Affiliations: Chulalongkorn Center of Excellence on Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand | Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, USA | Dipartimento di Scienze Neurologiche, Sapienza Universitá di Roma, Rome, Italy
Note:  Correspondence to: Roongroj Bhidayasiri, MD, FRCP, FRCPI, Chulalongkorn Center of Excellence on Parkinson's Disease & Related Disorders, Chulalongkorn University Hospital, 1873 Rama 4 Road, Bangkok 10330, Thailand. Tel.: +66 2 256 4627; Fax: +66 2 256 4630; E-mail: [email protected]
Abstract: Although nocturnal disturbances are increasingly recognized as an integral part of the continuum of daytime manifestations of Parkinson's disease (PD), there is still little evidence in the medical literature to support the occurrence of these complex phenomena in patients with atypical parkinsonian disorders (APDs). Based on the anatomical substrates in APDs, which are considered to be more extensive outside the basal ganglia than in PD, we might expect that patients with APDs encounter the whole range of nocturnal disturbances, including motor, sleep disorders, autonomic dysfunctions, and neuropsychiatric manifestations at a similar, or even greater, frequency than in PD. This article is a review of the current literature on the problems at nighttime of patients with progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, and dementia with Lewy bodies. MEDLINE, life science journals and online books were searched by querying appropriate key words. Reports were included if the studies were related to nocturnal manifestations in APDs. Forty articles fulfilled the selection criteria. Differences between these symptoms in APDs and PD are highlighted, given the evidence available about each manifestation. This analysis of nocturnal manifestations of APDs suggests the need for future studies to address these issues to improve the quality of life not only of patients with APDs but the caregivers who encounter the challenges of supporting these patients on a daily basis.
Keywords: Atypical parkinsonian disorders, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, dementia with lewy body, nocturnal manifestations, REM behavioral disorder, nocturia, nocturnal akinesia, hallucinations