Hallucinations, REM sleep, and Parkinson's disease - A medical hypothesis
Hallucinations, REM sleep, and Parkinson's disease - A medical hypothesis
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DOI：
10.1212/wnl.55.2.281
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发表时间：
2000-07-25
期刊：
影响因子：
9.9
通讯作者：
Agid, Y
中科院分区：
文献类型：
--
作者：
Arnulf, I;Bonnet, AM;Agid, Y
背景：PD患者在多巴胺能治疗后可出现致残性视幻觉。睡眠障碍，包括生动的梦和伴有运动行为的快速眼动睡眠（RBD），在这些患者中很常见。方法：对10例长期左旋多巴反应性PD伴幻觉的非痴呆患者进行夜间和日间幻觉与快速眼动睡眠的关系分析。7名患者表现出偏执和偏执妄想。进行夜间睡眠记录和标准多次白天睡眠潜伏期测试。这些结果与10名没有出现幻觉的PD患者的结果进行了比较。结果：10例有幻觉者均有RBD， 6例无幻觉者均有RBD。尽管两组人的夜间睡眠情况相似，但幻觉者在白天往往更困。在夜间快速眼动期和白天快速眼动期发作后，在3名和8名幻觉者中观察到妄想，在其他人中观察到0名和2名。白天的幻觉，与清醒期间的快速眼动睡眠侵入相一致，只有幻觉者才会报告。一名患者的大脑尸检显示，蓝下核的神经元中有许多路易小体，蓝下核是控制快速眼动睡眠的区域。结论：伴有快速眼动后幻觉的患者在夜间出现快速眼动后幻觉的同时出现的视觉幻觉可能是梦象。因此，PD患者的精神病可能反映了一种嗜睡样的快速眼动睡眠障碍。
Background: Patients with PD can have disabling visual hallucinations associated with dopaminergic therapy. Sleep disorders, including vivid dreams and REM sleep with motor behaviors (RBD), are frequent in these patients. Methods: The association of hallucinations and REM sleep both at night and during the day was examined in 10 consecutive nondemented patients with long-standing levodopa-responsive PD and hallucinations. Seven patients presented with paranoia and paranoid delusions. Overnight sleep recordings and standard multiple daytime sleep latency test were performed. The results were compared to those of 10 similar patients with PD not experiencing hallucinations. Results: RBD was detected in all 10 patients with hallucinations and in six without. Although nighttime sleep conditions were similar in both groups, hallucinators tended to be sleepier during the day. Delusions following nighttime REM period and daytime REM onsets were observed in three and eight of the hallucinators, and zero and two of the others. Daytime hallucinations, coincident with REM sleep intrusions during periods of wakefulness, were reported only by hallucinators. Postmortem examination of the brain of one patient showed numerous Lewy bodies in neurons of the subcoeruleus nucleus, a region that is involved in REM sleep control. Conclusion: The visual hallucinations that coincide with daytime episodes of REM sleep in patients who also experience post-REM delusions at night may be dream imagery. Psychosis in patients with PD may therefore reflect a narcolepsy-like REM sleep disorder.