Abstract
BACKGROUND: Dream content alterations in Parkinson's disease (PD) are associated with motor and cognitive dysfunction cross-sectionally. Although recent studies suggest abnormal dream content in PD might also predict cognitive decline, the relationship between dream content and motor decline in PD remains unknown. OBJECTIVE: To investigate whether abnormal dream content in PD predicts both motor and cognitive decline. METHODS: Data were obtained from the Parkinson's Progression Markers Initiative cohort study. Patients were evaluated at baseline and at the 60-month follow-up, with validated clinical scales, including the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), Montreal Cognitive Assessment (MoCA), and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III). Patients were dichotomized using RBDSQ item 2, which inquires whether they frequently experience aggression in their dreams. Regression analyses were used to assess whether frequent aggressive dreams at baseline predicted longitudinal changes in MDS-UPDRS III and MoCA scores as well as progression to Hoehn and Yahr stage 3 (H&Y ≥ 3) and cognitive impairment. RESULTS: Of the patients, 58/224 (25.9%) reported frequent aggressive dreams at baseline. Aggressive dreams predicted a faster increase in MDS-UPDRS III scores (β = 4.64; P = 0.007) and a faster decrease in MoCA scores (β = -1.49; P = 0.001). Furthermore, they conferred a 6-fold and 2-fold risk for progressing to H&Y ≥ 3 (odds ratio [OR] = 5.82; P = 0.005) and cognitive impairment (OR, 2.35; P = 0.023) within 60 months. These associations remained robust when adjusting for potential confounders. CONCLUSIONS: This study demonstrates for the first time that frequent aggressive dreams in newly diagnosed PD may independently predict early motor and cognitive decline.