II Key words : RBD RBD % REM RBD PSG PSG RBD RBD RBD PD DLB RBD MIBG PD DLB RBD PD RBD rapid eye movement sleep behavior disorder, RBD R

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1 II Key words : RBD RBD % REM RBD PSG PSG RBD RBD RBD PDDLB RBD MIBG PD DLB RBD PD RBD rapid eye movement sleep behavior disorder, RBD RBD Parkinson s disease, PD multiple system atrophy, MSAdementia with Lewy bodies, DLB RBD RBD I. RBD 1990 parasomnia RBD dream enacting behaviorrbd RBD 50 Vol. 17 No

2 平成年月日名前年齢歳男女下記のいずれかにをつけてから回答をお願いします 1. 自分自身だけで記入した 2. 家族あるいはベットパートナーと相談して記入した RBD スクリーニング問診票質問答え 1. とてもはっきりした夢をときどき見るはいいいえ 2. 攻撃的だったり動きが盛りだくさんだったりする夢をよく見るはいいいえ 3. 夢を見ているときに夢の中と同じ動作をすることが多いはいいいえ 4. 寝ている時にうでや足を動かしていることがあるはいいいえ 5. 寝ている時にうでや足を動かすので隣で寝ている人にケガを負わせたり自分がケガをしたりすることもあるはいいいえ 6. 夢を見ているときに以下のできごとが以前にあったり今もある 6.1 誰かとしゃべる大声でどなる大声でののしる大声で笑うはいいいえ 6.2 うでと足を突如動かす / けんかをしているようにはいいいえ 6.3 寝ている間に身振りや複雑な動作をする ( 例 : 手を振る挨拶をする何かを手で追い払うベッドから落ちる ) はいいいえ 6.4 ベッドの周りの物を落とす ( 例 : 電気スタンド本メガネ ) はいいいえ 7. 寝ている時に自分の動作で目が覚めることがあるはいいいえ 8. 目が覚めた後夢の内容をだいたい覚えているはいいいえ 9. 眠りがよく妨げられるはいいいえ 10. 以下のいずれかの神経系の病気を以前患っていたまたは現在患ってますか ( 例 : 脳卒中頭部外傷パーキンソン病むずむず脚症候群ナルコレプシーうつ病てんかん脳の炎症性疾患 ) はいいいえ Figure 1 : RBD screening questionnaire Japanese version RBDSQ J 20 RBDSQ J is a self rating questionnaire consisting of 13 items related to RBD. The maximum total score is 13 points. RBD is suspected when patients score 5 points or greater. 2 Japanese Journal of Cognitive Neuroscience

3 0.5% dream recalldream recall RBD RBD RBD RBD RBDSQ J 13 RBD 5 RBD 1 Fig. 1RBD polysomnography, PSG 3 International Classification of Sleep Disorders, Third Edition, ICSD 3 2 A. B. PSG II. RBD PD DLB MSA progressive supranuclear palsy, PSP Alzheimer s disease, AD Table 1 3 RBD RBD PD DLBSchenck 4 RBD RBD % PD RBD % RBD 13 PD 6 Postuma RBD RBD % % % RBD 172 RBD 62±14 n=147 69±10 C. PSG REM sleep without atonia, RWA D. RBD pseudo RBD Table 1 : Prevalence of RBD in neurodegenerative diseases modified from ref 3 RBD 15 60% 90% 86% 11% 7% 5% 3% Vol. 17 No

4 Table 2 : Accompanying features of idiopathic RBD MIBG R R SPECT/PET n=151 68±9 n=42 62±12 75± AD 59 MSA 19 AD 6 PSP 2 93% α 8 III. RBD MIBG 9 R R SPECT/PET Table 2 IV. RBD RBD 32 RBD PD 22 RBD PD RBD 50% RBD PD 73% RBD PD 11% 8% 10 RBD PD RBD PDD DLB V. PD Braak 11 PD PD REM RBD PD PD PD RBD RBD 12 RBD PD Postuma 13 RBD PD 4 48% RBD PD VI. 30% PD 4 Japanese Journal of Cognitive Neuroscience

5 80% PD PD RBD 14 PD 1, % 13.3% 11.0% 10.1% 15 PD Voxel based morphometry PD PD FDG PET SPECT/PET PD 16 VII. Lewy DLB 17 α RBD DLB 2005 DLB 18 Murray 19 DLB RBD MRI probable RBD DLB 77% DLB / AD probable RBD AD 70%MRI AD VIII. RBD mg g 3 12 mg mg RBD RBD 1 Miyamoto T, Miyamoto M, Iwanami M, Kobayashi M, Nakamura M, Inoue Y, Ando C, Hirata K The REM sleep behavior disorder screening questionnaire : validation study of a Japanese version. Sleep Med 10, American Academy of Sleep Medicine International Classification of Sleep Disorders third edition. Darien, IL, USA. 3 De Cock VC, Vidailhet M, Arnulf I Sleep disturbances in patients with parkinsonism. Nat Clin Pract Neurol 4, Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW Chronic behavioral disorders of human REM sleep : a new category of parasomnia. Sleep 9, Schenck CH, Bundlie SR, Mahowald MW Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 46, Schenck CH, Boeve BF, Mahowald MW De Vol. 17 No

6 layed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder : a 16 year update on a previously reported series. Sleep Med 14, Postuma RB, Gagnon JF, Vendette M, Fantini ML, Massicotte Marquez J, Montplaisir J Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder. Neurology 72, Allen RP, Barker PB, Wehrl F, Song HK, Earley CJ MRI measurement of brain iron in patients with restless legs syndrome. Neurology 56, Miyamoto T, Miyamoto M, Inoue Y, Usui Y, Suzuki K, Hirata K Reduced cardiac 123I MIBG scintigraphy in idiopathic REM sleep behavior disorder. Neurology 67, Gagnon JF, Vendette M, Postuma RB, Desjardins C, Massicotte Marquez J, Panisset M, Montplaisir J Mild cognitive impairment in rapid eye movement sleep behavior disorder and Parkinson s disease. Ann Neurol 66, Braak H, Del Tredici K, Rub U, de Vos RA, Jansen Steur EN, Braak E Staging of brain pathology related to sporadic Parkinson s disease. Neurobiol Aging 24, Kim YE, Jeon BS Clinical implication of REM sleep behavior disorder in Parkinson s disease. J Parkinsons Dis 4, Postuma RB, Bertrand JA, Montplaisir J, Desjardins C, Vendette M, Rios Romenets S, Panisset M, Gagnon JF 2012 Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson s disease : a prospective study. Mov Disord 27, Svenningsson P, Westman E, Ballard C, Aarsland D Cognitive impairment in patients with Parkinson s disease : diagnosis, biomarkers, and treatment. Lancet Neurol 11, Aarsland D, Bronnick K, Williams Gray C, Weintraub D, Marder K, Kulisevsky J, Burn D, Barone P, Pagonabarraga J, Allcock L, Santangelo G, Foltynie T, Janvin C, Larsen JP, Barker RA, Emre M Mild cognitive impairment in Parkinson disease : a multicenter pooled analysis. Neurology 75, Mollenhauer B, Rochester L, Chen Plotkin A, Brooks D What can biomarkers tell us about cognition in Parkinson s disease? Mov Disord 29, Lewy Parkinson In : 2010 : Ogose T, Manabe T, Abe T, Nakaya K Ophthalmoplegic migraine with a rise in cytomegalovirus specific IgG antibody. Pediatrics International 51, DaSilva AF, Granziera C, Tuch DS, Snyder J, Vincent M, Hadjikhani N Interictal alterations of the trigeminal somatosensory pathway and periaqueductal gray matter in migraine. Neuroreport 18, Brinkman GL, Coates EO, Jr The effect of bronchitis, smoking, and occupation on ventilation. Am Rev Respir Dis 87, Japanese Journal of Cognitive Neuroscience

7 Rapid eye movement sleep behavior disorder and neurodegenerative diseases Keisuke Suzuki 1, Masayuki Miyamoto 2, Koichi Hirata 1, Tomoyuki Miyamoto 3 1 Department of Neurology, Dokkyo Medical University, Tochigi, Japan 2 School of Nursing, Dokkyo Medical University, Tochigi, Japan 3 Department of Neurology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan Key words : rapid eye movement sleep behavior disorder, Lewy body disease, Parkinson s disease, dementia with Lewy bodies, sleep disorders, cognitive dysfunction Rapid eye movement sleep behavior disorder RBD is a parasomnia characterized by abnormal, dream enacting behavior during REM sleep associated with nightmare, often results in injury to themselves or their bed partners. Typically, most RBD patients can recall the details of vivid dreams upon awakening. RBD usually emerges after the age of 50 years with a male predilection and an estimated prevalence is reported to be 0.5% in the general population. The proposed pathophysiology of human RBD is that the involvement of brainstem nuclei responsible for controlling REM sleep, including pedunculopontine nucei, laterodorsal tegmental nucleus, sublaterodorsal nuclei and locus coeruleus, and neuronal networks involving the limbic system and neocortex may contribute to the occurrence of RBD. Detecting REM sleep without atonia by polysomnography PSG is required for RBD diagnosis ; however, prior to PSG examination, RBD screening tools, such as RBD screening questionnaire, are useful in clinical practice. Low dose clonazepam before bedtime is effective in most patients with RBD. Several follow up studies of RBD patients demonstrated the significant number of RBD patients developed synucleinopathies such as Parkinson s disease PD, dementia with Lewy bodies DLB and multiple system atrophy MSA. In addition, RBD patients exhibit olfactory impairment, color discrimination deficits, cognitive impairment, a reduced uptake of cardiac 123I MIBG scintigraphy and hyperechogenicity of the substantia nigra on transcranial sonography, which are observed in Lewy body diseases such as PD and DLB. Accumulating evidence suggests that idiopathic RBD could be a prodromal phase of Lewy body diseases and idiopathic RBD patients may be ideal condidates for future neuroprotective, disease modifying therapy. We also discuss characteristic findings of cognitive impairment in PD and RBD. Vol. 17 No

b. OSAS 45 MRI 3 8 AHI 15/h OSAS 173 AHI 5/h 19 MRI 9 II movement disorders 1. Parkinson PD PD PD rapid eye movement sleep behavior disorder RBD

b. OSAS 45 MRI 3 8 AHI 15/h OSAS 173 AHI 5/h 19 MRI 9 II movement disorders 1. Parkinson PD PD PD rapid eye movement sleep behavior disorder RBD * ****** Key Words : neurological disorder, sleep disturbance, cerebrovascular disease, Parkinson s disease, REM behavior disorder 31 156 160 2014 common Parkinson Parkinson disease PD I 1. 105 59 sleep