Link Between Parkinson Disease and Rapid Eye Movement Sleep Behavior Disorder With Dream Enactment: Possible Implications for Early Rehabilitation

Published:September 07, 2017DOI:


      The purpose of this article is 2-fold: first, to inform readers of the link between the loss of motor inhibition during rapid eye movement (REM) sleep dreaming, diagnosed as REM sleep behavior disorder, and the future onset of neurodegenerative disorders, such as Parkinson disease and dementia with Lewy bodies; it has been reported that motor disinhibition during REM sleep often precedes the onset of these disorders by years or even decades; second, to consider that the identification of REM sleep behavior disorder and the early involvement of rehabilitation and/or development of home exercise plans may aid in prolonging and even increasing function, independence, and quality of life, should such neurodegenerative disorders develop later in life.


      List of abbreviations:

      RBD (rapid eye movement sleep behavior disorder), REM (rapid eye movement)
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        • Silber M.H.
        • Ancoli-Israel S.
        • Bonnet M.H.
        • et al.
        The visual scoring of sleep in adults.
        J Clin Sleep Med. 2007; 3: 121-131
        • Morrison A.A.
        Symposium: dream research methodology: mechanisms underlying oneiric behaviour released in REM sleep by pontine lesions in cats.
        J Sleep Res. 1993; 2: 4-7
        • Schenck C.H.
        • Mahowald M.W.
        REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP.
        Sleep. 2002; 25: 120-138
        • Chen M.C.
        • Yu H.
        • Huang Z.L.
        • Lu J.
        Rapid eye movement sleep behavior disorder.
        Curr Opin Neurobiol. 2013; 23: 793-798
        • Iranzo A.
        • Santamaria J.
        • Tolosa E.
        The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases.
        Sleep Med Rev. 2009; 13: 385-401
        • Videnovic A.
        • Marlin C.
        • Alibiglou L.
        • Planetta P.J.
        • Vaillancourt D.E.
        • Mackinnon C.D.
        Increased REM sleep without atonia in Parkinson disease with freezing of gait.
        Neurology. 2013; 81: 1030-1035
        • Hall J.M.
        • Shine J.M.
        • O'Callaghan C.
        • et al.
        Freezing of gait and its associations in the early and advanced clinical motor stages of Parkinson's disease: a cross-sectional study.
        J Parkinsons Dis. 2015; 5: 881-891
        • Boeve B.F.
        REM sleep behavior disorder: updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease association, evolving concepts, controversies, and future directions.
        Ann N Y Acad Sci. 2010; 1184: 15-54
        • Postuma R.B.
        • Gagnon J.F.
        • Vendette M.
        • Desjardins C.
        • Montplaisir J.Y.
        Olfaction and color vision identify impending neurodegeneration in rapid eye movement sleep behavior disorder.
        Ann Neurol. 2011; 69: 811-818
        • Postuma R.B.
        • Gagnon J.F.
        • Bertrand J.A.
        • Génier Marchand D.
        • Montplaisir J.Y.
        Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials.
        Neurology. 2015; 84: 1104-1113
        • McDade E.M.
        • Boot B.P.
        • Christianson T.J.
        • et al.
        Subtle gait changes in patients with REM behavior disorder.
        Mov Disord. 2013; 28: 1847-1853
        • Iranzo A.
        • Tolosa E.
        • Gelpi E.
        • et al.
        Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study.
        Lancet Neurol. 2013; 12: 443-453
        • Schenck C.H.
        • Boeve B.F.
        • Mahowald M.W.
        Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series.
        Sleep Med. 2013; 14: 744-748
        • Kang S.H.
        • Yoon I.Y.
        • Lee S.D.
        • Han J.W.
        • Kim T.H.
        • Kim K.W.
        REM sleep behavior disorder in the Korean elderly population: prevalence and clinical characteristics.
        Sleep. 2013; 36: 1147-1152
        • Boot B.P.
        • Boeve B.F.
        • Roberts R.O.
        • et al.
        Probable rapid eye movement sleep behavior disorder increases risk for mild cognitive impairment and Parkinson disease: a population-based study.
        Ann Neurol. 2012; 71: 49-56
        • Mahlknecht P.
        • Seppi K.
        • Frauscher B.
        • et al.
        Probable RBD and association with neurodegenerative disease markers: a population-based study.
        Mov Disord. 2015; 30: 1417-1421
        • Lai Y.Y.
        • Siegel J.M.
        Muscle tone suppression and stepping produced by stimulation of midbrain and rostral pontine reticular formation.
        J Neurosci. 1990; 10: 2727-2734
        • Zoetmulder M.
        • Nikolic M.
        • Biernat H.
        • Korbo L.
        • Friberg L.
        • Jennum P.
        Increased motor activity during REM sleep is linked with dopamine function in idiopathic REM sleep behavior disorder and Parkinson disease.
        J Clin Sleep Med. 2016; 12: 895-903
        • Jennum P.
        • Christensen J.A.
        • Zoetmulder M.
        Neurophysiological basis of rapid eye movement sleep behavior disorder: informing future drug development.
        Nat Sci Sleep. 2016; 8: 107-120
        • Gagnon J.F.
        • Postuma R.B.
        • Montplaisir J.
        Update on the pharmacology of REM sleep behavior disorder.
        Neurology. 2006; 67: 742-747
        • Aurora R.N.
        • Zak R.S.
        • Maganti R.K.
        • et al.
        Best practice guide for the treatment of REM sleep behavior disorder (RBD).
        J Clin Sleep Med. 2010; 6: 85-95
        • Anderson K.N.
        • Shneerson J.M.
        Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam.
        J Clin Sleep Med. 2009; 5: 235-239
        • Devnani P.
        • Fernandes R.
        Management of REM sleep behavior disorder: an evidence based review.
        Ann Indian Acad Neurol. 2015; 18: 1-5
        • Lapierre O.
        • Montplaisir J.
        Polysomnographic features of REM sleep behavior disorder: development of a scoring method.
        Neurology. 1992; 42: 1371-1374
        • Dibble L.E.
        • Hale T.F.
        • Marcus R.L.
        • Droge J.
        • Gerber J.P.
        • LaStayo P.C.
        High-intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson's disease.
        Mov Disord. 2006; 21: 1444-1452
        • Corcos D.M.
        • Robichaud J.A.
        • David F.J.
        • et al.
        A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease.
        Mov Disord. 2013; 28: 1230-1240
        • Li F.
        • Harmer P.
        • Fitzgerald K.
        • et al.
        Tai chi and postural stability in patients with Parkinson's disease.
        N Engl J Med. 2012; 366: 511-519
        • Smania N.
        • Corato E.
        • Tinazzi M.
        • et al.
        Effect of balance training on postural instability in patients with idiopathic Parkinson's disease.
        Neurorehabil Neural Repair. 2010; 24: 826-834
        • Rodrigues de Paula F.
        • Teixeira-Salmela L.F.
        • Coelho de Morais Faria C.D.
        • Rocha de Brito P.
        • Cardoso F.
        Impact of an exercise program on physical, emotional, and social aspects of quality of life of individuals with Parkinson's disease.
        Mov Disord. 2006; 21: 1073-1077
        • Allen N.E.
        • Canning C.G.
        • Sherrington C.
        • et al.
        The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial.
        Mov Disord. 2010; 25: 1217-1225
        • Heyn P.
        • Abreu B.C.
        • Ottenbacher K.J.
        The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis.
        Arch Phys Med Rehabil. 2004; 85: 1694-1704
        • King L.A.
        • Horak F.B.
        Delaying mobility disability in people with Parkinson disease using a sensorimotor agility exercise program.
        Phys Ther. 2009; 89: 384-393
        • King A.C.
        • Oman R.F.
        • Brassington G.S.
        • Bliwise D.L.
        • Haskell W.L.
        Moderate-intensity exercise and self-rated quality of sleep in older adults: a randomized controlled trial.
        JAMA. 1997; 277: 32-37
        • Lun V.
        • Pullan N.
        • Labelle N.
        • Adams C.
        • Suchowersky O.
        Comparison of the effects of a self-supervised home exercise program with a physiotherapist-supervised exercise program on the motor symptoms of Parkinson's disease.
        Mov Disord. 2005; 20: 971-975
        • Nocera J.
        • Horvat M.
        • Ray C.T.
        Effects of home-based exercise on postural control and sensory organization in individuals with Parkinson disease.
        Parkinsonism Relat Disord. 2009; 15: 742
        • Rolland Y.
        • Pillard F.
        • Klapouszczak A.
        • et al.
        Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial.
        J Am Geriatr Soc. 2007; 55: 158-165
        • Roach K.E.
        • Tappen R.M.
        • Kirk-Sanchez N.
        • Williams C.L.
        • Loewenstein D.
        A randomized controlled trial of an activity specific exercise program for individuals with Alzheimer disease in long-term care settings.
        J Geriatr Phys Ther. 2011; 34: 50-56
        • Steinberg M.
        • Leoutsakos J.M.
        • Podewils L.J.
        • Lyketsos C.G.
        Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study.
        Int J Geriatr Psychiatry. 2009; 24: 680-685
        • Hurwitz A.
        The benefit of a home exercise regimen for ambulatory Parkinson's disease patients.
        J Neurosci Nurs. 1989; 21: 180-184
        • Calleo J.
        • Burrows C.
        • Levin H.
        • Marsh L.
        • Lai E.
        • York M.K.
        Cognitive rehabilitation for executive dysfunction in Parkinson's disease: application and current directions.
        Parkinsons Dis. 2012; 2012: 512892
        • Clare L.
        • Linden D.E.
        • Woods R.T.
        • et al.
        Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy.
        Am J Geriatr Psychiatry. 2010; 18: 928-939
        • Nombela C.
        • Bustillo P.J.
        • Castell P.F.
        • Sanchez L.
        • Medina V.
        • Herrero M.T.
        Cognitive rehabilitation in Parkinson's disease: evidence from neuroimaging.
        Front Neurol. 2011; 2: 82
        • Reuter I.
        • Mehnert S.
        • Sammer G.
        • Oechsner M.
        • Engelhardt M.
        Efficacy of a multimodal cognitive rehabilitation including psychomotor and endurance training in Parkinson's disease.
        J Aging Res. 2012; 2012: 235765
        • Sammer G.
        • Reuter I.
        • Hullmann K.
        • Kaps M.
        • Vaitl D.
        Training of executive functions in Parkinson's disease.
        J Neurol Sci. 2006; 248: 115-119
        • Sinforiani E.
        • Banchieri L.
        • Zucchella C.
        • Pacchetti C.
        • Sandrini G.
        Cognitive rehabilitation in Parkinson's disease.
        Arch Gerontol Geriatr Suppl. 2004; : 387-391
        • Baille G.
        • De Jesus A.M.
        • Perez T.
        • et al.
        Ventilatory dysfunction in Parkinson's disease.
        J Parkinsons Dis. 2016; 6: 463-471
        • Ahlskog J.E.
        Does vigorous exercise have a neuroprotective effect in Parkinson disease?.
        Neurology. 2011; 77: 288-294
        • Erickson K.I.
        • Voss M.W.
        • Prakash R.S.
        • et al.
        Exercise training increases size of hippocampus and improves memory.
        Proc Natl Acad Sci U S A. 2011; 108: 3017-3022
        • Lau Y.S.
        • Patki G.
        • Das-Panja K.
        • Le W.D.
        • Ahmad S.O.
        Neuroprotective effects and mechanisms of exercise in a chronic mouse model of Parkinson's disease with moderate neurodegeneration.
        Eur J Neurosci. 2011; 33: 1264-1274
        • Pereira A.C.
        • Huddleston D.E.
        • Brickman A.M.
        • et al.
        An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus.
        Proc Natl Acad Sci U S A. 2007; 104: 5638-5643
        • Reiter K.
        • Nielson K.A.
        • Smith T.J.
        • Weiss L.R.
        • Alfini A.J.
        • Smith J.C.
        Improved cardiorespiratory fitness is associated with increased cortical thickness in mild cognitive impairment.
        J Int Neuropsychol Soc. 2015; 21: 757-767
        • Smith J.C.
        • Nielson K.A.
        • Woodard J.L.
        • et al.
        Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer's disease.
        Front Aging Neurosci. 2014; 6: 61
        • Smith A.D.
        • Zigmond M.J.
        Can the brain be protected through exercise? Lessons from an animal model of parkinsonism.
        Exp Neurol. 2003; 184: 31-39
        • Park A.
        • Zid D.
        • Russell J.
        • et al.
        Effects of a formal exercise program on Parkinson's disease: a pilot study using a delayed start design.
        Parkinsonism Relat Disord. 2014; 20: 106-111
        • Lewin M.R.
        • Blum D.P.
        No evidence of neuroprotection? Perhaps not…perhaps so.
        Parkinsonism Relat Disord. 2014; 20: 1037
        • Carroll L.M.
        • Volpe D.
        • Morris M.E.
        • Saunders J.
        • Clifford A.M.
        Aquatic exercise therapy for people with Parkinson disease: a randomized controlled trial.
        Arch Phys Med Rehabil. 2017; 98: 631-638
        • McNeely M.E.
        • Duncan R.P.
        • Earhart G.M.
        A comparison of dance interventions in people with Parkinson disease and older adults.
        Maturitas. 2015; 81: 10-16
        • Ni M.
        • Signorile J.F.
        • Mooney K.
        • et al.
        Comparative effect of power training and high-speed yoga on motor function in older patients with Parkinson disease.
        Arch Phys Med Rehabil. 2016; 97: 345-354.e15
        • Ridgel A.L.
        • Phillips R.S.
        • Walter B.L.
        • Discenzo F.M.
        • Loparo K.A.
        Dynamic high-cadence cycling improves motor symptoms in Parkinson's disease.
        Front Neurol. 2015; 6: 194
        • Song R.
        • Grabowska W.
        • Park M.
        • et al.
        The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: a systematic review and meta-analysis.
        Parkinsonism Relat Disord. 2017; 41: 3-13
        • American Academy of Sleep Medicine
        International classification of sleep disorders, 3rd edition.
        American Academy of Sleep Medicine, Darien2014
        • Boeve B.F.
        • Molano J.R.
        • Ferman T.J.
        • et al.
        Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in an aging and dementia cohort.
        Sleep Med. 2011; 12: 445-453
        • Boeve B.F.
        • Molano J.R.
        • Ferman T.J.
        • et al.
        Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in a community-based sample.
        J Clin Sleep Med. 2013; 9: 475-480
        • Postuma R.B.
        • Arnulf I.
        • Hogl B.
        • et al.
        A single-question screen for REM sleep behavior disorder: a multicenter validation study.
        Mov Disord. 2012; 27: 913-916