REM Sleep Behavior Disorder and Cognitive Impairment in Parkinson's Disease

Abstract

Study objectives: REM sleep behavior disorder (RBD) is a parasomnia affecting 33% to 46% of patients with Parkinson's disease (PD). The existence of a unique and specific impaired cognitive profile in PD patients with RBD is still controversial. We extensively assessed cognitive functions to identify whether RBD is associated with more severe cognitive deficits in nondemented patients with PD.

Methods: One hundred sixty-two participants, including 53 PD patients with RBD, 40 PD patients without RBD, and 69 healthy subjects, underwent polysomnography, a neurological assessment and an extensive neuropsychological exam to assess attention, executive functions, episodic learning and memory, visuospatial abilities, and language.

Results: PD patients with RBD had poorer and clinically impaired performance in several cognitive tests compared to PD patients without RBD and healthy subjects. These two latter groups were similar on all cognitive measures. Mild cognitive impairment (MCI) diagnosis frequency was almost threefold higher in PD patients with RBD compared to PD patients without RBD (66% vs. 23%, p < .001). Moreover, subjective cognitive decline was reported in 89% of PD patients with RBD compared to 58% of PD patients without RBD (p = .024).

Conclusions: RBD in PD is associated with a more impaired cognitive profile and higher MCI diagnosis frequency, suggesting more severe and widespread neurodegeneration. This patient subgroup and their caregivers should receive targeted medical attention to better detect and monitor impairment and to enable the development of management interventions for cognitive decline and its consequences.

Keywords: Cognition; Mild cognitive impairment; Neuropsychology; Parkinson’s disease; REM sleep behavior disorder.

Figure 1

Percentage of patients with clinically impaired performance on neuropsychological tests. ***p < .001; **p < .01; *p < .05. MMSE = Mini-Mental State Examination; PD-RBD = Parkinson’s disease with REM sleep behavior disorder; PD-nRBD = PD without RBD; RAVLT = Rey Auditory-Verbal Learning Test; ROCF = Rey-O Complex Figure; Stroop components: II = Naming, III = Interference, IV = Flexibility.