title: Rapid eye movement sleep behavior disorder: a window on the emotional world of Parkinson disease.
abstract: OBJECTIVE
  REM sleep behavior disorder (RBD) is a parasomnia characterized by motor activity during sleep with dream mentation. Aggressiveness has been considered a peculiar feature of dreams associated with RBD, despite normal score in aggressiveness scales during wakefulness. We aimed to measure daytime aggressiveness and analyze dream contents in a population of patients with Parkinson disease (PD) with and without RBD.
  
  
  METHODS
  This is a single-center prospective observational study; it concerns the description of the clinical features of a medical disorder in a case series.
  
  
  METHODS
  The study was performed in the Department of Neurosciences of the Catholic University in Rome, Italy.
  
  
  METHODS
  Three groups of subjects were enrolled: patients with PD plus RBD, patients with PD without RBD, and healthy controls.
  
  
  METHODS
  The diagnosis of RBD was determined clinically and confirmed by means of overnight, laboratory-based video-polysomnography. For the evaluation of diurnal aggressiveness, the Buss-Perry Aggression Questionnaire (BPAQ) was used. The content of dreams was evaluated by means of the methods of Hall and Van De Castle.
  
  
  RESULTS
  Patients with PD without RBD displayed higher levels of anger, and verbal and physical aggressiveness than patients with PD and RBD and controls. Patients with PD and RBD and controls did not differ in hostility.
  
  
  CONCLUSIONS
  It can be hypothesized that a noradrenergic impairment at the level of the locus coeruleus could, at the same time, explain the presence of RBD, as well as the reduction of diurnal aggressiveness. This finding also suggests a role for REM sleep in regulating homeostasis of emotional brain function.
authors.affiliation: Unit of Child Neuropsychiatry, Catholic University, Rome, Italy.|International Psychoanalytical Association and Italian Psychoanalytical Association.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mariotti
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Quaranta
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Di Giacopo
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Bentivoglio
authors.affiliation: Institute of Psychiatry, Catholic University, Rome, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Mazza
authors.affiliation: Institute of Psychiatry, Catholic University, Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Martini
authors.affiliation: International Psychoanalytical Association and Italian Psychoanalytical Association.
authors.forename: Jorge
authors.initials: J
authors.lastname: Canestri
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Della Marca
mesh_terms: D000368:Aged; D000374:Aggression / Q000523:psychology; D016022:Case-Control Studies; D004325:Dreams / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D007558:Italy; D008125:Locus Coeruleus / Q000503:physiopathology; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D017286:Polysomnography; D011446:Prospective Studies; D020187:REM Sleep Behavior Disorder / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D012895:Sleep, REM / Q000502:physiology; D011795:Surveys and Questionnaires
keywords: Parkinson Disease; REM Behavior Disorder; aggressiveness; dreams; sleep