REM Sleep Behavior Disorder Linked to Clinical Progression of Parkinson Disease

Rapid eye movement sleep behavior disorder features may be a clinical marker for faster cognitive decline in Parkinson disease.

For patients with Parkinson disease (PD), rapid eye movement sleep behavior disorder (RBD) features are clinical markers for faster cognitive decline and possibly motor progression, according to results published in Parkinsonism and Related Disorders.

RBD is characterized by dream enactment and has already been associated with an increased incidence of neurodegenerative disorders, including PD.

The study included participants with PD (n=776). The researchers screened participants for RBD. Motor features were evaluated with the Unified Parkinson’s Disease Rating Scale (UPDRS parts I, III, and IV) and Hoehn and Yahr staging. Participants also completed the Mini-Mental State Examination (MMSE).

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The researchers compared participants with and without probably RBD (pRBD) who had at least 1 follow-up (60%) to estimate hazard rate ratios for progression events, defined as UPDRS-III ≥35 and MMSE ≤24

At baseline, 21% of participants had pRBD. Participants with pRBD tended to be male and had more self-reported diagnoses of myocardial infarction, anxiety, and depression before baseline.

In adjusted Cox regression models among participants with a Postural Instability and Gait Dysfunction phenotype, those with pRBD progressed more quickly to a UPDRS-III ≥35 (HR 1.92, 95% CI, 1.12-3.27) compared with those without pRBD.

Compared with participants without pRBD, all those with pRBD progressed twice as fast to an MMSE score ≤24 (HR 2.04, 95% CI 1.13-3.69).

“RBD-features may be a simple and useful screening for treatment trials and in clinical practice to identify those at risk for faster progression, who may benefit from pharmacological (changes in drug schemes) and non-pharmacological (including physical activity and prevention of falls) interventions,” the researchers wrote.


Folle AD, Paul KC, Bronstein JM, et al. Clinical progression in Parkinson’s disease with features of REM sleep behavior disorder: a population-based longitudinal study [published online January 29, 2019]. Parkinsonism Relat Disord. doi: 10.1016/j.parkreldis.2019.01.018