Impact of rapid eye movement sleep behavior disorder and autonomic disorders on Parkinson's disease: a review

Pérola de Oliveira; Francisco Cardoso

doi:10.1590/0004-282X-anp-2020-0173

Arquivos de Neuro-Psiquiatria, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(02): 156-166
DOI: 10.1590/0004-282X-anp-2020-0173

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Impact of rapid eye movement sleep behavior disorder and autonomic disorders on Parkinson's disease: a review

Impacto do transtorno comportamental do sono REM e doenças autonômicas na doença de Parkinson: uma revisão

Authors

Pérola de Oliveira

¹Rede SARAH de Hospitais de Reabilitação, Departamento de Neurologia, Brasília DF, Brazil.
Francisco Cardoso

²Universidade Federal de Minas Gerais, Unidade de Distúrbios do Movimento, Serviço de Neurologia, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.

Abstract

ABSTRACT

Parkinson's disease (PD) has heterogeneous clinical manifestations and prognoses. It is accompanied by a group of motor and non-motor symptoms ranging from independence to total disability, limiting work and personal care activities. Currently, disease subtype markers for informing prognosis remain elusive. However, some studies have reported an association between rapid eye movement (REM) sleep behavior disorder (RBD) and faster motor and non-motor symptom progression, including autonomic dysfunction and cognitive decline. Moreover, since autonomic dysfunction has been described in idiopathic forms of RBD, and they share some central regulatory pathways, it remains unclear whether they have a primary association or if they are more severe in patients with PD and RBD, and thus are a disease subtype marker. This article aimed at critically reviewing the literature on the controversies about the prevalence of RBD in PD, the higher incidence of PD non-motor symptoms associated with RBD, the evidence of faster motor worsening in parkinsonian patients with this parasomnia, and the main pathophysiological hypotheses that support these findings.

RESUMO

A doença de Parkinson (DP) apresenta variadas manifestações clínicas e distintos prognósticos. É caracterizada por um conjunto de sintomas motores e não motores que podem variar desde um quadro de independência até a completa incapacidade laborativa e de cuidados pessoais. Até o momento, não está claro quais seriam os marcadores de subtipos da doença que poderiam alertar para formas de prognóstico. Porém existem alguns estudos que mostram que a presença do transtorno comportamental do sono REM pode estar associada à progressão mais rápida dos sintomas motores e não motores, como disfunção autonômica e declínio cognitivo. Questiona-se ainda se a disautonomia está primariamente associada ao transtorno do sono REM, já que são relatadas nas formas idiopáticas deste transtorno de sono e compartilham alguns núcleos reguladores centrais. Ou se são mais graves nos pacientes com diagnóstico de DP e transtorno comportamental do sono REM, marcando assim um subtipo da doença. Esta revisão teve como objetivo revisar criticamente os principais estudos publicados envolvendo as controvérsias sobre a prevalência do transtorno comportamental do sono REM na DP, a maior incidência de sintomas não motores da DP associados ao transtorno do sono REM, as evidências de piora motora mais rápida nos pacientes parkinsonianos que apresentam este transtorno do sono e as principais hipóteses fisiopatológicas que justificam esses achados.

Keywords:

Parkinson Disease - REM Sleep Behavior Disorder - Autonomic Nervous System Diseases - Pathology - Epidemiology

Palavras-chave:

Doença de Parkinson - Transtorno do Comportamento do Sono REM - Doenças do Sistema Nervoso Autônomo - Patologia - Epidemiologia

Volltext

Referenzen

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