Motor Dysfunction in REM Sleep Behavior Disorder: A Rehabilitation Framework for Prodromal Synucleinopathy

Rebekah L.S. Summers, Miriam R. Rafferty, Michael J. Howell, Colum D. MacKinnon

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Parkinson disease (PD) and other related diseases with α-synuclein pathology are associated with a long prodromal or preclinical stage of disease. Predictive models based on diagnosis of idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) make it possible to identify people in the prodromal stage of synucleinopathy who have a high probability of future disease and provide an opportunity to implement neuroprotective therapies. However, rehabilitation providers may be unaware of iRBD and the motor abnormalities that indicate early motor system dysfunction related to α-synuclein pathology. Furthermore, there is no existing rehabilitation framework to guide early interventions for people with iRBD. The purpose of this work is to (1) review extrapyramidal signs of motor system dysfunction in people with iRBD and (2) propose a framework for early protective or preventive therapies in prodromal synucleinopathy using iRBD as a predictive marker. Longitudinal and cross-sectional studies indicate that the earliest emerging motor deficits in iRBD are bradykinesia, deficits performing activities of daily living, and abnormalities in speech, gait, and posture. These deficits may emerge up to 12 years before a diagnosis of synucleinopathy. The proposed rehabilitation framework for iRBD includes early exercise-based interventions of aerobic exercise, progressive resistance training, and multimodal exercise with rehabilitation consultations to address exercise prescription, progression, and monitoring. This rehabilitation framework may be used to implement neuroprotective, multidisciplinary, and proactive clinical care in people with a high likelihood of conversion to PD, dementia with Lewy bodies, or multiple systems atrophy.

Original languageEnglish (US)
Pages (from-to)611-621
Number of pages11
JournalNeurorehabilitation and Neural Repair
Volume35
Issue number7
Early online dateMay 12 2021
DOIs
StatePublished - Jul 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grants TL1R002493 and UL1TR002494, and the National Institutes of Health’s National Insitute of Neurological Disorders and Stroke Grant RO1 NS088679.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institutes of Health?s National Center for Advancing Translational Sciences, Grants TL1R002493 and UL1TR002494, and the National Institutes of Health?s National Insitute of Neurological Disorders and Stroke Grant RO1 NS088679.

Publisher Copyright:
© The Author(s) 2021.

Keywords

  • Parkinson disease
  • exercise
  • prodromal
  • rehabilitation
  • sleep disorders
  • α-synuclein

PubMed: MeSH publication types

  • Journal Article
  • Review

Fingerprint

Dive into the research topics of 'Motor Dysfunction in REM Sleep Behavior Disorder: A Rehabilitation Framework for Prodromal Synucleinopathy'. Together they form a unique fingerprint.

Cite this