Analysis Of The Clinical Features Of Parkinson’s Disease Patients With Rapid Eye Movement Sleep Behavior Disorders

Background: Parkinson’s disease(PD) is a type of neurodegenerative disease, commonly seen in middle aged patients, whose pathological changes include loss of a considerable amoun t of Substantia nigra’s dopaminergic neurons and other pigment containing neurons and appearance of lewy bodies within the cytoplasm of the remaining neurons. The main clinical features are resting tremor, bradycardia, postural instability, but in the recent years, researchers’ attention have been drawn to a number of non-motor symptoms such as sleep disorder, which precedes the onset of motor symptoms. Rapid eye movement(REM) phase of rapid eye movement sleep behavior disorder(RBD) is a period which constitutes of loss of muscle atonia(REM sleep without atonia,RSWA)as well as increased muscular movements whose pattern is directly related to the patients’ dreams(dream enactment behaviors, DEB). RBD was first described in the year of 1986, and it was considered as a separate entity, but in the recent years, studies have shown that RBD shares a close relationship with a variety of neurodegenerative diseases. For example, it may precede the occurrence of α-synuclein disease(α-synucleinopathies such as P arkinson’s disease), multiple system atrophy(MSA), dementia with Lewy bodies(DLB) and simple autonomic dysfunction(PAF). Researchers have even proposed that RBD may be also a hallmark of α-synucleinopathies. Among all the diseases, RBD shares the closest relationship with Parkinson’s disease, which brings us to realize that closer attention should be paid to identify RBD symptoms in patients with Parkinson’s and other neurodegenerative diseases. PD patients with RBD may have some specific signs and symptoms, whose patholophysiological mechanisms and relationship with PD need understanding, so that high risk groups patients could be identified early and as such, the appropriate neuroprotective treatment could be initiated as soon as possible to delay the onset or progression of the disease.Objective: 1. To discuss the incidence rate and gender particularities in PD patients with RBD. 2. To investigate PD patients with RBD(subdivided into early-onset and late-onset group RBD group) and those without RBD and to clarify their difference in terms of disease severity, Levodopa intake, non-motor complications, thus determining any specific clinical symptoms of PD patients with RBD. 3. Analysis of the relationship and trend between the occurrence of RBD in PD patients and PD typical motor symptoms, thus delineating the ability to use RBD as a mean to predict Parkinson’s disease. Through this clinical, we wish not only to draw attention to RBD symptoms in PD patients and its role in the prediction of PD, but also to investigate how RBD influences the course of RBD and whether the prospect of early medical intervention in PD patients with RBD is meaningful or not.Research Methods: From April 2014 to January 2015, in the First affiliated hospital of Dalian medical university, 106 PD patients were screened for RBD through analysis of the RBD screening questionnaire score(RBDSQ). Information was gathered concerning patients’ age, gender, clinical symptoms, PD history, Hoehn & Yahr stage, main type of motor symptoms, motor and non-motor complications, levodopa equivalent daily dose(LEDD). Each score includes the unified Parkinson’s disease rating scale(UPDRS), Minimental state examination, MMSE, Montreal cognitive Assessment(Mo CA) score, Hamilton anxiety scale(HAMA) and Hamilton depression(HAMD) score. Meanwhile, the incidence rate of idiopathic RBD(i RBD) in the above mentioned hospital among nonPD and other types of neurodegenerative disease patients was noted. The collected data were analyzed and their mean± standard deviation(ⅹ±s) was calculated via SPSS19.0 software, after which the data were further analyzed and compared via T test or ANOVA. Furthermore, the data were compared using the χ2 and Wilcoxon two-sample test, and data were considered to be statistically significant if P <0.05 or P <0.01.Results:1. The incidence rate of PD+RBD was 66.04%(70/106) with a male to female ratio of 1.7:1(44/26). Meanwhile, during the same period, the incidence of idiopathic RBD among non-PD and other neurodegenerative diseases was 1.06%(1/94). PD + RBD group patients have a longer average disease duration than PD-RBD group patients, and the difference was statistically significant(P <0.05).2. Non- tremor predominant patients among the PD+RBD group constitute 51 patients(72.9%) and 12 patients(33.3%) among the PD-RBD group, thus showing that nontremor predominant patients are more seen among PD+RBD patients. The difference between the two groups was statistically significant(P <0.01).3. The proportion of PD patients with gastrointestinal dysfunction and autonomic nervous dysfunction were greater in PD+RBD group than PD-RBD group(P<0.01). Assessment of psychological and cognitive function between the two groups reveals that the average MMSE and Mo CA scores in PD+RBD group was lower than that of PD-RBD group(P<0.05).4. Early onset PD+RBD and PD-RBD group patients have a lesser disease duration than late onset PD+RBD, the difference was significantly(P <0.05). Based on the UPDRS score and LEDD, the three groups of patients differ significantly in terms of duration(P <0.05). MMSE scores of early and late onset RBD+PD patients were lower than PD-RBD patients, and statistical difference was significant(P < 0.05). Statistical difference in terms of Mo CA scores between early onset RBD+PD patients and PD-RBD patients was significant(P<0.05). Although late-onset RBD group patients Mo CA scores were lower than PD-RBD group patients, the difference was not significant(P> 0.05).5. Early onset RBD+PD(RBD occurred before the onset of PD) group patients had a mean age of 65.3 ± 8.00 years, while late onset RBD+PD(RBD occurred after the onset of PD) group patients had a mean age of 58.7 ± 7.69 years, thus showing that early onset PD+RBD tends to occur later than late onset PD+RBD. The difference between the two groups was statistically significant(P <0.05).Conclusions:1. PD+RBD patients have a high incidence and more common in males; RBD is one of the early stage non-motor symptoms of senile PD patients. 2. Non tremor type of PD tends to dominate among PD+RBD group patients, which implies that RBD can be a symptom of non-tremor type of PD. 3. PD+RBD patients are more susceptible to develop gastrointestinal and urinary disturbances and also they tend to have a more severe cognitive impairment.