![]() ![]() In RBD, the motor atonia is lost, resulting in dream enactment behaviors (DEB) which range from verbal outbursts or simple movements to complex and sometimes violent motor phenomena that can lead to injuries to the patient or the patient’s bed partner. This normal skeletal muscle paralysis serves a protective purpose by preventing the expression of complex manifestations of movements during dreams in REM sleep. REM sleep, which is particularly associated with dreaming, is characterized physiologically by rapid eye movements, mixed frequency electroencephalographic rhythm, dreaming, and muscle atonia. We then provide possible clinical scenarios highlighting the controversy. Herein, we review RBD, the controversy surrounding disclosure of neurodegenerative disease risk, and methods by which disclosure may be performed. Yet many are struggling with the expectation of disclosing the diagnosis of RBD, especially when to disclose the risk of developing a neurodegenerative disease, to whom to disclose this risk, and how much to disclose. Clinicians, particularly neurologists and sleep clinicians, are familiar with the risk of “phenoconversion” (a transformation over time) from having a diagnosis of isolated REM sleep behavior disorder (iRBD) alone to RBD with the development of clinical manifestations of neurodegenerative disease. While RBD remains highly predictive of neuronal degeneration, no disease modifying strategies currently exist. ![]() Examples include Parkinson’s disease (PD), PD with dementia, dementia with Lewy bodies (DLB), which is the third most common cause of dementia worldwide, and multiple system atrophy. One such population at risk for dementia is composed of people with rapid eye movement (REM) sleep behavior disorder (RBD), a condition that is a prodrome for neurodegenerative disease, particularly α-synucleinopathies, which are characterized by an abnormal accumulation of aggregates of α-synuclein protein in the neurons or glia. Given the high cost of care and lack of available disease preventative strategies, there is an urgent need to identify modifiable risk factors and identify people at risk-prior to disease onset-as disease modifying therapies may be most effective in earlier stages of the diseases. By 2050, this number is expected to increase to a staggering 132 million worldwide and nearly 14 million in the USA. Worldwide, nearly 50 million people have dementia with more than 5 million in the USA. Discussion should occur early to give patients time to prepare for the future and consider participating in research. If so, disclosure should be patient centered, focusing on what might happen. Patients should be asked if they want to know about future risks. We provide an approach to risk disclosure for patients with iRBD. Although there are few data on disclosure in iRBD, evidence from discussing risk in other diseases with dementia provides some guidance. Balancing the relevant ethical principles of beneficence, nonmaleficence, and autonomy is challenging. Neurodegeneration risk disclosure in iRBD is controversial because of a long latency to disease onset and a lack of preventative strategies. Herein, we summarize this controversy and provide guidance on disclosure. Our staff will contact your insurance and provide proper documents for approval prior to your sleep study.People with isolated REM (rapid eye movement) sleep behavior disorder (iRBD) have a high lifetime risk of developing a neurodegenerative disease, including dementia, but disclosure of this risk remains controversial. Insurance companies will usually cover a sleep study if properly indicated. Sleep walking and sleep terror (parasomnias)Īn overnight sleep study will provide a large amount of information that will add to your medical profile and help the sleep specialist make the proper diagnosis and initiate proper therapy.Sleep-related, disordered breathing such as sleep apnea. ![]() Often when the sleep disorder is alleviated, other ailments are cured or become much easier to treat. These types of disorders have been linked to physical, emotional, and psychological problems including hypertension, diabetes, obesity, impotence, and depression. Offering professional help and treatment for people with sleep disorders. * Contact your Primary Care Provider or give us a call to set up an appointment * ![]()
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