irritability (ABC-I) subscale change from baseline, which was improved by nicotine compared to placebo. Sleep ratings were also improved by nicotine and correlated with ABC-I improvement. These findings support further investigation of nAChR agonists for aggression and sleep in ASD.
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Affiliation(s)
- Alan S Lewis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. .,Department of Psychiatry, Yale University School of Medicine, 184 Liberty Street, Room LV120, New Haven, CT, 06519, USA.
| | - Gerrit Ian van Schalkwyk
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA.,Butler Hospital, Providence, RI, USA
| | - Mayra Ortiz Lopez
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Fred R Volkmar
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Marina R Picciotto
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Barner C, Altgassen M, Born J, Diekelmann S. Effects of sleep on the realization of complex plans. J Sleep Res 2019; 28:e12655. [DOI: 10.1111/jsr.12655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Christine Barner
- Institute of Medical Psychology and Behavioral Neurobiology University of Tübingen Tübingen Germany
| | - Mareike Altgassen
- Donders Institute for Brain Cognition and Behaviour Radboud University Nijmegen the Netherlands
| | - Jan Born
- Institute of Medical Psychology and Behavioral Neurobiology University of Tübingen Tübingen Germany
- Center for Integrative Neuroscience (CIN) University of Tübingen Tübingen Germany
| | - Susanne Diekelmann
- Institute of Medical Psychology and Behavioral Neurobiology University of Tübingen Tübingen Germany
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Deeb W, Nozile-Firth K, Okun MS. Parkinson's disease: Diagnosis and appreciation of comorbidities. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:257-277. [PMID: 31753136 DOI: 10.1016/b978-0-12-804766-8.00014-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Parkinson's disease (PD) is a complex neuropsychiatric disorder that manifests with a variety of motor and nonmotor symptoms. Its incidence increases with age. It is important for clinicians to be able to distinguish symptoms of aging and other comorbidities from those of PD. The diagnosis of PD has traditionally been rendered using strict criteria that mainly rely on the cardinal motor symptoms of rest tremor, rigidity, and bradykinesia. However, newer diagnostic criteria proposed by the Movement Disorders Society for diagnosis of PD collectively reflect a greater appreciation for the nonmotor symptoms. The treatment of PD remains symptomatic and the most noticeable improvements have been documented in the motor symptoms. Levodopa remains the gold standard for therapy, however there are now many other potential medical and surgical treatment strategies. Nonmotor symptoms have been shown to affect quality of life more than the motor symptoms. There is ongoing research into symptomatic and disease modifying treatments. Given the multisystem involvement in PD, an interdisciplinary patient-centered approach is recommended by most experts. This chapter addresses first the diagnostic approach and the many geriatric considerations. This is followed by a review of the nonmotor symptoms. Finally, a summary of current treatment strategies in PD is presented along with potential treatment complications.
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Affiliation(s)
- Wissam Deeb
- Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States.
| | - Kamilia Nozile-Firth
- Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
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Marinus J, Zhu K, Marras C, Aarsland D, van Hilten JJ. Risk factors for non-motor symptoms in Parkinson's disease. Lancet Neurol 2018; 17:559-568. [DOI: 10.1016/s1474-4422(18)30127-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 12/29/2022]
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Lee J, Kim Y, Kim YL. Non-pharmacological therapies for sleep disturbances in people with Parkinson's disease: A systematic review. J Adv Nurs 2018; 74:1741-1751. [PMID: 29700848 DOI: 10.1111/jan.13694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 02/28/2024]
Abstract
AIM To determine the effectiveness of non-pharmacological therapies for sleep disturbances in people with Parkinson's disease (PD). BACKGROUND Sleep disturbances, which are common in people with PD, may diminish their quality of life. Non-pharmacological therapies are preferred over pharmacological therapies for improving sleep quality, owing to fewer adverse effects. DESIGN Systematic literature review. DATA SOURCES A systematic search of eight databases and hand searching was conducted for papers published between 1 January 2000 - 1 January 2016. REVIEW METHODS The Cochrane methods were followed. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool. RESULTS Eight studies were identified for data extraction. Therapeutic domains included physical exercise, cognitive behavioural and complementary interventions. Therapies in four of the eight studies significantly improved sleep quality and the unified PD rating scale score. Other studies showed no clear effects on sleep (N = 1), limited effects on sleep (N = 1) or effects in both the intervention and control groups, indicating that the intervention had no distinctive effects (N = 2). CONCLUSIONS The non-pharmacological intervention types and sleep-related measured outcomes were heterogeneous. Most therapies had inconsistent effects on sleep. The insufficient evidence for non-pharmacological treatments seems related to the unique motor-associated clinical features of PD, which restrict the use of physical exercise therapy, or to individual "wearing-off" periods, which limit group therapy. Further studies on non-pharmacological therapies are required to identify the best interventions for improving sleep quality in people with PD.
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Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Yonji Kim
- Graduate School, College of Nursing, Yonsei University, Seoul, Korea
| | - Yie Lin Kim
- Graduate School, College of Nursing, Yonsei University, Seoul, Korea
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Rana AQ, Qureshi ARM, Shamli Oghli Y, Saqib Y, Mohammed B, Sarfraz Z, Rana R. Decreased sleep quality in Parkinson's patients is associated with higher anxiety and depression prevalence and severity, and correlates with pain intensity and quality. Neurol Res 2018; 40:696-701. [PMID: 29663852 DOI: 10.1080/01616412.2018.1462880] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Pain, poor sleep quality, restless legs syndrome (RLS), and other symptoms are frequently reported by patients with Parkinson's disease (PD). However, the impact that pain severity and interference has on non-motor symptoms (NMS) has not been extensively studied. The objective of the present study is to explore the relationship between sleep quality in PD to pain and other NMS that affect quality of life. METHODS The study included 100 PD patients and 100 age and gender-matched controls assessed for pain severity and pain interference using the Brief Pain Inventory and sleep quality using the Pittsburgh Sleep Quality Index. Participants were also evaluated for their subjective levels of anxiety and depression using the Hospital Anxiety and Depression Scale. RESULTS PD patients with poor sleep quality had greater pain severity and pain interference than controls and PD patients with good or borderline sleep quality. PD patients with poor sleep quality also had the greatest case-ness and severity for depression and anxiety. However, RLS was not significantly correlated with depression, anxiety or pain. DISCUSSION Poor sleep quality in PD patients is related to greater pain severity, pain interference, and more radiating and paresthestic pain that is independent of RLS. There is a higher prevalence of depression and anxiety in PD patients compared to controls, especially in PD patients with poor sleep quality. Our findings suggest a relationship between poor sleep quality in PD with pain, anxiety and depression. Prospective studies are warranted to investigate the causal relationship.
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Affiliation(s)
- Abdul Qayyum Rana
- a Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre , Toronto , Canada
| | - Abdul Rehman M Qureshi
- a Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre , Toronto , Canada.,b Department of Biological Sciences , University of Toronto at Scarborough , Toronto , Canada
| | - Yazan Shamli Oghli
- a Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre , Toronto , Canada.,b Department of Biological Sciences , University of Toronto at Scarborough , Toronto , Canada
| | - Yosuf Saqib
- c Faculty of Science , York University , Toronto , Canada
| | - Bilal Mohammed
- c Faculty of Science , York University , Toronto , Canada
| | - Zainab Sarfraz
- a Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre , Toronto , Canada
| | - Ruqqiyah Rana
- a Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre , Toronto , Canada
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Absent Audiovisual Integration Elicited by Peripheral Stimuli in Parkinson's Disease. PARKINSONS DISEASE 2018; 2018:1648017. [PMID: 29850014 PMCID: PMC5924975 DOI: 10.1155/2018/1648017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/01/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
Abstract
The basal ganglia, which have been shown to be a significant multisensory hub, are disordered in Parkinson's disease (PD). This study was to investigate the audiovisual integration of peripheral stimuli in PD patients with/without sleep disturbances. Thirty-six age-matched normal controls (NC) and 30 PD patients were recruited for an auditory/visual discrimination experiment. The mean response times for each participant were analyzed using repeated measures ANOVA and race model. The results showed that the response to all stimuli was significantly delayed for PD compared to NC (all p < 0.01). The response to audiovisual stimuli was significantly faster than that to unimodal stimuli in both NC and PD (p < 0.001). Additionally, audiovisual integration was absent in PD; however, it did occur in NC. Further analysis showed that there was no significant audiovisual integration in PD with/without cognitive impairment or in PD with/without sleep disturbances. Furthermore, audiovisual facilitation was not associated with Hoehn and Yahr stage, disease duration, or the presence of sleep disturbances (all p > 0.05). The current results showed that audiovisual multisensory integration for peripheral stimuli is absent in PD regardless of sleep disturbances and further suggested the abnormal audiovisual integration might be a potential early manifestation of PD.
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Fernández-Pajarín G, Sesar Á, Ares B, Castro A. Evaluating the Efficacy of Nocturnal Continuous Subcutaneous Apomorphine Infusion in Sleep Disorders in Advanced Parkinson's Disease: The APO-NIGHT Study. JOURNAL OF PARKINSONS DISEASE 2017; 6:787-792. [PMID: 27662329 DOI: 10.3233/jpd-160886] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are not many data about the beneficial effect of nocturnal continuous subcutaneous apomorphine infusion (NCSAI) over sleep disturbances in advanced Parkinson's disease (PD). OBJECTIVE Evaluate the effect of the NCSAI in sleeping problems and insomnia due to nocturnal hypokinesia inadvanced PD. METHODS We assessed 17 advanced PD patients with several sleep disturbances measured by SCOPA-SLEEP and PDSS scales. All the patients were on apomorphine infusion during daytime. This therapy was extended to nighttime. We evaluated the patients before the onset and after six weeks with NCSAI. RESULTS NCSAI allowed highly significant improvements in SCOPA-SLEEP and PDSS scales (p<0.0001), and daytime somnolence. NCSAI was well tolerated with no major adverse effects were noticed. CONCLUSION This study shows and confirms the efficacy of NCSAI on the sleep disturbances related to advanced PD. We provide an easy protocol to start this therapy.
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Trotti LM, Karroum EG. Melatonin for Sleep Disorders in Patients with Neurodegenerative Diseases. Curr Neurol Neurosci Rep 2017; 16:63. [PMID: 27180068 DOI: 10.1007/s11910-016-0664-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In patients with neurodegenerative diseases, sleep disorders are common; they impair the quality of life for patients and caregivers and are associated with poorer clinical outcomes. Melatonin has circadian, hypnotic, and free radical-scavenging effects, and preclinical data suggest benefits of melatonin on neurodegeneration. However, randomized, controlled trials of melatonin in patients with neurodegenerative diseases have not shown strong effects. Trials in Alzheimer's patients demonstrate a lack of benefit on sleep quantity. Subjective measures of sleep quality are mixed, with possible symptomatic improvements seen only on some measures or at some time points. Benefits on cognition have not been observed across several studies. In Parkinson's patients, there may be minimal benefit on objective sleep measures, but a suggestion of subjective benefit in few, small studies. Effective treatments for the sleep disorders associated with neurodegenerative diseases are urgently needed, but current data are insufficient to establish melatonin as such a treatment.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Dr NE, Atlanta, GA, 30329, USA.
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA, USA.
| | - Elias G Karroum
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA, USA
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Wang Y, Shen Y, Xiong KP, He PC, Mao CJ, Li J, Wang FY, Wang YL, Huang JY, Liu CF. Tonic Electromyogram Density in Multiple System Atrophy with Predominant Parkinsonism and Parkinson's Disease. Chin Med J (Engl) 2017; 130:684-690. [PMID: 28303851 PMCID: PMC5358418 DOI: 10.4103/0366-6999.201603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Both Parkinson's disease (PD) and multiple system atrophy (MSA) have associated sleep disorders related to the underlying neurodegenerative pathology. Clinically, MSA with predominant parkinsonism (MSA-P) resembles PD in the manifestation of prominent parkinsonism. Whether the amount of rapid eye movement (REM) sleep without atonia could be a potential marker for differentiating MSA-P from PD has not been thoroughly investigated. This study aimed to examine whether sleep parameters could provide a method for differentiating MSA-P from PD. METHODS This study comprised 24 MSA-P patients and 30 PD patients, and they were of similar age, gender, and REM sleep behavior disorder (RBD) prevalence. All patients underwent clinical evaluation and one night of video-polysomnography recording. The tonic and phasic chin electromyogram (EMG) activity was manually quantified during REM sleep of each patient. We divided both groups in terms of whether they had RBD to make subgroup analysis. RESULTS No significant difference between MSA-P group and PD group had been found in clinical characteristics and sleep architecture. However, MSA-P patients had higher apnea-hypopnea index (AHI; 1.15 [0.00, 8.73]/h vs. 0.00 [0.00, 0.55]/h, P = 0.024) and higher tonic chin EMG density (34.02 [18.48, 57.18]% vs. 8.40 [3.11, 13.06]%, P < 0.001) as compared to PD patients. Subgroup analysis found that tonic EMG density in MSA + RBD subgroup was higher than that in PD + RBD subgroup (55.04 [26.81, 69.62]% vs. 11.40 [8.51, 20.41]%, P < 0.001). Furthermore, no evidence of any difference in tonic EMG density emerged between PD + RBD and MSA - RBD subgroups (P > 0.05). Both disease duration (P = 0.056) and AHI (P = 0.051) showed no significant differences during subgroup analysis although there was a trend toward longer disease duration in PD + RBD subgroup and higher AHI in MSA - RBD subgroup. Stepwise multiple linear regression analysis identified the presence of MSA-P (β = 0.552, P < 0.001) and RBD (β = 0.433, P < 0.001) as predictors of higher tonic EMG density. CONCLUSION Tonic chin EMG density could be a potential marker for differentiating MSA-P from PD.
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Affiliation(s)
- Yi Wang
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Yun Shen
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Kang-Ping Xiong
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Pei-Cheng He
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Cheng-Jie Mao
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Jie Li
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Fu-Yu Wang
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Ya-Li Wang
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
| | - Jun-Ying Huang
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Chun-Feng Liu
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
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Fu YT, Mao CJ, Ma LJ, Zhang HJ, Wang Y, Li J, Huang JY, Liu JY, Liu CF. Pain Correlates with Sleep Disturbances in Parkinson's Disease Patients. Pain Pract 2017; 18:29-37. [PMID: 28371220 DOI: 10.1111/papr.12578] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/19/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Yun-Ting Fu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Cheng-Jie Mao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
- Sleep Center; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Li-Jing Ma
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Hui-Jun Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Yi Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Jie Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
- Sleep Center; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Jun-Ying Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
- Sleep Center; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Jun-Yi Liu
- Institute of Neuroscience; Soochow University; Suzhou China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
- Sleep Center; The Second Affiliated Hospital of Soochow University; Suzhou China
- Institute of Neuroscience; Soochow University; Suzhou China
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Perez-Lloret S, Peralta MC, Barrantes FJ. Pharmacotherapies for Parkinson's disease symptoms related to cholinergic degeneration. Expert Opin Pharmacother 2016; 17:2405-2415. [PMID: 27785919 DOI: 10.1080/14656566.2016.1254189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Dopamine depletion is one of the most important features of Parkinson's Disease (PD). However, insufficient response to dopaminergic replacement therapy suggests the involvement of other neurotransmitter systems in the pathophysiology of PD. Cholinergic degeneration contributes to gait impairments, cognitive impairment, psychosis, and REM-sleep disturbances, among other symptoms. Areas covered: In this review, we explore the idea that enhancing cholinergic tone by pharmacological or neurosurgical procedures could be a first-line therapeutic strategy for the treatment of symptoms derived from cholinergic degeneration in PD. Expert opinion: Rivastigmine, a drug that increases cholinergic tone by inhibiting the enzyme cholinesterase, is effective for dementia, whereas the use of Donepezil is still in the realm of investigation. Interesting results suggest the efficacy of these drugs in the treatment of gait dysfunction. Evidence on the clinical effects of these drugs for psychosis and REM-sleep disturbances is still weak. Stimulation of the pedunculo-pontine tegmental nuclei (which provide cholinergic innervation to the brain stem and subcortical nuclei) has also been used with some success for the treatment of gait dysfunction. Anticholinergic drugs should be used with caution in PD, as they may aggravate cholinergic symptoms. Notwithstanding, in some patients they might help control parkinsonian motor symptoms.
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Affiliation(s)
- Santiago Perez-Lloret
- a Institute of Cardiology Research , University of Buenos Aires, National Research Council (CONICET-ININCA) , Buenos Aires , Argentina
| | - María Cecilia Peralta
- b Parkinson's Disease and Movement Disorders Clinic, Neurology Department , CEMIC University Hospital , Buenos Aires , Argentina
| | - Francisco J Barrantes
- c Laboratory of Molecular Neurobiology , Institute for Biomedical Research, UCA-CONICET, Faculty of Medical Sciences , Buenos Aires , Argentina
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Pagano G, Molloy S, Bain PG, Rabiner EA, Chaudhuri KR, Brooks DJ, Pavese N. Sleep problems and hypothalamic dopamine D3 receptor availability in Parkinson disease. Neurology 2016; 87:2451-2456. [PMID: 27807182 DOI: 10.1212/wnl.0000000000003396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 09/06/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate the relationship between hypothalamic D3 dopamine receptor availability and severity of sleep problems in Parkinson disease (PD). METHODS Twelve patients were assessed with PET and the high-affinity dopamine D3 receptor radioligand [11C]-propyl-hexahydro-naphtho-oxazin ([11C]-PHNO). Severity of sleep problems was rated with appropriate subitems of the Unified Parkinson's Disease Rating Scale part I (patient questionnaire) and the Epworth Sleepiness Scale. RESULTS We found that lower dopamine D3 receptor availability measured with [11C]-PHNO PET was associated with greater severity of excessive daytime sleepiness but not with problems of falling asleep or insomnia. CONCLUSION In our cohort of patients with PD, the occurrence of excessive daytime sleepiness was linked to reductions in hypothalamic dopamine D3 receptor availability. If these preliminary findings are confirmed in larger cohorts of patients with polysomnographic characterization, selective pharmacologic modulation of the dopaminergic D3 system could be used to increase daytime alertness in patients with PD.
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Affiliation(s)
- Gennaro Pagano
- From the Division of Brain Sciences (G.P., P.G.B., D.J.B., N.P.), Imperial College London; Imperial College NHS Trust (S.M.); Imanova Ltd (E.A.R.); National Parkinson Foundation International Centre of Excellence (E.A.R.), King's College London and National Institute for Health Research Biomedical Research Centre and King's College London; Institute of Neuroscience (D.J.B., N.P.), Newcastle University, UK; and Institute of Clinical Medicine (D.J.B., N.P.), University of Aarhus, Denmark
| | - Sophie Molloy
- From the Division of Brain Sciences (G.P., P.G.B., D.J.B., N.P.), Imperial College London; Imperial College NHS Trust (S.M.); Imanova Ltd (E.A.R.); National Parkinson Foundation International Centre of Excellence (E.A.R.), King's College London and National Institute for Health Research Biomedical Research Centre and King's College London; Institute of Neuroscience (D.J.B., N.P.), Newcastle University, UK; and Institute of Clinical Medicine (D.J.B., N.P.), University of Aarhus, Denmark
| | - Peter G Bain
- From the Division of Brain Sciences (G.P., P.G.B., D.J.B., N.P.), Imperial College London; Imperial College NHS Trust (S.M.); Imanova Ltd (E.A.R.); National Parkinson Foundation International Centre of Excellence (E.A.R.), King's College London and National Institute for Health Research Biomedical Research Centre and King's College London; Institute of Neuroscience (D.J.B., N.P.), Newcastle University, UK; and Institute of Clinical Medicine (D.J.B., N.P.), University of Aarhus, Denmark
| | - Eugenii A Rabiner
- From the Division of Brain Sciences (G.P., P.G.B., D.J.B., N.P.), Imperial College London; Imperial College NHS Trust (S.M.); Imanova Ltd (E.A.R.); National Parkinson Foundation International Centre of Excellence (E.A.R.), King's College London and National Institute for Health Research Biomedical Research Centre and King's College London; Institute of Neuroscience (D.J.B., N.P.), Newcastle University, UK; and Institute of Clinical Medicine (D.J.B., N.P.), University of Aarhus, Denmark
| | - K Ray Chaudhuri
- From the Division of Brain Sciences (G.P., P.G.B., D.J.B., N.P.), Imperial College London; Imperial College NHS Trust (S.M.); Imanova Ltd (E.A.R.); National Parkinson Foundation International Centre of Excellence (E.A.R.), King's College London and National Institute for Health Research Biomedical Research Centre and King's College London; Institute of Neuroscience (D.J.B., N.P.), Newcastle University, UK; and Institute of Clinical Medicine (D.J.B., N.P.), University of Aarhus, Denmark
| | - David J Brooks
- From the Division of Brain Sciences (G.P., P.G.B., D.J.B., N.P.), Imperial College London; Imperial College NHS Trust (S.M.); Imanova Ltd (E.A.R.); National Parkinson Foundation International Centre of Excellence (E.A.R.), King's College London and National Institute for Health Research Biomedical Research Centre and King's College London; Institute of Neuroscience (D.J.B., N.P.), Newcastle University, UK; and Institute of Clinical Medicine (D.J.B., N.P.), University of Aarhus, Denmark
| | - Nicola Pavese
- From the Division of Brain Sciences (G.P., P.G.B., D.J.B., N.P.), Imperial College London; Imperial College NHS Trust (S.M.); Imanova Ltd (E.A.R.); National Parkinson Foundation International Centre of Excellence (E.A.R.), King's College London and National Institute for Health Research Biomedical Research Centre and King's College London; Institute of Neuroscience (D.J.B., N.P.), Newcastle University, UK; and Institute of Clinical Medicine (D.J.B., N.P.), University of Aarhus, Denmark.
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Xing Y, Tang Y, Zhao L, Wang Q, Qin W, Ji X, Zhang J, Jia J. Associations between plasma ceramides and cognitive and neuropsychiatric manifestations in Parkinson's disease dementia. J Neurol Sci 2016; 370:82-87. [PMID: 27772793 DOI: 10.1016/j.jns.2016.09.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/16/2016] [Accepted: 09/16/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The abnormal metabolism of ceramides may account for the pathogenesis of Parkinson's disease dementia (PDD). However, the effect of ceramides on cognitive domain impairments and neuropsychiatric symptoms of PDD remains unknown. METHODS A total of 38 PDD, 40 PD with no cognitive impairment (PD-NC) and 40 normal controls were included. A series of cognitive tests and the Neuropsychiatric Inventory (NPI) were used to assess cognitive domains and neuropsychiatric symptoms. A non-fasting blood sample was obtained from each subject. Plasma ceramide levels were tested by HPLC-MS/MS analysis. RESULTS C14:0 and C24:1 levels were significantly higher in PDD than in PD-NC and normal controls. Verbal memory was negatively correlated with C14:0 and C24:1. After controlling for confounding factors, C22:0, C20:0 and C18:0 were significantly associated with hallucinations, anxiety and sleep behavior disturbances, respectively. CONCLUSION In PDD, the increase in ceramide levels was correlated with decreased memory function and associated with higher odds of multiple neuropsychiatric symptoms.
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Affiliation(s)
- Yi Xing
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yi Tang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Lina Zhao
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Ji
- Department of Cadre Health Care, Beijing Jishuitan Hospital, Beijing, China
| | - Jinlan Zhang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Jianping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Perez-Lloret S, Barrantes FJ. Deficits in cholinergic neurotransmission and their clinical correlates in Parkinson's disease. NPJ PARKINSONS DISEASE 2016; 2:16001. [PMID: 28725692 PMCID: PMC5516588 DOI: 10.1038/npjparkd.2016.1] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/10/2015] [Accepted: 12/21/2015] [Indexed: 01/04/2023]
Abstract
In view of its ability to explain the most frequent motor symptoms of Parkinson’s Disease (PD), degeneration of dopaminergic neurons has been considered one of the disease’s main pathophysiological features. Several studies have shown that neurodegeneration also affects noradrenergic, serotoninergic, cholinergic and other monoaminergic neuronal populations. In this work, the characteristics of cholinergic deficits in PD and their clinical correlates are reviewed. Important neurophysiological processes at the root of several motor and cognitive functions remit to cholinergic neurotransmission at the synaptic, pathway, and circuital levels. The bulk of evidence highlights the link between cholinergic alterations and PD motor symptoms, gait dysfunction, levodopa-induced dyskinesias, cognitive deterioration, psychosis, sleep abnormalities, autonomic dysfunction, and altered olfactory function. The pathophysiology of these symptoms is related to alteration of the cholinergic tone in the striatum and/or to degeneration of cholinergic nuclei, most importantly the nucleus basalis magnocellularis and the pedunculopontine nucleus. Several results suggest the clinical usefulness of antimuscarinic drugs for treating PD motor symptoms and of inhibitors of the enzyme acetylcholinesterase for the treatment of dementia. Data also suggest that these inhibitors and pedunculopontine nucleus deep-brain stimulation might also be effective in preventing falls. Finally, several drugs acting on nicotinic receptors have proved efficacious for treating levodopa-induced dyskinesias and cognitive impairment and as neuroprotective agents in PD animal models. Results in human patients are still lacking.
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Affiliation(s)
- Santiago Perez-Lloret
- Institute of Cardiologic Research, National Scientific and Research Council (ININCA-CONICET), Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Francisco J Barrantes
- Laboratory of Molecular Neurobiology, Institute for Biomedical Research, UCA-CONICET, Faculty of Medical Sciences, Buenos Aires, Argentina
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Abstract
Sleep disturbances are a common presenting symptom of older-age adults to their physicians. This article explores normal changes in sleep pattern with aging and primary sleep disorders in the elderly. Behavioral factors and primary psychiatric disorders affecting sleep in this population are reviewed. Further discussion examines sleep changes associated with 2 common forms of neurocognitive disorder: Alzheimer disease and Lewy Body Dementia. Common medical illnesses in the elderly are discussed in relation to sleep symptoms. Nonpharmacological and pharmacologic treatment strategies are summarized, with emphasis placed on risk of side effects in older adults. Future targets are considered.
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Affiliation(s)
- Kristina F Zdanys
- Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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Restless Legs Syndrome and Leg Motor Restlessness in Parkinson's Disease. PARKINSONS DISEASE 2015; 2015:490938. [PMID: 26504610 PMCID: PMC4609490 DOI: 10.1155/2015/490938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 01/15/2023]
Abstract
Sleep disturbances are important nonmotor symptoms in Parkinson's disease (PD) that are associated with a negative impact on quality of life. Restless legs syndrome (RLS), which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR), which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders.
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