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Sleep disorder related to Parkinson's disease.
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Sleep disorders occur in 74-98% of patients with idiopathic Parkinson's
disease (PD), adversely affecting their quality of life.

Sleep disruption takes the form of sleep fragmentation with frequent and
prolonged awakenings and daytime sleepiness.

Nocturia, difficulty in turning over in bed, painful leg cramps, vivid
dreams/nightmares, back pain, limb/facial dystonia and leg jerks are the
main causes of nocturnal awakening in PD patients.

Sleep disturbance gradually worsens with disease progression, suggesting
that it is related to the severity of the disease.

Sleep disturbances may be generally considered as part of the normal aging
process, being more common in the elderly.

However, no significant associations between sleep disturbances and either
age or disease duration was found in a survey of 100 PD patients.

Disturbed sleep maintenance in PD patients was more severe than in
age-matched controls, and nocturnal awakening was frequently caused by
nocturia, pain, stiffness and difficulty in turning over in bed.

Sleep disturbance is also a complication of chronic levodopa therapy.

Recent data suggest that controlled-release levodopa is less likely to
cause nocturnal symptoms than standard levodopa, particularly in
mild-to-moderate disease.

Depression, which is common in PD patients, contributes to sleep
disturbance but has a lesser influence than the disease process itself.

Hypnotic and sedative agents, as well as anti-depressants if required, are
useful in ameliorating sleep disturbances in PD patients; intranasal
desmopressin appears to be effective in reducing nocturia.

J Neurol 1997 Apr;244(4 Suppl 1):S3-S6
Partinen M
Haaga Centre for Neurological Research, Helsinki, Finland.
PMID: 9112582, MUID: 97266863

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Sleep disturbances in Parkinson's disease patients and spouses.
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OBJECTIVES: The prevalence of self-rated sleep disturbance in patients with
Parkinson's disease (PD) and their spouses was compared with healthy
controls, and the association of sleep disturbance with demographic,
psychological, and disease variables was assessed.

DESIGN: The sleep ratings from three groups, PD patients, their spouses,
and healthy controls, were compared using analyses of variance. Stepwise
regressions were used to predict sleep disturbance for each group and=
 gender.

SETTING: Participants completed questionnaires as part of a nationwide
survey in Germany.

PARTICIPANTS: Participants included 153 PD-spouse pairs and a group of 103
healthy controls.

MEASUREMENTS: Zung Self-Rating Depression Scale and self-ratings of sleep
disturbance, stress level, and disease symptoms (for PD patients).

RESULTS: Sleep disturbances were significantly higher in women than in men
in all groups.

For PD patients, sleep disturbance occurred frequently in 25% of male and
41% of female participants and was best predicted by the patient's
depression rating.

For spouses, frequent sleep disturbance was reported by 27% of male and 48%
of females and was likewise predicted by the spouse's own rating of
depression.

A second, relatively less common type of sleep disturbance was also
reported by spouses. This disturbance was associated with waking during the
night to help the patient and was best predicted by patient factors.

CONCLUSION: Improvement of sleep quality of caregivers may be an important
component of treatment to reduce distress caused by PD.

J Am Geriatr Soc 1997 Feb;45(2):194-199
Smith MC, Ellgring H, Oertel WH
Dept. of Psychology, University of Portsmouth, UK.
PMID: 9033518, MUID: 97185837

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Complications of disease and therapy:
A comparison of younger [41-64] and older [65+] patients with PD
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The incidence of complications associated with disease and treatment was
compared in younger versus elderly patients with Parkinson's disease (PD).

One hundred sixty-five patient records were divided according to patient
age into two groups ("younger," 41-64, and "elderly," 65+ years) and
reviewed for the incidence of dyskinesias, fluctuations, freezing,
psychosis, dementia, depression, and insomnia.

Younger patients had a greater incidence of:
        chorea          (75.8 percent vs 49.5 percent),
        dystonia        (82.3 percent vs 49.0 percent),
        fluctuations    (90.1 percent vs 68.1 percent),
        depression      (73.2 percent vs 36.8 percent), and
        insomnia        (57.9 percent vs 18.1 percent).

There were no significant differences in the incidence of freezing,
dementia, or psychosis.

At the time of the first adverse event, there was no difference in patient
characteristics such as gender, lag time from disease diagnosis to levodopa
initiation, disease symptoms at the time of diagnosis, levodopa dose, or
concomitant drug use despite the fact that the older group had a longer
duration of disease, higher Hoehn and Yahr stage, an older age at onset of
PD, and longer duration of levodopa use.

Younger patients with PD experience a greater incidence of adverse effects
than do elderly PD patients.

The spectrum of adverse effects is comparable to those of young-onset (40
or under) patients.

Ann Clin Lab Sci 1996 Sep;26(5):389-395
Wagner ML, Fedak MN, Sage JI, Mark MH
College of Pharmacy, Rutgers State University, New Jersey 08855, USA.
PMID: 8879356, MUID: 97033698

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Sleep disorders, pain, and depression in Parkinson's disease.
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A consecutive series of patients with Parkinson's disease (PD) were
examined for the presence of sleep disturbances, pain, and depression.

We found that patients with PD and major depression had significantly more
sleep disturbances and severe pain than non-depressed patients with PD.

Moreover, depression scores accounted for most of the variance in a
stepwise regression analysis of the effect of numerous clinical variables
on either sleep disorders or pain severity.

These findings suggest that depression is the most important factor
associated with the common problems of sleep disorder and pain among
patients with PD.

Eur Neurol 1991;31(6):352-355
Starkstein SE, Preziosi TJ, Robinson RG
University of Buenos Aires, Argentina.
PMID: 1756757, MUID: 92097600

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Sleep EEG in depressed and nondepressed patients with Parkinson's disease.
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Sleep patterns of two consecutive nights were analyzed in 26 drug-free
patients with Parkinson's disease (PD), who were clinically divided into
depressed (n =3D 8) and nondepressed (n =3D 18) groups.

Sleep electroencephalographic (EEG) recording showed significantly shorter
rapid eye movement (REM) latency in depressed PD patients (41.1 +/- 21.7
min) compared to nondepressed PD patients (129.0 +/- 84.9 min, p less than
0.002).

Furthermore, shortened REM latency (less than or equal to 65.0 min) was
observed with significantly more frequency in depressed PD patients (6 out
of 8) compared to nondepressed PD patients (4 out of 18, p less than 0.02).

The other sleep parameters studied did not differ significantly between the
two groups of patients.

Because shortened REM latency is one of the most reliably documented
biological features of major depression, these findings may be of some
importance for understanding the nature of depression in the course of PD.

J Neuropsychiatry Clin Neurosci 1991;3(2):176-179
Kostic VS, Susic V, Przedborski S, Sternic N
Neurological Clinic UCC, School of Medicine, Belgrade, Yugoslavia.
PMID: 1821232, MUID: 92330431

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Treatment with weak electromagnetic fields
restores dream recall in a Parkinsonian patient.
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Absent or markedly reduced REM sleep with cessation of dream recall has
been documented in numerous neurological disorders associated with
subcortical dementia including Parkinson's disease, progressive
supranuclear palsy and Huntington's chorea.

This report concerns a 69 year old Parkinsonian patient who experienced
complete cessation of dreaming since the onset of motor disability 13 years
ago.

Long term treatment with levodopa and dopamine (DA) receptor agonists
(bromocriptine and pergolide mesylate) did not affect dream recall.

However, dreaming was restored after the patient received three treatment
sessions with AC pulsed picotesla range electromagnetic fields (EMFs)
applied extracranially over three successive days.

Six months later, during which time the patient received 3 additional
treatment sessions with EMFs, he reported dreaming vividly with intense
colored visual imagery almost every night with some of the dreams having
sexual content.

In addition, he began to experience hypnagogic imagery prior to the onset
of sleep.

Cessation of dream recall has been associated with right hemispheric
dysfunction and its restoration by treatment with EMFs points to right
hemispheric activation, which is supported by improvement in this patient's
visual memory known to be subserved by the right temporal lobe.

Moreover, since DA neurons activate REM sleep mechanisms and facilitate
dream recall, it appears that application of EMFs enhanced DA activity in
the mesolimbic system which has been implicated in dream recall.

Also, since administration of pineal melatonin has been reported to induce
vivid dreams with intense colored visual imagery in normal subjects and
narcoleptic patients, it is suggested that enhanced nocturnal melatonin
secretion was associated with restoration of dream recall in this patient.

These findings demonstrate that unlike chronic levodopa therapy,
intermittent pulsed applications of AC picotesla EMFs may induce in
Parkinsonism reactivation of reticular-limbic-pineal systems involved in
the generation of dreaming.

Int J Neurosci 1997 Jun;90(1-2):75-86
Sandyk R
Institute for Biomedical Engineering and Rehabilitation Services,
Touro College, Dix Hills, NY 11746, USA.
PMID: 9285289, MUID: 97431196

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'Sleep Benefit' [SB] in Parkinson's disease [PD]
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Sleep benefit (SB) In Parkinson's disease (PD) is not well characterized.

To determine SB frequency, as well as to characterize and correlate it with
other disease variables, we evaluated prospectively a consecutive series of
312 PD patients by means of a structured questionnaire: 55% reported having
SB and 35% reported that awakening was their best time of the day.

Because of SB, 21% of the entire population were able to skip or delay
medication. The mean duration of the phenomenon was 85.4 +/- 67 min.

Patients with SB were significantly older (p < 0.0002), had disease longer
(p < 0.05), and were often men (chi 2 =3D 3.5, df 1, p =3D 0.05).

Patients with SB took sleep medication with similar frequency as those
without SB. There were no differences in hours of sleep or sleep latency.

Sleep problems such as nightmares or somnambulism, but not the number of
sleep awakenings, were similar in both groups.

In conclusion, SB is a frequent phenomenon, especially in men, elderly
patients, and patients with longer disease duration.

SB enables the morning L-dopa dose to be postponed in approximately 50% of
patients.

Mov Disord 1997 Jul;12(4):506-508
Merello M, Hughes A, Colosimo C, Hoffman M, Starkstein S, Leiguarda R
Institute for Neurological Research, Buenos Aires, Argentina.
PMID: 9251067, MUID: 97394754

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Clinical correlates of 'Sleep Benefit' [SB] in Parkinson's disease [PD]
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The phenomenon of sleep benefit, a period of lessened disability or feeling
"on" upon awakening from sleep in the morning, has received scant attention
in the literature on Parkinson's disease.

We interviewed 162 consecutive patients regarding disease onset, medication
history, and symptoms, evaluated them using the Unified Parkinson's Disease
Rating Scale, and assessed them as to the presence or absence of sleep
benefit.

Thirty-three percent reported experiencing sleep benefit.

Compared with patients not having sleep benefit, patients with sleep
benefit tended to be younger at disease onset, have longer disease
duration, take higher total daily doses of levodopa, have longer duration
of levodopa treatment, and exhibit less cognitive and physical disability.

The findings of this study suggest that sleep benefit is a common
phenomenon that may be anticipated in a subgroup of patients with
Parkinson's disease.

The mechanisms underlying sleep benefit do not appear to be simple and may
be multifactorial.

Clinicians need to be aware of the authenticity of patients' reports of
sleep benefit and consider the existence of this phenomenon when
prescribing or adjusting patients' medication schedules.

Neurology 1997 Apr;48(4):1115-1117=7F
Currie LJ, Bennett JP Jr, Harrison MB, Trugman JM, Wooten GF
University of Virginia Health Sciences Center, Virginia 22908, USA.
PMID: 9109914, MUID: 97264042

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