Rede SARAH de Hospitais de Reabilitação, Departamento de Neurologia, Brasília DF, Brazil.
Universidade Federal de Minas Gerais, Unidade de Distúrbios do Movimento, Serviço de Neurologia, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.
Arq Neuropsiquiatr. 2021 Feb;79(2):156-166. doi: 10.1590/0004-282X-anp-2020-0173.
Parkinson's disease (PD) has heterogeneous clinical manifestations and prognoses. It is accompanied by a group of motor and non-motor symptoms ranging from independence to total disability, limiting work and personal care activities. Currently, disease subtype markers for informing prognosis remain elusive. However, some studies have reported an association between rapid eye movement (REM) sleep behavior disorder (RBD) and faster motor and non-motor symptom progression, including autonomic dysfunction and cognitive decline. Moreover, since autonomic dysfunction has been described in idiopathic forms of RBD, and they share some central regulatory pathways, it remains unclear whether they have a primary association or if they are more severe in patients with PD and RBD, and thus are a disease subtype marker. This article aimed at critically reviewing the literature on the controversies about the prevalence of RBD in PD, the higher incidence of PD non-motor symptoms associated with RBD, the evidence of faster motor worsening in parkinsonian patients with this parasomnia, and the main pathophysiological hypotheses that support these findings.
帕金森病（PD）具有异质性的临床表现和预后。它伴随着一系列运动和非运动症状，从轻度到完全残疾，限制了工作和个人护理活动。目前，用于告知预后的疾病亚型标志物仍难以捉摸。然而，一些研究报告了快速眼动（REM）睡眠行为障碍（RBD）与更快的运动和非运动症状进展之间的关联，包括自主神经功能障碍和认知能力下降。此外，由于自主神经功能障碍已在特发性 RBD 中被描述，并且它们共享一些中枢调节途径，因此尚不清楚它们是否具有原发性关联，或者它们在 PD 和 RBD 患者中更为严重，从而成为疾病亚型标志物。本文旨在批判性地回顾有关 PD 中 RBD 的患病率、与 RBD 相关的更高 PD 非运动症状发生率、患有这种睡眠障碍的帕金森病患者运动恶化更快的证据以及支持这些发现的主要病理生理学假说的文献。
