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Medication and dementia
Published in Graham A. Jackson, Debbie Tolson, Textbook of Dementia Care, 2019
Parkinson’s disease-like symptoms occur in the majority of patients with DLB and it is a major cause of functional impairment. Guidance suggests these physical symptoms should be treated in the same way as Parkinson’s disease. However anti-Parkinson’s medications can worsen psychiatric symptoms in DLB and therefore caution is necessary (Goldman et al. 2008). Patients with DLB are often exquisitely sensitive to antipsychotics and these should therefore only be used when absolutely necessary (McKeith et al. 2005). Quetiapine has been recommended for psychotic symptoms in dementia with Parkinsonism but appears to be unhelpful (Kurlan et al. 2007). Low dose Clonazepam, Melatonin and Quetiapine may be helpful for REM sleep behaviour disorder (Aurora et al. 2010; Briggs et al. 2016).
Medical Conditions and Diseases
Published in Clete A. Kushida, Sleep Deprivation, 2004
Naomi L. Rogers, Jacqueline D. Kloss
Significant periods of movement are also evident during REM sleep periods, when REM sleep behavior disorder is present (117,138). These include vocalizations, increased muscle tone, and complex muscle movements. During NREM sleep, increased incidence of periodic limb movements is also evident in up to one third of Parkinson’s patients (139). Muscle activity is often present in limbs that also express tremor during waking periods.
The association between sleep deficits and sedentary behavior in people with mild Parkinson disease
Published in Disability and Rehabilitation, 2022
Rachel A. Prusynski, Valerie E. Kelly, Donald J. Fogelberg, Sujata Pradhan
Sleep disturbance is one of the most common nonmotor symptoms reported by people with Parkinson disease (PD) [1]. A wide variety of sleep disorders, related to both disease processes as well as medication side effects, can co-occur with PD, including insomnia, rapid eye movement (REM) sleep behavior disorder, restless leg syndrome, and narcolepsy. Sleep disturbances significantly impact overall function and quality of life for people with PD [1–3]. Insomnia is prevalent in a majority of people with PD and is defined as one or more of the following: difficulty falling asleep, difficulty staying asleep, early awakening, or nonrefreshing sleep [4]. Although sleep disturbance in PD is complex, insomnia has been demonstrated to have greater negative impact on quality of life for people with PD than motor symptoms such as gait difficulties [4,5]. Sleep disturbance often occurs early in the course of PD, and some sleep disorders, such as REM sleep behavior disorder, can precede the onset of any motor manifestations of PD, often occurring years before PD diagnosis [1].
Treating hallucinations in Parkinson’s disease
Published in Expert Review of Neurotherapeutics, 2022
Alice Powell, Elie Matar, Simon J. G. Lewis
Disease related factors typically reflect the degree of neurodegeneration across neurotransmitter systems in line with disease duration and often the severity of motor features [4,9,18,19]. Interestingly, the presence of rapid eye movement (REM) sleep behavior disorder (RBD) is also associated with hallucinations [20–22] despite often occurring before patients are even diagnosed with PD. Hallucinations are associated with cognitive impairment [4,19,20] but may also predict future cognitive decline [23] suggesting that they do not simply reflect part of the dementing process. These relationships may reflect the influence of comorbid Alzheimer’s disease pathology (β-amyloid plaques and tau-containing neurofibrillary tangles), which is frequently found in the brains of patients with PD (>50%) [24]. The coexistence of this neuropathology is associated with both an earlier onset of dementia in PD and the presence of visual hallucinations [22,25]. Genetic factors are also likely important with an association, particularly, with glucocerebrosidase (GBA) and earlier emergence of psychosis as well as cognitive impairment [26].
Pharmacotherapeutic options in the treatment of nocturia: an update on the current oral drug therapies
Published in Expert Opinion on Pharmacotherapy, 2022
Most antidepressants can alter sleep patterns in various stages such as sleep initiation and maintenance although these effects can vary in different drugs [60]. Some antidepressants can have sleep-disturbing effect early in the course of drug use such as clomipramine and fluoxetine while others actually improve sleep such as amitriptyline and the newer serotonin receptor antagonists. Nonetheless, it is important to be mindful that some antidepressants may worsen certain sleep problems in patients such as those with restless legs syndrome and REM sleep behavior disorder [60]. Interestingly, published literature shows an increase in nocturnal micturitions in patients suffering from major depression and after adjusting for age and major depression, twice as many patients taking selective serotonin receptor antagonists reported two or more nocturnal voids compared to those not on the drug [61].