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REM sleep behavior disorder predicts cognitive impairment in Parkinson disease without dementia

From Centre d'Étude du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Coeur de Montréal (M.V., J.-F.G., A.D., J.M.-M., J.M.); Centre de Recherche, Institut Universitaire de Gériatrie de Montréal (J.-F.G., J.D.); Department of Neurology, Montreal General Hospital (R.B.P.); and Unité des Troubles du Mouvement André Barbeau, Pavillon Hôtel-Dieu du Centre Hospitalier de l'Université de Montréal (M.P.), Québec, Canada.

Address correspondence and reprint requests to Dr. Jacques Montplaisir, CRCPC, Centre d'Étude du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Cæur de Montréal, 5400 Boul. Gouin Ouest, Montréal, Québec, Canada, H4J 1C5 JY.Montplaisir{at}UMontreal.ca

Objective: To assess the relationship between the presence of REM sleep behavior disorder (RBD) and the cognitive profile of nondemented patients with Parkinson disease (PD).

Background: Cognitive impairment is an important nonmotor symptom in PD. Waking EEG slowing in nondemented PD has been related to the presence of RBD, a parasomnia affecting brainstem structures and frequently reported in PD. For this reason, RBD may be associated with cognitive impairment in PD.

Methods: Thirty-four patients with PD (18 patients with polysomnographic-confirmed RBD and 16 patients without RBD) and 25 healthy control subjects matched for age and educational level underwent sleep laboratory recordings and a comprehensive neuropsychological assessment.

Results: Patients with PD and concomitant RBD showed significantly poorer performance on standardized tests measuring episodic verbal memory, executive functions, as well as visuospatial and visuoperceptual processing compared to both patients with PD without RBD and control subjects. Patients with PD without RBD had no detectable cognitive impairment compared to controls.

Conclusions: This study shows that cognitive impairment in nondemented patients with Parkinson disease (PD) is closely related to the presence of REM sleep behavior disorder, a sleep disturbance that was not controlled for in previous studies assessing cognitive deficits in PD.

GLOSSARY: BDI-II = Beck-II Depression Inventory; DLB = dementia with Lewy bodies; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders; EOG = electro-oculograms; ICSD = International Classification of Sleep Disorders; MMSE = Mini-Mental State Examination; PD = Parkinson disease; PD-NRBD = patients with PD without RBD; PD-RBD = patients with concomitant RBD; RAVLT = Rey Auditory Verbal Learning Test; RBD = REM sleep behavior disorder; UPDRS = Unified Parkinson's Disease Rating Scale.

*These authors contributed equally to this work.

Supported by the Canadian Institutes of Health Research (operating grant to J.M. and postdoctoral studentship to J.F.G.) and the "Fonds de la Recherche en Santé du Québec" (studentship to M.V. and J.M.M.). J.M. holds a Canadian Government Chair on Sleep Disorders.

Disclosure: M. Vendette, J.-F. Gagnon, A. Décary, J. Massicotte-Marquez, and J. Doyon report no conflicts of interest. R.B. Postuma received personal compensation from Novartis for consulting services. M. Panisset received personal compensation from Novartis, Prestwick, and Teva for consulting services and he received financial support for research activities from Prestwick, Novartis, Teva Neuroscience, Elan Pharmaceutical, Schering, Eisai, Sarizotan, Merck, Amarin Neurosciences, and Kyowa. J. Montplaisir received personal compensation as consultant (Boehringer Ingelheim, Servier, Shire BioChem), speaker (Boehringer Ingelheim, Shire), and he received financial support for research activities from Sanofi Synthelabo, GlaxoSmithKline.

Received December 28, 2006. Accepted in final form May 22, 2007.

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