Objective: Assess the relation between dream content and non-motor symptoms in Parkinson’s disease (PD) and idiopathic REM sleep behavior disorder (iRBD).

Background: Although a link with psychosis, dopaminergics, cognitive function or RBD was proposed, the clinical significance of vivid dreams in PD remains debatable. Dream alteration was described as a core feature of iRBD, but recent work has challenged this.

Methods: Subjects: all non-demented PD and all iRBD patients attending a neurological outpatient clinic during one year period (excluding patients with < years 3 schooling); a group of non-affected control subjects. RBD diagnosis: REM sleep behavioral disorder questionnaire followed by video-polysomnography. Scales for non-motor symptom assessment: Parkinson’s disease Psychosis Scale (PPQ), Montreal Cognitive Assessment Scale, SCOPA-Sleep, Hospital Anxiety/Depression Scale, Apathy Scale. Dream assessment: dream reports were collected by the dream diary method and content was evaluated with the Hall and Van Castle system.

Results: A total of 205 dreams were collected, from 5 iRBD, 26 PD (7 with RBD) patients and 20 controls. Bodily misfortunes were significantly more frequent in each patient group than in the control group. Aggression and Physical Aggression were significantly more frequent in PD-RBD patients. Patients on clonazepam (n=4) had significantly lower Misfortune and Negative Emotion and higher Aggressor indexes. Misfortunes and Bodily Misfortunes indexes were significantly and negatively correlated with SCOPA Nighttime Disturbances and Physical Aggression, Friendliness, Good fortune, Failure, Sexuality and Negative emotions with PPQ delirium scores (positive correlations).

Conclusions: Patients dreams differed significantly from non-affected subjects, mainly in negative features. Clonazepam seems to exert a different influence on distinct dream features. Misfortunes and negative emotions occurred as a general feature of patients dreams and were negatively related to SCOPA Nighttime disturbance score, but dream aggressiveness was specifically linked with the presence of RBD and worse psychosis. While the former could be interpreted as negative influence of sleep fragmentation/shortening in dream complexity, the latter points to a relation between RBD, psychosis and dream aggressiveness, suggesting a common dysfunction of the limbic system.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-relation-between-dream-content-and-non-motor-symptoms-in-parkinsons-disease-and-idiopathic-rem-sleep-behavior-disorder/