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Hanein Y, Mirelman A. The Home-Based Sleep Laboratory. JOURNAL OF PARKINSON'S DISEASE 2022; 11:S71-S76. [PMID: 33682729 PMCID: PMC8385505 DOI: 10.3233/jpd-202412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
Sleep disturbances are prevalent in neurodegenerative diseases in general, and in Parkinson's disease (PD) in particular. Recent evidence points to the clinical value of sleep in disease progression and improving quality of life. Therefore, monitoring sleep quality in an ongoing manner at the convenience of one's home has the potential to improve clinical research and to contribute to significantly better personalized treatment. Further, precise mapping of sleep patterns of each patient can contribute to a better understanding of the disease, its progression and the appropriate medical treatment. Here we review selective, state-of-the-art, home-based devices for assessing sleep and sleep related disorders. We highlight the large potential as well as the main challenges. In particular, we discuss medical validity, standardization and regulatory concerns that currently impede widespread clinical adoption of existing devices. Finally, we propose a roadmap with the technological and scientific steps that are required to impact PD research and treatment.
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Affiliation(s)
- Yael Hanein
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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2
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Mc Carthy CE. Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person. Med Sci (Basel) 2021; 9:medsci9020031. [PMID: 34063838 PMCID: PMC8162526 DOI: 10.3390/medsci9020031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson's disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.
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Affiliation(s)
- Christine E. Mc Carthy
- Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland;
- HRB-Clinical Research Facility, National University of Ireland, Galway, Co., Galway, Ireland
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3
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Shedding Light on Nocturnal Movements in Parkinson's Disease: Evidence from Wearable Technologies. SENSORS 2020; 20:s20185171. [PMID: 32927816 PMCID: PMC7571235 DOI: 10.3390/s20185171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.
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5
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Madrid-Navarro CJ, Puertas Cuesta FJ, Escamilla-Sevilla F, Campos M, Ruiz Abellán F, Rol MA, Madrid JA. Validation of a Device for the Ambulatory Monitoring of Sleep Patterns: A Pilot Study on Parkinson's Disease. Front Neurol 2019; 10:356. [PMID: 31031690 PMCID: PMC6470193 DOI: 10.3389/fneur.2019.00356] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
The development of wearable devices has increase interest in the use of ambulatory methods to detect sleep disorders more objectively than those permitted by subjective scales evaluating sleep quality, while subjects maintain their usual lifestyle. This study aims to validate an ambulatory circadian monitoring (ACM) device for the detection of sleep and wake states and apply it to the evaluation of sleep quality in patients with Parkinson disease (PD). A polysomnographic validation study was conducted on a group of patients with different sleep disorders in a preliminary phase, followed by a pilot study to apply this methodology to PD patients. The ACM device makes it possible to estimate the main sleep parameters very accurately, as demonstrated by: (a) the lack of significant differences between the mean values detected by PSG and ACM in time in bed (TIB), total sleep time (TST), sleep efficiency (SE), and time awake after sleep onset (WASO); (b) the slope of the correlation lines between the parameters estimated by the two procedures, very close to 1, which demonstrates the linearity of the predictions; (c) the low bias value in the estimates obtained through ACM. Sleep in PD is associated with lower distal skin temperature, efficiency and overall sleep time; greater WASO, activity during sleep and duration of naps and a worse circadian function index. In summary, the ACM device has proven to be clinically useful to evaluate sleep in an objective manner, thanks to the integrated management of different complementary variables, having advantages over conventional actigraphy.
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Affiliation(s)
- Carlos Javier Madrid-Navarro
- Neurology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Francisco Javier Puertas Cuesta
- Unidad de Sueño, Hospital Universitario de la Ribera de Alzira, Valencia, Spain.,Centre de Sommeil, Service de Neurologie, CHU Liege, Liege, Belgium
| | - Francisco Escamilla-Sevilla
- Neurology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Manuel Campos
- Chronobiology Laboratory, IMIB-Arrixaca, CIBERFES, Instituto de Salud Carlos III, Universidad de Murcia, Murcia, Spain
| | | | - Maria Angeles Rol
- Chronobiology Laboratory, IMIB-Arrixaca, CIBERFES, Instituto de Salud Carlos III, Universidad de Murcia, Murcia, Spain
| | - Juan Antonio Madrid
- Chronobiology Laboratory, IMIB-Arrixaca, CIBERFES, Instituto de Salud Carlos III, Universidad de Murcia, Murcia, Spain
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6
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Abbott SM, Malkani RG, Zee PC. Circadian disruption and human health: A bidirectional relationship. Eur J Neurosci 2019; 51:567-583. [PMID: 30549337 DOI: 10.1111/ejn.14298] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
Circadian rhythm disorders have been classically associated with disorders of abnormal timing of the sleep-wake cycle, however circadian dysfunction can play a role in a wide range of pathology, ranging from the increased risk for cardiometabolic disease and malignancy in shift workers, prompting the need for a new field focused on the larger concept of circadian medicine. The relationship between circadian disruption and human health is bidirectional, with changes in circadian amplitude often preceding the classical symptoms of neurodegenerative disorders. As our understanding of the importance of circadian dysfunction in disease grows, we need to develop better clinical techniques for identifying circadian rhythms and also develop circadian based strategies for disease management. Overall this review highlights the need to bring the concept of time to all aspects of medicine, emphasizing circadian medicine as a prime example of both personalized and precision medicine.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Roneil G Malkani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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7
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Madrid-Navarro CJ, Escamilla-Sevilla F, Mínguez-Castellanos A, Campos M, Ruiz-Abellán F, Madrid JA, Rol MA. Multidimensional Circadian Monitoring by Wearable Biosensors in Parkinson's Disease. Front Neurol 2018; 9:157. [PMID: 29632508 PMCID: PMC5879441 DOI: 10.3389/fneur.2018.00157] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/02/2018] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD) is associated with several non-motor symptoms that may precede the diagnosis and constitute a major source of frailty in this population. The digital era in health care has open up new prospects to move forward from the qualitative and subjective scoring for PD with the use of new wearable biosensors that enable frequent quantitative, reliable, repeatable, and multidimensional measurements to be made with minimal discomfort and inconvenience for patients. A cross-sectional study was conducted to test a wrist-worn device combined with machine-learning processing to detect circadian rhythms of sleep, motor, and autonomic disruption, which can be suitable for the objective and non-invasive evaluation of PD patients. Wrist skin temperature, motor acceleration, time in movement, hand position, light exposure, and sleep rhythms were continuously measured in 12 PD patients and 12 age-matched healthy controls for seven consecutive days using an ambulatory circadian monitoring device (ACM). Our study demonstrates that a multichannel ACM device collects reliable and complementary information from motor (acceleration and time in movement) and common non-motor (sleep and skin temperature rhythms) features frequently disrupted in PD. Acceleration during the daytime (as indicative of motor impairment), time in movement during sleep (representative of fragmented sleep) and their ratio (A/T) are the best indexes to objectively characterize the most common symptoms of PD, allowing for a reliable and easy scoring method to evaluate patients. Chronodisruption score, measured by the integrative algorithm known as the circadian function index is directly linked to a low A/T score. Our work attempts to implement innovative technologies based on wearable, multisensor, objective, and easy-to-use devices, to quantify PD circadian rhythms in huge populations over extended periods of time, while controlling at the same time exposure to exogenous circadian synchronizers.
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Affiliation(s)
- Carlos J Madrid-Navarro
- Neurology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Francisco Escamilla-Sevilla
- Neurology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Adolfo Mínguez-Castellanos
- Neurology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Manuel Campos
- Chronobiology Laboratory, IMIB-Arrixaca, Universidad de Murcia, CIBERFES, Instituto de Salud Carlos III, Murcia, Spain
| | | | - Juan A Madrid
- Chronobiology Laboratory, IMIB-Arrixaca, Universidad de Murcia, CIBERFES, Instituto de Salud Carlos III, Murcia, Spain
| | - M A Rol
- Chronobiology Laboratory, IMIB-Arrixaca, Universidad de Murcia, CIBERFES, Instituto de Salud Carlos III, Murcia, Spain
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Mantovani S, Smith SS, Gordon R, O'Sullivan JD. An overview of sleep and circadian dysfunction in Parkinson's disease. J Sleep Res 2018; 27:e12673. [PMID: 29493044 DOI: 10.1111/jsr.12673] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 12/18/2022]
Abstract
Sleep and circadian alterations are amongst the very first symptoms experienced in Parkinson's disease, and sleep alterations are present in the majority of patients with overt clinical manifestation of Parkinson's disease. However, the magnitude of sleep and circadian dysfunction in Parkinson's disease, and its influence on the pathophysiology of Parkinson's disease remains often unclear and a matter of debate. In particular, the confounding influences of dopaminergic therapy on sleep and circadian dysfunction are a major challenge, and need to be more carefully addressed in clinical studies. The scope of this narrative review is to summarise the current knowledge around both sleep and circadian alterations in Parkinson's disease. We provide an overview on the frequency of excessive daytime sleepiness, insomnia, restless legs, obstructive apnea and nocturia in Parkinson's disease, as well as addressing sleep structure, rapid eye movement sleep behaviour disorder and circadian features in Parkinson's disease. Sleep and circadian disorders have been linked to pathological conditions that are often co-morbid in Parkinson's disease, including cognitive decline, memory impairment and neurodegeneration. Therefore, targeting sleep and circadian alterations could be one of the earliest and most promising opportunities to slow disease progression. We hope that this review will contribute to advance the discussion and inform new research efforts to progress our knowledge in this field.
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Affiliation(s)
- Susanna Mantovani
- Faculty of Medicine, The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.,Wesley Medical Research, Auchenflower, QLD, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Simon S Smith
- Institute for Social Science Research (ISSR), The University of Queensland, Indooroopilly, Australia
| | - Richard Gordon
- Faculty of Medicine, The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.,Wesley Medical Research, Auchenflower, QLD, Australia
| | - John D O'Sullivan
- Faculty of Medicine, The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.,Wesley Medical Research, Auchenflower, QLD, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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9
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Sabbar M, Dkhissi-Benyahya O, Benazzouz A, Lakhdar-Ghazal N. Circadian Clock Protein Content and Daily Rhythm of Locomotor Activity Are Altered after Chronic Exposure to Lead in Rat. Front Behav Neurosci 2017; 11:178. [PMID: 28970786 PMCID: PMC5609114 DOI: 10.3389/fnbeh.2017.00178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022] Open
Abstract
Lead exposure has been reported to produce many clinical features, including parkinsonism. However, its consequences on the circadian rhythms are still unknown. Here we aimed to examine the circadian rhythms of locomotor activity following lead intoxication and investigate the mechanisms by which lead may induce alterations of circadian rhythms in rats. Male Wistar rats were injected with lead or sodium acetate (10 mg/kg/day, i.p.) during 4 weeks. Both groups were tested in the “open field” to quantify the exploratory activity and in the rotarod to evaluate motor coordination. Then, animals were submitted to continuous 24 h recordings of locomotor activity under 14/10 Light/dark (14/10 LD) cycle and in complete darkness (DD). At the end of experiments, the clock proteins BMAL1, PER1-2, and CRY1-2 were assayed in the suprachiasmatic nucleus (SCN) using immunohistochemistry. We showed that lead significantly reduced the number of crossing in the open field, impaired motor coordination and altered the daily locomotor activity rhythm. When the LD cycle was advanced by 6 h, both groups adjusted their daily locomotor activity to the new LD cycle with high onset variability in lead-intoxicated rats compared to controls. Lead also led to a decrease in the number of immunoreactive cells (ir-) of BMAL1, PER1, and PER2 without affecting the number of ir-CRY1 and ir-CRY2 cells in the SCN. Our data provide strong evidence that lead intoxication disturbs the rhythm of locomotor activity and alters clock proteins expression in the SCN. They contribute to the understanding of the mechanism by which lead induce circadian rhythms disturbances.
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Affiliation(s)
- Mariam Sabbar
- Équipe de Recherche sur les Rythmes Biologiques, Neurosciences et Environnement, Faculté des Sciences, Université Mohammed VRabat, Morocco
| | - Ouria Dkhissi-Benyahya
- INSERM, Stem Cell and Brain Research Institute U1208, University of Lyon, Université Claude Bernard Lyon 1Lyon, France
| | - Abdelhamid Benazzouz
- Institut des Maladies Neurodégénératives, Univ. de Bordeaux, UMR5293Bordeaux, France.,Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, UMR5293Bordeaux, France
| | - Nouria Lakhdar-Ghazal
- Équipe de Recherche sur les Rythmes Biologiques, Neurosciences et Environnement, Faculté des Sciences, Université Mohammed VRabat, Morocco
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Abstract
Apart from the typical motor symptoms, Parkinson's disease is characterized by a wide range of different non-motor symptoms, which are highly prevalent in all stages of the disease and have an incisive influence on quality of life. Moreover, their treatment continues to be challenging. In this review, we critically summarize the evidence for the impact of dopaminergic therapies on non-motor symptoms in Parkinson's disease. We performed a PubMed search to identify relevant clinical studies that investigated the response of non-motor symptoms to dopaminergic therapy. In the domain of neuropsychiatric disturbances, there is increasing evidence that dopamine agonists can ameliorate depression or anxiety. Other neuropsychiatric symptoms such as psychosis or impulse control disorders can also be worsened or even be induced by dopaminergic agents. For the treatment of sleep disturbances, it is essential to identify different subtypes of sleep pathologies. While there is for example profound evidence for the effectiveness of dopaminergic medication for the treatment of restless legs syndrome and sleep fragmentation, evidence for an improvement of rapid eye movement sleep behavior disorder is lacking. With regard to the broad spectrum of autonomic disturbances, response to dopaminergic treatment seems to differ largely, with on the one hand, some evidence for an improvement of sexual function or sweating with dopaminergic treatment, while on the other hand, constipation can be worsened. Finally, the analysis of sensory deficits reveals that some forms of pain, in particular fluctuation-dependent dystonic pain, can be well addressed by adapting the dopaminergic therapy, while no effect has been seen so far for hyposmia or visual deficits. Moreover, the occurrence of non-motor fluctuations is gaining increased attention, as they can be specifically addressed by a more continuous dopaminergic intake. Taken together, there is evidence of a good response of some (but not all) non-motor symptoms to dopaminergic therapy, which must be individually adapted to the special spectrum of symptoms.
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Affiliation(s)
- Eva Schaeffer
- Department of Neurology, Christians-Albrechts University, Arnold-Heller-Str. 3, Haus 41, Kiel, 24105, Germany.
| | - Daniela Berg
- Department of Neurology, Christians-Albrechts University, Arnold-Heller-Str. 3, Haus 41, Kiel, 24105, Germany
- Department of Neurodegeneration, Hertie-Institute of Clinical Brain Research, Tuebingen, Germany
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Bhidayasiri R, Martinez-Martin P. Clinical Assessments in Parkinson's Disease: Scales and Monitoring. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:129-182. [PMID: 28554406 DOI: 10.1016/bs.irn.2017.01.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Measurement of disease state is essential in both clinical practice and research in order to assess the severity and progression of a patient's disease status, effect of treatment, and alterations in other relevant factors. Parkinson's disease (PD) is a complex disorder expressed through many motor and nonmotor manifestations, which cause disabilities that can vary both gradually over time or come on suddenly. In addition, there is a wide interpatient variability making the appraisal of the many facets of this disease difficult. Two kinds of measure are used for the evaluation of PD. The first is subjective, inferential, based on rater-based interview and examination or patient self-assessment, and consist of rating scales and questionnaires. These evaluations provide estimations of conceptual, nonobservable factors (e.g., symptoms), usually scored on an ordinal scale. The second type of measure is objective, factual, based on technology-based devices capturing physical characteristics of the pathological phenomena (e.g., sensors to measure the frequency and amplitude of tremor). These instrumental evaluations furnish appraisals with real numbers on an interval scale for which a unit exists. In both categories of measures, a broad variety of tools exist. This chapter aims to present an up-to-date summary of the most relevant characteristics of the most widely used scales, questionnaires, and technological resources currently applied to the assessment of PD. The review concludes that, in our opinion: (1) no assessment methods can substitute the clinical judgment and (2) subjective and objective measures in PD complement each other, each method having strengths and weaknesses.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Juntendo University, Tokyo, Japan.
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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Videnovic A, Golombek D. Circadian Dysregulation in Parkinson's Disease. Neurobiol Sleep Circadian Rhythms 2017; 2:53-58. [PMID: 28713867 PMCID: PMC5509072 DOI: 10.1016/j.nbscr.2016.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/19/2016] [Accepted: 11/03/2016] [Indexed: 12/27/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder that affects over one million individuals in the US alone. PD is characterized by a plethora of motor and non-motor manifestations, resulting from a progressive degeneration of dopaminergic neurons and disbalance of several other neurotransmitters. A growing body of evidence points to significant alterations of the circadian system in PD. This is not surprising given the pivotal role that dopamine plays in circadian regulation as well as the role of circadian influences in dopamine metabolism. In this review we present basic and clinical investigations that examined the function of the circadian system in PD.
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Affiliation(s)
- Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital Harvard Medical School, MGH Neurological Clinical Research Institute, 165 Cambridge Street, Suite 600, Boston, MA 02446, United States
| | - Diego Golombek
- Department of Science and Technology, National University of Quilmes/CONICET, R.S. Peña 352, 1876 Bernal, Buenos Aires, Argentina
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A New Perspective for Parkinson's Disease: Circadian Rhythm. Neurosci Bull 2016; 33:62-72. [PMID: 27995565 DOI: 10.1007/s12264-016-0089-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/14/2016] [Indexed: 12/31/2022] Open
Abstract
Circadian rhythm is manifested by the behavioral and physiological changes from day to night, which is controlled by the pacemaker and its regulator. The former is located at the suprachiasmatic nuclei (SCN) in the anterior hypothalamus, while the latter is composed of clock genes present in all tissues. Circadian desynchronization influences normal patterns of day-night rhythms such as sleep and alertness cycles, rest and activity cycles. Parkinson's disease (PD) exhibits diurnal fluctuations. Circadian dysfunction has been observed in PD patients and animal models, which may result in negative consequences to the homeostasis and even exacerbate the disease progression. Therefore, circadian therapies, including light stimulation, physical activity, dietary and social schedules, may be helpful for PD patients. However, the cellular and molecular mechanisms that underlie the circadian dysfunction in PD remain elusive. Further research on circadian patterns is needed. This article summarizes the existing research on the circadian rhythms in PD, focusing on the clinical symptom variations, molecular changes, as well as the available treatment options.
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14
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Schroeder LA, Rufra O, Sauvageot N, Fays F, Pieri V, Diederich NJ. Reduced Rapid Eye Movement Density in Parkinson Disease: A Polysomnography-Based Case-Control Study. Sleep 2016; 39:2133-2139. [PMID: 27748239 DOI: 10.5665/sleep.6312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/05/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To explore rapid eye movement density (RD) in patients with idiopathic Parkinson disease (IPD) and to investigate its usefulness as surrogate marker of excessive daytime sleepiness, a frequent complaint in IPD patients. METHODS Retrospective polysomnography study on 81 subjects without dementia: 29 patients with early stage IPD (disease duration ≤ 3 y), 21 patients with middle- stage IPD (disease duration > 3 and < 8 y) and 31 healthy controls (HC). Rapid eye movement (REM) sleep was defined as any REM episode with > 3 min of continuous REM sleep. RD was defined as number of ocular movements per minute of REM sleep. Patients with early stage IPD and HC fulfilled the PD-specific sleepiness questionnaires Parkinson's Disease Sleep Scale (PDSS) and the Nonmotor Symptoms Questionnaire for Parkinson's disease (NMSQuest). RESULTS RD was lower in patients with IPD than in HC. The difference was most significant between patients with middle stage IPD and HC (P = 0.001), and most prominent for the third REM episode, again when comparing patients with middle stage IPD and HC (P = 0.03). RD was independent from sex, age, and other sleep parameters. In early stage IPD, RD correlated with the PDSS score (r = -0.63, P = 0.001) and the sleep-related questions of the NMSQuest score (r = 0.48, P = 0.017). CONCLUSIONS REM density is reduced in patients with IPD and correlates with subjective scores on sleep impairment. As an indicator of persistent high sleep pressure, reduced RD in IPD is eligible as a biomarker of excessive daytime sleepiness in IPD. It possibly reflects direct involvement of the brainstem REM generation sites by the disease process. RD is a promising new tool for sleep research in IPD.
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Affiliation(s)
- Lynn A Schroeder
- Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg
| | - Olivier Rufra
- Interdisciplinary Sleep Laboratory, Centre Hospitalier de Luxembourg
| | - Nicolas Sauvageot
- Competence Center of Methodology and Statistics, Luxembourg Institute of Health, Luxembourg-City, Luxembourg
| | - François Fays
- Competence Center of Methodology and Statistics, Luxembourg Institute of Health, Luxembourg-City, Luxembourg
| | - Vannina Pieri
- Department of Neurosciences, Centre Hospitalier de Luxembourg
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15
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Zhu K, van Hilten JJ, Marinus J. The course of insomnia in Parkinson's disease. Parkinsonism Relat Disord 2016; 33:51-57. [PMID: 27639814 DOI: 10.1016/j.parkreldis.2016.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/01/2016] [Accepted: 09/07/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Insomnia is a debilitating symptom in Parkinson's disease (PD) that has been scarcely investigated in a longitudinal design. Knowledge of factors associated with occurrence of insomnia may provide clues for an increased understanding of underlying pathophysiology and facilitate early detection. The objective of this study is to examine the course and factors associated with longitudinal changes in insomnia severity in patients with PD. METHODS Analyses were performed in data of the SCOPA-PROPARK cohort, a 5-year longitudinal cohort study (2003-2011) of 421 PD patients who have been examined annually. Linear mixed models were used to identify factors associated with longitudinal changes in scores of the SCOPA-SLEEP-Nighttime sleep (NS) problems section. A generalized estimating equations (GEE) analysis was performed to determine which baseline variables were associated with the different aspects of insomnia (sleep initiation or maintenance difficulty). RESULTS Baseline SCOPA-SLEEP-NS scores were available for 412 patients, of whom 110 (27%) had insomnia (i.e. score ≥ 7). Of the remaining 302 patients, 99 (33%) developed insomnia at some point during follow-up. More severe depressive symptoms, motor fluctuations, higher dopamine agonist doses and sleep medication use were independently associated with higher SCOPA-SLEEP-NS scores over time. GEE analysis did not identify an unique set of determinants that affected specific aspects of insomnia. CONCLUSION The presence of depressive symptoms, motor fluctuations and the use of higher doses of dopamine agonists are associated with more severe insomnia. Attention to these aspects could potentially contribute to a better management of insomnia symptoms in PD.
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Affiliation(s)
- Kangdi Zhu
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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16
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Videnovic A, Willis GL. Circadian system - A novel diagnostic and therapeutic target in Parkinson's disease? Mov Disord 2016; 31:260-9. [PMID: 26826022 DOI: 10.1002/mds.26509] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 01/05/2023] Open
Abstract
The circadian system regulates biological rhythmicity in the human body. The role of the circadian system in neurological disorders is a theme that is attracting an increasing amount of interest from the scientific community. This has arisen, in part, from emerging evidence that disorders such as Parkinson's disease (PD) are multifactorial with many features exhibiting diurnal fluctuations, thereby suggestive of circadian involvement. Although the importance of fluctuating motor and nonmotor manifestations in PD have been well acknowledged, the role of the circadian system has received little attention until recently. It is proposed that intervening with circadian function provides a novel research avenue down which new strategies for improving symptomatic treatment and slowing of the progressive degenerative process can be approached to lessen the burden of PD. In this article we review the literature describing existing circadian research in PD and its experimental models.
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Affiliation(s)
- Aleksandar Videnovic
- Movement Disorders Unit, Massachusetts General Hospital, Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory L Willis
- The Bronowski Institute of Behavioural Neuroscience, Kyneton, Victoria, Australia
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17
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Abstract
Circadian rhythms have a major role in physiology and behavior. Circadian disruption has negative consequences for physiologic homeostasis at molecular, cellular, organ-system, and whole-organism levels. The onset of many cerebrovascular insults shows circadian temporal trends. Impaired sleep-wake cycle, the most robust output rhythms of the circadian system, is significantly affected by neurodegenerative disorders, may precede them by decades, and may also affect their progression. Emerging evidence suggests that circadian disruption may be a risk factor for these neurologic disorders. This article discusses the implications of circadian rhythms in brain disorders, with an emphasis on cerebrovascular and neurodegenerative disorders.
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Affiliation(s)
- Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA.
| | - Phyllis C Zee
- Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 North Lake Shore Drive, Chicago, IL 60611, USA
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18
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Sleep in Neurodegenerative Disorders. CURRENT SLEEP MEDICINE REPORTS 2015. [DOI: 10.1007/s40675-015-0016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Salawu F, Olokoba A. Excessive daytime sleepiness and unintended sleep episodes associated with Parkinson's disease. Oman Med J 2015; 30:3-10. [PMID: 25829994 DOI: 10.5001/omj.2015.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/07/2014] [Indexed: 12/20/2022] Open
Abstract
This article looks at the issues of excessive daytime sleepiness and unintended sleep episodes in patients with Parkinson's disease (PD) and explores the reasons why patients might suffer from these symptoms, and what steps could be taken to manage them. During the last decade, understanding of sleep/wake regulation has increased. Several brainstem nuclei and their communication pathways in the ascending arousing system through the hypothalamus and thalamus to the cortex play key roles in sleep disorders. Insomnia is the most common sleep disorder in PD patients, and excessive daytime sleepiness is also common. Excessive daytime sleepiness affects up to 50% of PD patients and a growing body of research has established this sleep disturbance as a marker of preclinical and premotor PD. It is a frequent and highly persistent feature in PD, with multifactorial underlying pathophysiology. Both age and disease-related disturbances of sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contribute to excessive daytime sleepiness. Effective management of sleep disturbances and excessive daytime sleepiness can greatly improve the quality of life for patients with PD.
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Affiliation(s)
- Fatai Salawu
- Department of Medicine, Federal Medical Centre, Yola, Nigeria
| | - Abdulfatai Olokoba
- Department of General Internal Medicine, University of Ilorin Teaching Hospital, Ilorin. Nigeria
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20
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Louter M, Maetzler W, Prinzen J, van Lummel RC, Hobert M, Arends JBAM, Bloem BR, Streffer J, Berg D, Overeem S, Liepelt-Scarfone I. Accelerometer-based quantitative analysis of axial nocturnal movements differentiates patients with Parkinson's disease, but not high-risk individuals, from controls. J Neurol Neurosurg Psychiatry 2015; 86:32-7. [PMID: 24777169 DOI: 10.1136/jnnp-2013-306851] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There is a need for prodromal markers to diagnose Parkinson's disease (PD) as early as possible. Knowing that most patients with overt PD have abnormal nocturnal movement patterns, we hypothesised that such changes might occur already in non-PD individuals with a potentially high risk for future development of the disease. METHODS Eleven patients with early PD (Hoehn & Yahr stage ≤2.5), 13 healthy controls and 33 subjects with a high risk of developing PD (HR-PD) were investigated. HR-PD was defined by the occurrence of hyperechogenicity of the substantia nigra in combination with prodromal markers (eg, slight motor signs, olfactory dysfunction). A triaxial accelerometer was used to quantify nocturnal movements during two nights per study participant. Outcome measurements included mean acceleration, and qualitative axial movement parameters, such as duration and speed. RESULTS Mean acceleration of nocturnal movements was lower in patients with PD compared to controls. Frequency and speed of axial movements did not differ between patients with PD and controls, but mean size and duration were lower in PD. The HR-PD group did not significantly differ from the control group in any of the parameters analysed. CONCLUSIONS Compared with controls, patients with PD had an overall decreased mean acceleration, as well as smaller and shorter nocturnal axial movements. These changes did not occur in our potential HR-PD individuals, suggesting that relevant axial movement alterations during sleep have either not developed or cannot be detected by the means applied in this at-risk cohort.
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Affiliation(s)
- Maartje Louter
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical centre, Nijmegen, The Netherlands Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands
| | - Walter Maetzler
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | | | - Markus Hobert
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Johan B A M Arends
- Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands Department of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical centre, Nijmegen, The Netherlands
| | - Johannes Streffer
- Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | - Daniela Berg
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sebastiaan Overeem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical centre, Nijmegen, The Netherlands Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands
| | - Inga Liepelt-Scarfone
- Department for Neurodegenerative Diseases, Centre of Neurology, German Center of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Ferreira T, Prabhakar S, Kharbanda PS. Sleep disturbances in drug naïve Parkinson's disease (PD) patients and effect of levodopa on sleep. Ann Indian Acad Neurol 2014; 17:416-9. [PMID: 25506163 PMCID: PMC4251015 DOI: 10.4103/0972-2327.144016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/09/2014] [Accepted: 06/05/2014] [Indexed: 11/06/2022] Open
Abstract
Context: Parkinson's disease (PD) is associated with sleep disturbances, attributed to the neurodegenerative process and therapeutic drugs. Studies have found levodopa to increase wakefulness in some patients while increasing sleepiness in others. Aims: To confirm sleep disturbances in drug naïve PD patients and understand the impact of levodopa on their sleep. Materials and Methods: Twenty-three drug naïve PD patients and 31 age-gender matched controls were compared using the Parkinson's Disease Sleep Scale (PDSS) and Epworth Sleepiness Scale (ESS). A polysomnogram objectively compared sleep quality. Of the 23 patients, the 12 initiated on levodopa were reassessed subjectively and through polysomnography after 2 months of therapy. Statistical Analysis: Data was expressed as mean ± standard deviation, median, and range. Continuous variables were analyzed by Student's T test for normally distributed data and Mann–Whitney U test for skewed data. Discrete variables were compared by Chi Square tests (Pearson Chi square Test or Fisher's Exact Test). Wilcoxon signed ranks test was applied in the analysis of paired data pre- and post-levodopa. A P value < 0.05 was considered as statistically significant. Statistical analysis of the data was done using the Statistical Package for the Social Sciences (SPSS) version 12. Results: Drug naïve PD patients had lower PDSS scores than controls. The sleep architecture changes observed on polysomnogram were reduced NREM Stage III and REM sleep and increased sleep latency and wake after sleep onset time. Following levodopa, improved sleep efficiency with reduced sleep latency and wake after sleep onset time was noted, coupled with improved PDSS scores. However, NREM Stage III and REM sleep duration did not increase. Discussion: PD patients take longer to fall asleep and have difficulty in sleep maintenance. Sleep maintenance is affected by nocturia, REM behavioral disorder, nocturnal cramps, akinesia, and tremors, as observed in PDSS scores. Levodopa improves sleep efficiency by improving motor scores without altering sleep architecture. Conclusions: Poor sleep quality and sleep architecture changes occur secondary to the neurodegenerative process in PD patients. Though levodopa improves sleep quality by reducing rigidity and tremor, it does not reverse sleep architecture changes.
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Affiliation(s)
- Teresa Ferreira
- Department of Neurology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudesh Prabhakar
- Department of Neurology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parampreet S Kharbanda
- Department of Neurology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Videnovic A, Lazar AS, Barker RA, Overeem S. 'The clocks that time us'--circadian rhythms in neurodegenerative disorders. Nat Rev Neurol 2014; 10:683-93. [PMID: 25385339 PMCID: PMC4344830 DOI: 10.1038/nrneurol.2014.206] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Circadian rhythms are physiological and behavioural cycles generated by an endogenous biological clock, the suprachiasmatic nucleus. The circadian system influences the majority of physiological processes, including sleep-wake homeostasis. Impaired sleep and alertness are common symptoms of neurodegenerative disorders, and circadian dysfunction might exacerbate the disease process. The pathophysiology of sleep-wake disturbances in these disorders remains largely unknown, and is presumably multifactorial. Circadian rhythm dysfunction is often observed in patients with Alzheimer disease, in whom it has a major impact on quality of life and represents one of the most important factors leading to institutionalization of patients. Similarly, sleep and circadian problems represent common nonmotor features of Parkinson disease and Huntington disease. Clinical studies and experiments in animal models of neurodegenerative disorders have revealed the progressive nature of circadian dysfunction throughout the course of neurodegeneration, and suggest strategies for the restoration of circadian rhythmicity involving behavioural and pharmacological interventions that target the sleep-wake cycle. In this Review, we discuss the role of the circadian system in the regulation of the sleep-wake cycle, and outline the implications of disrupted circadian timekeeping in neurodegenerative diseases.
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Affiliation(s)
- Aleksandar Videnovic
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street Suite 650, Boston, MA 02114, USA
| | - Alpar S Lazar
- University of Cambridge, John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, Forvie Site, Cambridge CB2 2PY, UK
| | - Roger A Barker
- University of Cambridge, John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, Forvie Site, Cambridge CB2 2PY, UK
| | - Sebastiaan Overeem
- Department of Neurology, Radboud University Medical Centre, P.O. Box 9101, Nijmegen 6500 HB, Netherlands
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Zhou H, Shen C, Chen J, Qian H, Zheng Y, Liu Y, Xian W, Pei Z, Chen L. Tremor and clinical fluctuation are related to sleep disorders in Chinese patients with Parkinson's disease. Transl Neurodegener 2014; 3:21. [PMID: 25349692 PMCID: PMC4209517 DOI: 10.1186/2047-9158-3-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/18/2014] [Indexed: 01/09/2023] Open
Abstract
Objective To study the relationship between sleep disturbances and symptoms in patients with Parkinson’s disease (PD). Methods The Parkinson’s Disease Sleep Scale-Chinese Version (PDSS-CV) was used to evaluate the sleep disturbances of PD patients in a cross sectional study. The Unified Parkinson’s Disease Rating Scale (UPDRS) parts II-IV, and the Hoehn & Yahr (H&Y) stage were used to determine the level of motor function in PD and the severity of PD. The Spearman correlation and a multiple regression analysis were used to identify the relationship between sleep disturbances and symptoms of PD. The quantities derived from the UPDRS and the H&Y stage and disease duration were compared between groups of patients either with or without sleep disturbances identified by the PDSS. This study was conducted from December 2011 to March 2012 at the First Affiliated Hospital of Sun Yat-sen University, in Guangzhou. Results A total of 136 PD patients were included in this study. The overall total PDSS score in PD patients was 107.58 ± 23.35 points (range: 30–146). There were significant differences in the disease duration, the H&Y stage, and the UPDRS section subscores between groups of patients either with or without sleep disturbances (Kruskal-Wallis Test, p <0.05). There were significant negative correlations between PDSS scores and the UPDRS subscores, the H&Y stage and the disease duration (Spearman correlation, p < 0.05). The multiple regression analysis indicated that sleep disturbances identified by the PDSS were only associated with daily life activity, tremor intensity and clinical fluctuation (R2 = 0.22, F(3,132) = 12.4, p < 0.001). The correlations were also significant when the contribution of the other two factors was excluded using partial correlations. Conclusions The level of daily life activity and the occurrences of tremor and clinical fluctuation are likely to be important factors that lead to PD patients’ sleep disturbances. This study may elucidate an important clue for the relationship between sleep disturbances and PD symptoms.
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Affiliation(s)
- Hongyan Zhou
- Department of Neurological Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Cunzhou Shen
- Department of Neurological Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Chen
- Department of Internal Medicine, Nansha central Hospital, Guangzhou 511457, China
| | - Hao Qian
- Department of Neurology, The Second Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510300, China
| | - Yifan Zheng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Yanmei Liu
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Wenbiao Xian
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Zhong Pei
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
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Hobert MA, Maetzler W, Aminian K, Chiari L. Technical and clinical view on ambulatory assessment in Parkinson's disease. Acta Neurol Scand 2014; 130:139-47. [PMID: 24689772 DOI: 10.1111/ane.12248] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Abstract
With the progress of technologies of recent years, methods have become available that use wearable sensors and ambulatory systems to measure aspects of--particular axial--motor function. As Parkinson's disease (PD) can be considered a model disorder for motor impairment, a significant number of studies have already been performed with these patients using such techniques. In general, motion sensors such as accelerometers and gyroscopes are used, in combination with lightweight electronics that do not interfere with normal human motion. A fundamental advantage in comparison with usual clinical assessment is that these sensors allow a more quantitative, objective, and reliable evaluation of symptoms; they have also significant advantages compared to in-lab technologies (e.g., optoelectronic motion capture) as they allow long-term monitoring under real-life conditions. In addition, based on recent findings particularly from studies using functional imaging, we learned that non-motor symptoms, specifically cognitive aspects, may be at least indirectly assessable. It is hypothesized that ambulatory quantitative assessment strategies will allow users, clinicians, and scientists in the future to gain more quantitative, unobtrusive, and everyday relevant data out of their clinical evaluation and can also be designed as pervasive (everywhere) and intensive (anytime) tools for ambulatory assessment and even rehabilitation of motor and (partly) non-motor symptoms in PD.
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Affiliation(s)
- M. A. Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research; Department of Neurodegenerative Diseases; University of Tübingen; Tübingen Germany
- DZNE; German Center for Neurodegenerative Diseases; Tübingen Germany
| | - W. Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research; Department of Neurodegenerative Diseases; University of Tübingen; Tübingen Germany
- DZNE; German Center for Neurodegenerative Diseases; Tübingen Germany
| | - K. Aminian
- Ecole Polytechnique Fédérale de Lausanne; Laboratory of Movement Analysis and Measurement; Lausanne Switzerland
| | - L. Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”; University of Bologna; Bologna Italy
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25
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Lima MMS. Sleep disturbances in Parkinson's disease: the contribution of dopamine in REM sleep regulation. Sleep Med Rev 2013; 17:367-75. [PMID: 23481545 DOI: 10.1016/j.smrv.2012.10.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 09/14/2012] [Accepted: 10/29/2012] [Indexed: 11/29/2022]
Abstract
Nearly all patients with Parkinson's disease (PD) have sleep disturbances. While it has been suggested that these disturbances involve a dopaminergic component, the specific mechanisms that contribute to this behavior are far from being fully understood. In this article, we have reviewed the current understanding of the linkage between sleep and PD, focusing on the participation of the dopaminergic system in the regulation of rapid eye movement (REM) sleep. The presence of an REM sleep behavior disorder in patients with PD might reflect the early involvement of dopaminergic neurotransmission in REM sleep-related structures. Therefore, it has been suggested that these structures are affected by an imbalance of dopamine levels. Several studies have demonstrated that neurons in the substantia nigra pars compacta (SNpc) and in the ventral tegmental area (VTA) are active during REM sleep and that sleep-related disturbances may result when these neurons are targeted by neurotoxins. We discuss current evidence suggesting the presence of a putative reciprocal connectivity between the SNpc, VTA, the pedunculopontine tegmental nucleus and reticular formation, which may exert an important influence on the REM sleep mechanism. This review provides a comprehensive overview of the literature that addresses this challenging and unrecognized component of PD.
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Affiliation(s)
- Marcelo M S Lima
- Laboratório de Neurofisiologia, Departamento de Fisiologia, Universidade Federal do Paraná, Curitiba, Paraná, Brasil.
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26
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Chahine LM, Daley J, Horn S, Duda JE, Colcher A, Hurtig H, Cantor C, Dahodwala N. Association between dopaminergic medications and nocturnal sleep in early-stage Parkinson's disease. Parkinsonism Relat Disord 2013; 19:859-63. [PMID: 23751512 DOI: 10.1016/j.parkreldis.2013.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/20/2013] [Accepted: 05/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Poor nocturnal sleep is common in Parkinson's disease (PD) and negatively impacts quality of life. There is little data on how dopaminergic drugs influence nocturnal sleep in PD, particularly in relation to medication timing. We examined the association between dopaminergic medications and subjective and objective nocturnal sleep in PD. METHODS Individuals with PD were recruited from the outpatient clinic. Demographics and disease information were collected. Patients underwent one-night polysomnography and responded to SCOPA-SLEEP, a self-administered questionnaire which includes a section on nighttime sleep and an overall measure of sleep quality; higher scores indicate worse sleep. Medication intake, including medication timing in relation to bedtime, was obtained and converted to levodopa equivalents. RESULTS 41 Males and 21 females, median age 63.9 years, participated. Median disease duration was 5 years. After adjusting for age, sex, disease severity, and disease duration, greater total levodopa equivalent intake within 4 h of sleep was associated with higher total SCOPA-nighttime score (p = 0.009) and greater wake time after sleep onset (p = 0.049). Greater dopaminergic medication intake prior to sleep was also associated with less rapid eye movement (REM) sleep as a percent of total sleep time (p = 0.004). CONCLUSIONS Higher amounts of dopaminergic medications taken prior to sleep were associated with poor sleep quality and less REM sleep. Although poor nocturnal sleep in PD is likely multi-factorial in etiology, our findings suggest that timing and dose of medications prior to sleep need to be considered in its management.
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Affiliation(s)
- Lama M Chahine
- Department of Neurology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA 19107, USA.
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27
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Louter M, van Sloun RJG, Pevernagie DAA, Arends JBAM, Cluitmans PJ, Bloem BR, Overeem S. Subjectively impaired bed mobility in Parkinson disease affects sleep efficiency. Sleep Med 2013; 14:668-74. [PMID: 23643658 DOI: 10.1016/j.sleep.2013.03.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 03/15/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Impaired bed mobility (IBM) may be an important reason for the high prevalence of sleep insomnia in Parkinson disease (PD). Here we assessed the influence of subjectively IBM on both subjective and objective sleep parameters in insomnia PD patients with (PD+IBM) and without (PD-IBM) concerns of IBM and controls with primary insomnia. METHODS We included 44 PD patients with sleep initiation or maintenance concerns and 44 control subjects with primary insomnia. Sleep questionnaires, polysomnographic sleep parameters, activity data, and the number of body position changes were compared between PD patients and controls as well as within the PD group between PD+IBM vs PD-IBM subjects. RESULTS There were 54.5% of PD subjects who reported having IBM. In the PD+IBM group, the number of body position changes was significantly lower than in PD-IBM (0.4/h [0.0-1.8] vs 1.4/h [0.0-4.6], P=.015). Sleep efficiency (SE) was lower in PD+IBM patients (63.5; 26.2-85.6) compared to PD-IBM patients (78.4; 54.8-92.6; P<.001). CONCLUSION PD patients who report IBM have fewer sleep-related body position changes (i.e., nocturnal hypokinesia) than PD patients without such concerns. Furthermore, objective SE is significantly diminished in these patients.
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Affiliation(s)
- Maartje Louter
- Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands
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28
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Videnovic A, Golombek D. Circadian and sleep disorders in Parkinson's disease. Exp Neurol 2012; 243:45-56. [PMID: 22935723 DOI: 10.1016/j.expneurol.2012.08.018] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/08/2012] [Accepted: 08/14/2012] [Indexed: 01/17/2023]
Abstract
Impaired sleep and alertness, initially recognized by James Parkinson in his famous monograph "An Essay on the Shaking Palsy" in 1817, is one of the most common and disabling nonmotor symptoms of Parkinson's disease (PD). It is only recently, however, that sleep disturbances in PD have received the attention of medical and research community. Dopamine, the major neurotransmitter implicated in the pathogenesis of PD, plays a pivotal role in the regulation of sleep and circadian homeostasis. Sleep dysfunction affects up to 90% of patients with PD, and may precede the onset of the disease by decades. Sleep dysfunction in PD may be categorized into disturbances of overnight sleep and daytime alertness. Etiology of impaired sleep and alertness in PD is multifactorial. Co-existent primary sleep disorders, medication side effects, overnight re-emergence of motor symptoms, and primary neurodegeneration itself, are main causes of sleep disruption and excessive daytime sleepiness among patients with PD. Increasing body of evidence suggests that the circadian system becomes dysregulated in PD, which may lead to poor sleep and alertness. Treatment options are limited and frequently associated with unwanted side effects. Further studies that will examine pathophysiology of sleep dysfunction in PD, and focus on novel treatment approaches are therefore very much needed. In this article we review the role of dopamine in regulation of sleep and alertness and discuss main sleep and circadian disturbances associated with PD.
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Affiliation(s)
- Aleksandar Videnovic
- PD and Movement Disorders Center, Circadian Rhythms and Sleep Research Laboratory, Department of Neurology, Northwestern University, 710 N Lake Shore Dr #1106, Chicago, IL 60611, USA.
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29
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Abstract
The recognition and treatment of nonmotor symptoms are increasingly emphasized in the care of Parkinson's disease (PD) patients. This manuscript will review signs and symptoms localized, generally, to the cortex, basal ganglia, brainstem, spinal cord, and peripheral nervous system. Cortical manifestations include dementia, mild cognitive impairment, and psychosis. Apathy, restlessness (akathisia), and impulse control disorders will be linked as basal ganglia symptoms. Symptoms attributed to the brainstem comprise depression, anxiety, and sleep disorders. Peripheral nervous system disturbances may lead to orthostatic hypotension, constipation, pain, and sensory disturbances.
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Affiliation(s)
- Mark Stacy
- Department of Neurology, Duke University Medical Center, Durham, North Carolina 27705, USA.
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30
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Lax P, Esquiva G, Esteve-Rudd J, Otalora BB, Madrid JA, Cuenca N. Circadian Dysfunction in a Rotenone-Induced Parkinsonian Rodent Model. Chronobiol Int 2012; 29:147-56. [DOI: 10.3109/07420528.2011.649870] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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31
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Srinivasan V, Cardinali DP, Srinivasan US, Kaur C, Brown GM, Spence DW, Hardeland R, Pandi-Perumal SR. Therapeutic potential of melatonin and its analogs in Parkinson's disease: focus on sleep and neuroprotection. Ther Adv Neurol Disord 2011; 4:297-317. [PMID: 22010042 DOI: 10.1177/1756285611406166] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Sleep disorders constitute major nonmotor features of Parkinson's disease (PD) that have a substantial effect on patients' quality of life and can be related to the progression of the neurodegenerative disease. They can also serve as preclinical markers for PD, as it is the case for rapid eye movement (REM)-associated sleep behavior disorder (RBD). Although the etiology of sleep disorders in PD remains undefined, the assessment of the components of the circadian system, including melatonin secretion, could give therapeutically valuable insight on their pathophysiopathology. Melatonin is a regulator of the sleep/wake cycle and also acts as an effective antioxidant and mitochondrial function protector. A reduction in the expression of melatonin MT(1) and MT(2) receptors has been documented in the substantia nigra of PD patients. The efficacy of melatonin for preventing neuronal cell death and for ameliorating PD symptoms has been demonstrated in animal models of PD employing neurotoxins. A small number of controlled trials indicate that melatonin is useful in treating disturbed sleep in PD, in particular RBD. Whether melatonin and the recently developed melatonergic agents (ramelteon, tasimelteon, agomelatine) have therapeutic potential in PD is also discussed.
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Affiliation(s)
- Venkatramanujam Srinivasan
- Sri Sathya Sai Medical Educational and Research Foundation, Prasanthi Nilayam, Plot-40, Kovai Thirunagar, Coimbatore 641014, India
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Weiss A, Sharifi S, Plotnik M, van Vugt JPP, Giladi N, Hausdorff JM. Toward Automated, At-Home Assessment of Mobility Among Patients With Parkinson Disease, Using a Body-Worn Accelerometer. Neurorehabil Neural Repair 2011; 25:810-8. [DOI: 10.1177/1545968311424869] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To develop an automated and objective method to assess mobility in Parkinson disease (PD) patients in daily-life settings and to investigate whether accelerometer-derived measures discriminate between PD and healthy controls as they walk and simulate activities of daily living (ADL). Methods. Healthy older adults (17) and patients with PD (22) wore a triaxial accelerometer on their lower back during short walks (validation study) and during a walk around the medical center to simulate daily activities (ADL simulation). The variability (consistency and rhythmicity) of stepping was assessed. The patients completed the walks before and after taking their anti-Parkinsonian medications. Frequency-based acceleration measures included dominant frequency, amplitude (strength of signal frequency), width (frequency dispersion), and slope (a combination reflecting amplitude and width) of the main frequency of the power spectral density in the 0.5- to 3.0-Hz band. A subset of the Unified Parkinson-Disease Rating Scale provided a clinical measure of gait impairment (UPDRS-Gait5). A PD patient and control wore the sensors for 3 days at home. Results. The width was larger, and the amplitude and slope were smaller in the PD patients compared to the controls in the validation study and ADL simulation ( P < .02). The width decreased, and the amplitude and slope increased when patients took anti-Parkinsonian medications ( P < .007). Significant correlations were observed between acceleration-derived measures and UPDRS-Gait5. The data obtained at home was similar to the clinic data. Conclusions. Frequency-derived measures are valid and sensitive estimates of stride-to-stride variability that can be used to assess the quality and consistency of walking in patients with PD in real-life settings.
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Affiliation(s)
- Aner Weiss
- Laboratory for Gait & Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Sarvi Sharifi
- Department of Biomedical Signals and Systems, Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Meir Plotnik
- Laboratory for Gait & Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Nir Giladi
- Laboratory for Gait & Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Physical Therapy (NG) and Neurology (JMH), Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeffrey M. Hausdorff
- Laboratory for Gait & Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Physical Therapy (NG) and Neurology (JMH), Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Abstract
SUMMARY Parkinson’s disease (PD) patients demonstrate a variety of sleep/wake complaints. Some of these are associated with dopaminergic dysfunction, some presumed to arise from nondopaminergic PD pathology, some from PD treatments and, in some, the etiologies are multifactorial or unknown. Optimal management of sleep/wake problems requires a good understanding of sleep/wake principals in the PD population, as there are few controlled trials to dictate therapy. In this article, we review the main causes of sleep/wake disorders in PD patients, namely sleep fragmentation, excessive daytime sleepiness, restless legs syndrome, periodic limb movement of sleep, rapid eye movement sleep behavioral disorder and sleep apnea. Available therapies and management recommendations for each disorder are given particular emphasis.
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Affiliation(s)
- Raja Mehanna
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Verhave PS, Jongsma MJ, Van den Berg RM, Vis JC, Vanwersch RAP, Smit AB, Van Someren EJW, Philippens IHCHM. REM sleep behavior disorder in the marmoset MPTP model of early Parkinson disease. Sleep 2011; 34:1119-25. [PMID: 21804674 PMCID: PMC3138167 DOI: 10.5665/sleep.1174] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Sleep problems are a common phenomenon in most neurological and psychiatric diseases. In Parkinson disease (PD), for instance, sleep problems may be the most common and burdensome non-motor symptoms in addition to the well-described classical motor symptoms. Since sleep disturbances generally become apparent in the disease before motor symptoms emerge, they may represent early diagnostic tools and a means to investigate early mechanisms in PD onset. The sleep disturbance, REM sleep behavior disorder (RBD), precedes PD in one-third of patients. We therefore investigated sleep changes in marmoset monkeys treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP), the non-human primate model for idiopathic PD. DESIGN Mild parkinsonism was induced in 5 marmoset monkeys (3M/2F) over a 2-week period of subchronic MPTP treatment. Electroencephalograms (EEGs) and electromyograms (EMGs) were recorded weekly. Motor activity and hand-eye coordination were also measured weekly, and any signs of parkinsonism were noted each day. Sleep parameters, motor activity, and performance data before and after MPTP treatment were compared between MPTP-treated marmosets and 4 control marmosets (1M/3F). RESULTS MPTP increased the number of sleep epochs with high-amplitude EMG bouts during REM sleep relative to control animals (mean ± SEM percentage of REM 58.2 ± 9.3 vs. 29.6 ± 7.7; P < 0.05). Of all sleep parameters measured, RBD-like measures discriminated best between MPTP-treated and control animals. On the other hand, functional motor behavior, as measured by hand-eye coordination, was not affected by MPTP treatment (correct trials MPTP: 23.40 ± 3.56 vs. control: 36.13 ± 5.88 correct trials; P = 0.32). CONCLUSIONS This REM sleep-specific change, in the absence of profound changes in wake motor behaviors, suggests that the MPTP marmoset model of PD could be used for further studies into the mechanisms and treatment of RBD and other sleep disorders in premotor symptom PD.
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Affiliation(s)
- Peternella S Verhave
- BU CBRN Protection, TNO Defence, Security and Safety, Rijswijk, The Netherlands.
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Abstract
The aim of this review is to provide data on sleep disturbances in three categories of neurodegenerative disorders: synucleinopathies, tauopathies, and other diseases (this heterogeneous group includes also spinocerebellar degeneration and amyotrophic lateral sclerosis). Analysing and knowing sleep disorders in neurodegenerative diseases may offer important insights into the pathomechanism of some of these diseases and calls attention to the still insufficiently known 'sleep neurology'. The identification of sleep disorders in some neurodegenerative conditions may make their diagnosis easier and earlier; for example, rapid eye movements sleep behaviour disorder may precede any other clinical manifestation of synucleinopathies by more than 10 years.
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Affiliation(s)
- A Raggi
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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Chastin SFM, Baker K, Jones D, Burn D, Granat MH, Rochester L. The pattern of habitual sedentary behavior is different in advanced Parkinson's disease. Mov Disord 2011; 25:2114-20. [PMID: 20721926 DOI: 10.1002/mds.23146] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Physical behavior changes in Parkinson's disease (PD), however, objective evidence of this is lacking. This study explored methods to objectively quantify sedentary behavior (SB) in advanced PD with the aim of identifying changes that could impact on the burden of disease. We compared the SB of 17 PD (UPDRS III 29.1 ± 5.5; disease duration 12.5 ± 6.4; H&Y (3 & 4) and 17 aged and gender matched healthy subjects. SB was measured objectively over a 7 day period using the activPAL accelerometer. SB was defined as sitting or lying and described in terms of the volume and pattern of SB. Comparison between PD and controls showed that whilst there was no difference in the volume of sedentary time (P = 0.15), there was a significant difference in distribution (P < 0.01) and pattern of accumulation of sedentary time (P < 0.01). Bouts of SB in people with PD tend to last longer than that of controls, whilst the total time spent inactive is the same for the two groups. These results suggest that PD leads to a change in the pattern of SB but not the volume. This may be interpreted as a strategy to conserve energy to maximize function. Studying the pattern of SB appears promising and has the potential to help us to understand the impact of PD and the consequences of changes in SB on the burden of disease.
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Affiliation(s)
- Aleksandar Videnovic
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Conroy DA, Brower KJ. Alcohol, toxins, and medications as a cause of sleep dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2011; 98:587-612. [PMID: 21056213 DOI: 10.1016/b978-0-444-52006-7.00038-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Deirdre A Conroy
- University of Michigan Addiction Resarch Center, Ann Arbor, MI 48109-2700, USA
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Cochen De Cock V, Dauvilliers Y. Comment prendre en charge la somnolence associée à la maladie de Parkinson ? Rev Neurol (Paris) 2010; 166:793-9. [DOI: 10.1016/j.neurol.2010.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 07/09/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Arias P, Vivas J, Grieve KL, Cudeiro J. Double-blind, randomized, placebo controlled trial on the effect of 10 days low-frequency rTMS over the vertex on sleep in Parkinson’s disease. Sleep Med 2010; 11:759-65. [PMID: 20674489 DOI: 10.1016/j.sleep.2010.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 05/18/2010] [Accepted: 05/19/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Pablo Arias
- Neuroscience and Motor Control Group (NEUROcom), Department of Medicine-INEF and Institute for Biomedical Research (INIBIC), University of A Coruña, Spain
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Stavitsky K, Saurman JL, McNamara P, Cronin-Golomb A. Sleep in Parkinson's disease: a comparison of actigraphy and subjective measures. Parkinsonism Relat Disord 2010; 16:280-3. [PMID: 20202887 DOI: 10.1016/j.parkreldis.2010.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 01/19/2010] [Accepted: 02/03/2010] [Indexed: 11/26/2022]
Abstract
Sleep disturbances are common in Parkinson's disease (PD). Actigraphy has emerged as an alternative to polysomnography to measure sleep, raising the question of its ability to capture sleep quality in PD patients. Our aim was to compare self-report data with actigraphic data. Thirty non-demented individuals with PD and 14 normal control participants (NC) were included. Sleep was measured using 24-h wrist actigraphy over a seven day period, during which time participants kept a sleep diary. Subjective sleep and arousal questionnaires included the Parkinson's Disease Sleep Scale and Epworth Sleepiness Scale. Patients with PD presented with more sleep problems than NC. In NC, none of the actigraphic sleep variables were related to any of the self-report measures of sleep. In PD, scores on subjective sleep measures correlated with actigraphy-derived estimates of sleep quality. Our results suggest that actigraphy is an appropriate method of measuring sleep quality in PD.
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Affiliation(s)
- K Stavitsky
- Department of Psychology, Boston University, 648 Beacon St., 2nd floor, Boston, MA 02215, USA
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42
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Abstract
The cardinal characteristics of Parkinson disease (PD) include resting tremor, rigidity, and bradykinesia. Patients may also develop autonomic dysfunction, cognitive changes, psychiatric symptoms, sensory complaints, and sleep disturbances. The treatment of motor and non-motor symptoms of Parkinson disease is addressed in this article.
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Affiliation(s)
- Mark Stacy
- Division of Neurology, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA.
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NASS ALEXANDER, NASS ROBERTDANIEL. ACTIGRAPHIC EVIDENCE FOR NIGHT-TIME HYPERKINESIA IN PARKINSON’S DISEASE. Int J Neurosci 2009; 118:291-310. [DOI: 10.1080/00207450701591065] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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van Dijk KD, Møst EIS, Van Someren EJW, Berendse HW, van der Werf YD. Beneficial effect of transcranial magnetic stimulation on sleep in Parkinson's disease. Mov Disord 2009; 24:878-84. [PMID: 19224604 DOI: 10.1002/mds.22462] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Karin D van Dijk
- Department of Neurology, VU University Medical Center Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands.
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Kashihara K, Ohno M, Kawada S, Imamura T. Frequent nocturnal vocalization in pure autonomic failure. J Int Med Res 2008; 36:489-95. [PMID: 18534130 DOI: 10.1177/147323000803600313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nocturnal vocalization is frequent in Parkinson's disease patients with rapid eye movement (REM) sleep behaviour disorder (RBD). We investigated the frequency of nocturnal vocalization and other sleep problems in patients with pure autonomic failure (PAF) and compared the results with idiopathic Parkinson's disease (IPD) and dementia with Lewy bodies (DLB). We interviewed consecutive patient-caregiver pairs with PAF (n = 13), IPD (n = 200) and DLB (n = 19), and ischaemic stroke patients (controls, n = 43). Nocturnal vocalization was similarly frequent in PAF, IPD and DLB. Other dream enactments and vivid dreams also were more frequent in PAF, IPD and DLB compared with controls. Excessive night-time awakenings and daytime sleepiness were frequent in IPD but rare in PAF and controls. Clinical manifestation of sleep disturbances, at least of RBD-like symptoms including nocturnal vocalization and other dream enactments, may occur in PAF, as in IPD and DLB.
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Affiliation(s)
- K Kashihara
- Department of Neurology, Okayama Kyokuto Hospital, 567-1 Kuraka, Okayama, Japan.
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Whitehead DL, Davies AD, Playfer JR, Turnbull CJ. Circadian rest-activity rhythm is altered in Parkinson's disease patients with hallucinations. Mov Disord 2008; 23:1137-45. [DOI: 10.1002/mds.22057] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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48
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Sleep disturbances in patients with parkinsonism. ACTA ACUST UNITED AC 2008; 4:254-66. [PMID: 18398415 DOI: 10.1038/ncpneuro0775] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 02/04/2008] [Indexed: 01/21/2023]
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Sleep disorders associated with Parkinson's disease: role of dopamine, epidemiology, and clinical scales of assessment. CNS Spectr 2008; 13:6-11. [PMID: 18323761 DOI: 10.1017/s1092852900017260] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sleep dysfunction is common among patients with Parkinson's disease and occurs in approximately two thirds of patients. The problems range from nocturnal issues such as difficulty with sleep initiation, sleep fragmentation, disturbance of circadian rhythm, and rapid eye movement sleep behavior disorder, to daytime problems such as excessive daytime sleepiness. Frequent nighttime awakening and sleep disruption are the most common sleep problems in Parkinson's disease. Dopamine plays an important role in maintaining wakefulness. To improve sleep in Parkinson's disease, it is important to achieve the critical balance of adequate dopaminergic therapy and control of symptoms. Increased dopaminergic agents can cause dyskinesias and painful dystonia, and undertreatment can cause nighttime akinesia, rigidity, and worse quality of sleep. Other nondopaminergic drugs commonly used in Parkinson's disease can also affect sleep. In patients with advanced Parkinson's disease, deep brain stimulation of the subthalamic nucleus has a favorable impact on sleep quality and sleep architecture.
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50
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Loo HV, Tan EK. Case–control study of restless legs syndrome and quality of sleep in Parkinson's disease. J Neurol Sci 2008; 266:145-9. [DOI: 10.1016/j.jns.2007.09.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 07/29/2007] [Accepted: 09/14/2007] [Indexed: 12/01/2022]
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