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Sleep disorder not just a bad dream

18 September 2017
REM sleep behaviour disorder a precursor to neurological diseases

REM sleep behaviour disorder is a precursor to neurological diseases including Parkinson's Disease and Lewy Body Dementia.

REM sleep behaviour disorder is not just indicative of a bad dream but can be a precursor to neurological diseases and clinicians need to be aware of it, says Professor Simon Lewis from the University of Sydney’s Brain and Mind Centre.

Published today in the Medical Journal of Australia, the research paper says people with RBD are often at a higher risk of neurodegenerative diseases, including Parkinson’s disease and Lewy Body Dementia (LBD).

Professor Lewis says while RBD has a relatively low prevalence in the population, research indicates that 80 percent of patients with RBD will go on to develop Parkinson’s or Lewy Body Dementia in the next 15 years.

People suffering from REM sleep behaviour disorder (RBD) often display physical signs of disruption such as violent movements and vocalisations.

“RBD is when patients begin acting out their dreams. Normally, when you’re having a bad dream or even a normal dream, our brain prevents us from moving around. However, this mechanism breaks down in Parkinson’s and Lewy Body Dementia. Patients often have little idea they have RBD initially, but they usually present to a clinician with sleep-related injuries or unpleasant dream content,” he says.

“RBD currently represents our best opportunity to identify those patients at risk of developing Parkinson’s and Lewy Body Dementia before they develop other clinical features. This in turn may offer a therapeutic window in the future to try and stop the disease from ever developing.”

Simple screening test available

RBD can often be detected by a simple screening questionnaire and patients then need to be adequately investigated to exclude potential mimics.

“There are other mimics of the RBD such as severe sleep apnoea, excess alcohol and certain medications.”

“Many of these causes will have specific treatment strategies but in patients presenting with RBD where no other cause can be identified, then it’s more likely they are showing early indications of a neurodegenerative disease in evolution,” he says.

Professor Lewis says RBD can usually be treated successfully in an effort to reduce injuries and these patients can be referred on to expert clinicians who have experience with neurodegeneration.

“Given that a number of neuroprotective trials are underway to identify how patients might be protected from neurodegenerative disease, health care professionals will need to have an increased awareness of RBD.”

Elliott Richardson

Assistant Media Advisor (Medicine, Dentistry, Nursing and Pharmacy)