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AAN 2024 | Significance of RBD pathophysiology for neurodegenerative diseases
Aleksandar Videnovic, MD, from the Massachusetts General Hospital, Harvard Medical School Boston, MA, discusses REM sleep behavior disorder (RBD), a parasomnia in which patients display movement during often negatively emotionally charged dreams. It has been determined that many patients with this condition go on to develop synucleinopathies, including Parkinson’s disease, multiple system atrophy (MSA), and dementia with Lewy bodies, making RBD a clinically important early marker of neurodegeneration. Dr Videnovic outlines the pathology of RBD, explaining that brainstem connections to peripheral skeletal muscles are disrupted allowing for movement during sleep. As synuclein-mediated neurodegenerative disorders progress into various brain regions, they can cause a dysregulation of circuitry leading to disruption of REM sleep, which in early stages manifests as RBD. This interview took place at the American Academy of Neurology (AAN) Annual Meeting 2024 in Denver, CO.
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Transcript
REM sleep behavior disorder (RBD) is a sleep disorder. It belongs to a group of sleep disorders called parasomnias. In these conditions, patients who are affected by this disorder act out their dreams, and these dreams are usually filled with negative emotional context: patients are frequently threatened in their dreams, and they are able to act out their dreams and try to defend themselves in their sleep as they are not paralyzed like we would normally be if there was no RBD present...
REM sleep behavior disorder (RBD) is a sleep disorder. It belongs to a group of sleep disorders called parasomnias. In these conditions, patients who are affected by this disorder act out their dreams, and these dreams are usually filled with negative emotional context: patients are frequently threatened in their dreams, and they are able to act out their dreams and try to defend themselves in their sleep as they are not paralyzed like we would normally be if there was no RBD present. This condition has been the focus of the medical and scientific community over the past 10 to 15 years, and increasingly so over the past few years, as it is clear that in the majority of patients affected with this disease there is likely an ongoing neurodegenerative process. This leads to one of these conditions that we call synucleinopathies. There are three major diseases within this group: Parkinson’s disease, Lewy body dementia and multiple systems atrophy. So, our patients who act out their dreams in the middle of the night (especially those who are above age 50), are at a highly increased risk to develop one of these conditions. And that’s why this disease has become very important, because it enables us to have a window into the early stages of this neurodegenerative process that at the moment, we don’t have a cure for.
In the core of REM sleep behavior disorder is the disturbance of the circuitry within several brainstem nuclei, and their connections to our peripheral skeletal musculature. These connections are something that are disturbed in this condition, enabling individuals with this disorder to act out their dreams. We now understand that as the pathological process of these synuclein specific neurodegenerative disorders progress, they march through the areas of brain, affecting brainstem regions as well. Those pathological changes are then responsible for dysregulation of this circuitry that is responsible for normal REM sleep. As these pathological changes are occurring in the brain, one of the manifestations, as I mentioned, usually in the very early stages of neurodegeneration, is the emergence of this REM sleep behavior disorder.
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