I chronic di seases
Patient’s Predisposed To Parkinson’s And Alzheimer’s Disease
By Leonard Feld
Although their genetic underpinnings differ, Alzheimer’s disease, Parkinson’s disease and Huntington’s disease are all characterized by the untimely death of brain cells. What triggers cell death in the brain?1 American neurologists and sleep experts suggest in a recent study that rapid eye movement (REM) sleep behav- ior disorder could be an early sign of Parkinson’s disease or dementia that de- velops 25 to 50 years later.2
Neurologist and Sleep specialist Dr. Bradley F. Boeve and colleagues from the Mayo Clinic College of Medicine, Rochester, Minnesota arrived at their findings in a paper published in the jour- nal Neurology on July 28, 2010. REM typically happens several times during a night’s sleep, and normally during REM nearly every muscle is paralyzed and our bodies lie still. Boeve, who is also a mem- ber of the American Academy of Neurol- ogy, told the press that: “Our findings suggest that in some patients, conditions such as Parkinson’s disease or dementia with Lewy bodies have a very long span of activity within the brain and they also may have a long period of time where other symptoms aren’t apparent”. 2
The REM disorder is much more com- mon in men than women and usually starts in the middle age or later, although younger people can have it too. For their study, Boeve and colleagues searched pa- tients records held at the Mayo Clinic and identified 27 patients registered from 2002 to 2006 who experienced REM and sleep behavior disorder for at least 15 years before developing one of three neu- rological conditions: Parkinson’s disease, dementia with Lewy bodies or multiple system atrophy (a disorder with symp-
velop therapies that would slow down or stop the progression of these disorders years before the symptoms of Parkinson’s disease or dementia appear”. Scientist can’t say how many people who experi- ence REM sleep behavior disorder will go on to develop neurological diseases like Parkinson’s or dementia. Not all patients with REM and sleep disorders have the aforementioned diseases. However, be- tween 74% and 100% of the patients studied have REM and sleep disorders.
toms similar to Parkinson’s). All the pa- tients were examined by specialist in sleep medicine to confirm REM sleep be- havior disorder and neurologists to con- firm the later disease symptoms. 13 of the patients developed dementia, 13 de- veloped Parkinson’s and one developed multiple system atrophy.2
The researchers found that the median interval between onset of REM sleep be- havior disorder and the neurological dis- ease symptoms was 25 years and ranged up to 50 years. 100% of the affected pa- tients had sleep and REM disorders. “At most recent follow-up, 63% of patients progressed to develop dementia [Parkin- son’s disease or dementia with Lewy bod- ies]. Associated autonomic dysfunction was confirmed in 74% of all patients.”
According to the National Institute of Neurological Disorders and Stroke, about 40 million people in the United States suffer from chronic long-term sleep dis- orders. Sleep Disorder Breathing (SDB) is caused by a structural problem in the nasal passage or oral airway that hinders respiration during sleep and a lack of oxygen. This structural problem is re- ferred to as Temporal Mandibular Joint Dysfunction (TMJD). A nasal obstruction can be the results of swollen tonsils or adenoids, allergies, inflamed sinus mem-
branes, and anatomically small airway, or a combination thereof. An oral airway obstruction occurs because of malocclu- sion, bite problems, obesity, a hormonal imbalance/deficiency, your tongue being too far back because of poor jaw align- ment (TMJD) or a combination thereof.
If the structural problem has its roots in the nasal passages, such as allergies or swollen sinuses, it is imperative to con- sult with an otolaryngologist (E.N.T spe- cialist). Otherwise, the oral airway must be examined. A normal airway remains patent during sleep. Normally the airway retains its muscle tone even if the airway is completely relaxed. When a person suffering from SDB falls asleep, the mus- cles in the airway relax, but then partially or fully collapse in on one another as the individual breathes in and out. The sounds of snoring that a bed partner may hear are the result of pharyngeal tissues vibrating against one another or because of the tongue being too far back. To suf- ficiently oxygenate the body, the air must force its way through the airway, which may be partially or fully ob- structed due to the loss of an open airway and a lack of oxygen to the brain.
Sleep disorders may be defined as those that disturb, disrupt or fragment quality, restful REM and refreshing sleep. Despite the attention being accorded to sleep today, it has been reported that only ap- proximately 10% of patients with clini- cally deficient sleep syndromes have been recognized.3
Among them are: • 80% of all patients with uncontrolled high blood pressure4 • 60% of all stroke patients5 • 50% of all congestive heart failure pa- tients6 • 30% of all patients with coronary artery disease7
Approximately one-third of the US pop- ulation suffers from sleep disorders8 such as: snoring, Upper Airway Resistance Syn- drome (UARS), Obstructive Sleep Apnea (OSA), sleep bruxism or clenching and REM disorders.9
Diagnosis- Polysomnography is the uni- versally accepted standard of care in di- agnosing OSA. Home sleep testing has recently been approved as an option to qualify a patient for insurance coverage. Dental signs: wearing of teeth, abfrac- tions, scalloped tongue, high vaulted palate, narrow dental arches, deep over- bite, open bite, large overjet, bony growths called tori or exostosis, missing or replaced posterior teeth with crowns, bridge or root canals and abnormalities in the upper airway.
“More research is needed on this possible link so that scientist may be able to de-
Summary The clinical consequences of untreated sleep disorders are devastating. Serious medical conditions including (but not limited to) high blood pressure, heart at- tacks, stroke, ADHD, sexual dysfunction, decreased mental functions, car acci- dents, growth retardation in children, crowded or mal-aligned teeth (too small of a mouth or no room for the teeth) all can lead to a decreased quality of life. In the majority of cases, sleep disorders can be diagnosed and managed by qualified practitioners. According to the American Academy of Sleep Medicine and Sleep Medicine Dentistry, dentist who have post graduate education are first in the line of defense against SDB by diagnos- ing patients’ dental structures. Patients are best served by having their primary care physician work together with a qual- ified dental practitioner to properly diag- nose and treat SDB. An editorial comment in the same issue of the jour- nal pointed out there is no evidence that people who experience narcolepsy (eg feeling extremely fatigued and falling asleep unexpectedly several times a day) with or without REM sleep behavior dis- order, will later develop neurodegenera- tive disease.1
Dr. Leonard J. Feld can be contacted at 760- 341-2873. If you would like more informa- tion, you are invited to attend a complimentary medical seminar on the first Thursday of each month from 10 - 11am at 74-976 HWY 11, Indian Wells (Across from Ralph’s Shopping Center).
References 1. Original paper: Nakamura T, Wang L, et.al
.: Transnitrosylation of XIAP regulates caspase- dependent neuronal cell death. Molecular Cell. Published online Jule 30, 2010. 2. “REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century.” D.O. Claassen, K.A. Josephs, J.E., Ahlskog, M.H. Silber, M. Tippmann-Peikert, and B.F. Boeve. Neurology July 29, 2010. 3. Young T, Evans L, Finn L, et.al
.: Estima- tion of the clinically diagnosed proportion of sleep apnea syndrome in middle aged men and women. Sleep 1997; 20:705-706. 4. Logan AG, et.al
.: High prevalence of un- recognized sleep apnea in drug-resistant hy- pertension.
2001;19(12):2271-2277. 5. Basetti C, Alrich MS: Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 1999; 22(2):217-223. 6. Javaheri S, et.al
.: Sleep apnea in 81 ambu- latory male patients with stable heart fail- ure. Circulation 1998; 97:2154-2159. 7. Schafer H, Koehler U, Ewing S, et.al
.: Ob- structive sleep apnea as a risk marker in coronary artery disease. Cardiology 1999; 92(2):78-84. 8. Fairbanks NF, Mickelson SA and Wood- son BT. Snoring and obstructive sleep apnea. Philadelphia: Lippincott Williams & Wilkins, 2003l; 10. 9. Young T, Palta M, Dempsey J, et. al.: The Occurrence of sleep-disordered breathing.
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