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Journal of Geriatric Psychiatry and Neurology, Vol. 17, No. 3, 146-157 (2004)
DOI: 10.1177/0891988704267465
© 2004 SAGE Publications

REM Sleep Behavior Disorder in Parkinson’s Disease and Dementia with Lewy Bodies

Bradley F. Boeve, MD

Mayo Clinic, 200 First Street SW, Rochester, MN 55905bboeve{at}mayo.edu

Michael H. Silber, MBChB

Sleep Disorders Center; Department of Neurology

Tanis J. Ferman, PhD

Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Psychology and Psychiatry; Alzheimer’s Disease Research Center

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid, often frightening dreams associated with simple or complex motor behavior during REM sleep. Patients appear to "act out their dreams," in which the exhibited behaviors mirror the content of the dreams. Management of RBD involves counseling about safety measures in the sleep environment; in those at risk for injury, clonazepam and/or melatonin is usually effective. In this article, the authors present a detailed review of the clinical and polysomnographic features, differential diagnosis, diagnostic criteria, management strategies, and pathophysiologic mechanisms of RBD. They then review the literature and their institutional experience of RBD associated with neurodegenerative disease, particularly Parkinson’s disease and dementia with Lewy bodies. The evolving data suggests that RBD may have clinical diagnostic and pathophysiologic significance in isolation and when associated with neurodegenerative disease. (J Geriatr Psychiatry Neurol 2004; 17:146-157)

Key Words: REM sleep behavior disorder • Parkinson’s disease • dementia with Lewy bodies • synuclein • synucleinopathy

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