Apathy in Parkinson's disease with REM sleep behavior disorder.

Bargiotas, Panagiotis; Ntafouli, Maria; Lachenmayer, Lenard; Krack, Paul; Schüpbach, Michael; Bassetti, Claudio (2019). Apathy in Parkinson's disease with REM sleep behavior disorder. Journal of the neurological sciences, 399, pp. 194-198. Elsevier 10.1016/j.jns.2019.02.028

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OBJECTIVES Rapid eye movement (REM) sleep behavior disorder (RBD) in patients with Parkinson's disease (PD) is associated with increased risk of non-motor symptoms. However, the association between RBD and apathy in PD remains unclear. AIMS To compare the prevalence and severity of apathy symptoms in PD patients with RBD (PD-RBD+) and without (PD-RBD-). In addition, we explored the association between apathy, depressive symptoms and RBD, taking into consideration the concomitant influence of demographic, disease- and therapy-associated variables. METHODS Sixty-four PD patients were evaluated with systematic motor (unified Parkinson's disease rating scale, UPDRS-III) and non-motor assessments. The diagnosis of RBD was based on the international consensus criteria using video-polysomnography. Apathy, sleepiness, depressive symptoms and cognitive performance were assessed using the Starkstein apathy (SAS, cut-off = 14), the Epworth sleepiness (ESS), the Hamilton depression (HAM-D, cut-off = 9) scales and the mini-mental state examination (MMSE), respectively. RESULTS Among 64 patients, 26 (40%) had RBD. In the PD-RBD+ group, apathy symptoms were more frequent (52% vs 42%) and more severe (14.3 ± 5.8 vs 11.2 ± 4.9, p < 0.05), especially in the females (17.3 ± 6.0 vs 11.4 ± 5.8 in males, p < 0.05) compared to the PD-RBD- group. A high percentage of patients, especially in the PD-RBD+ group (53%), had isolated apathy without increased depressive symptoms. Increased depressive symptoms were also more frequent (50% vs 20%) and more severe in the PD-RBD+ group. The two groups were comparable in respect to demographic and clinical characteristics. CONCLUSIONS In PD, RBD is associated with isolated apathy and increased severity of depressive symptoms, independent of medication, motor and other non-motor symptoms. Potential mechanisms underlying this association are discussed.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Bargiotas, Panagiotis; Ntafouli, Maria; Lachenmayer, Lenard; Krack, Paul; Schüpbach, Michael and Bassetti, Claudio


600 Technology > 610 Medicine & health








Chantal Kottler

Date Deposited:

14 Nov 2019 08:44

Last Modified:

14 Nov 2019 08:44

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Apathy Depression Mood disturbances Non-motor symptoms Parkinson's disease REM parasomnia REM sleep behavior disorder (RBD) Sleep-wake disturbances





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