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Clinical Aspects of Idiopathic RBD

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Rapid-Eye-Movement Sleep Behavior Disorder

Abstract

Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by unpleasant dreams, dream-enacting behaviors, loss of REM sleep atonia, lack of waking motor and cognitive complaints, and the absence of a detectable underlying condition. iRBD typically occurs in people aged 50 years or older, mainly in men, with an estimated prevalence of 0.3–1%. Content of dreams is usually of frightening situations where patients are attacked or chased, and they often have to defend themselves with aggressive behaviors. The most common RBD behaviors are limb and body jerks, but elaborated and aggressive behaviors are also typical, with consequent sleep-related injuries. Despite the ongoing motor-behavioral activity during REM sleep with RBD, it is surprising that patients usually report a good night’s sleep and feel rested upon arising in the morning. Since about 50% of patients are completely unaware of their sleep behaviors, interviews with bed partners are essential to obtain a full clinical description. Clonazepam and melatonin typically have a beneficial effect in treating both RBD nightmares and vigorous behaviors. iRBD patients show markers of neurodegeneration (hyposmia, depression, constipation, substantia nigra hyperechogenicity, abnormal executive, and visuospatial functions) and the neuropathological substrate of Parkinson disease (deposits of abnormal synuclein in the peripheral autonomous nervous system, microglial activation in substantia nigra, and decreased dopamine activity in the striatum). In the majority of cases, there is a progression from iRBD to Parkinson disease, dementia with Lewy bodies, mild cognitive impairment, and multiple system atrophy. iRBD constitutes an excellent target population to test neuroprotective agents to halt or delay the occurrence of parkinsonism and dementia.

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Authors and Affiliations

  1. Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain

    Laura Pérez-Carbonell & Alex Iranzo

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  1. Laura Pérez-Carbonell
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  2. Alex Iranzo
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Correspondence to Alex Iranzo .

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Editors and Affiliations

  1. Minnesota Regional Sleep Disorders Center, Departments of Psychiatry, University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, MN, USA

    Carlos H. Schenck

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

    Birgit Högl

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

    Aleksandar Videnovic

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Pérez-Carbonell, L., Iranzo, A. (2019). Clinical Aspects of Idiopathic RBD. In: Schenck, C., Högl, B., Videnovic, A. (eds) Rapid-Eye-Movement Sleep Behavior Disorder. Springer, Cham. https://doi.org/10.1007/978-3-319-90152-7_4

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