Enacted dreams could be an early sign of Parkinson’s disease.
Alan Alda was running for his life. The actor, best known for his role on the television series M*A*S*H, wasn’t on a set. This threat was real—or at least it felt that way. So when he saw a bag of potatoes in front of him, he grabbed it and threw it at his attacker. Suddenly, the scene shifted. He was in his bedroom, having lurched out of sleep, and the sack of potatoes was a pillow he’d just chucked at his wife.
One of the most common RBD-linked ailments is Parkinson’s disease, characterized mainly by progressive loss of motor control. Another is Lewy body dementia, in which small clusters of α-synuclein called Lewy bodies build up in the brain, disrupting movement and cognition. A third type of synucleinopathy, multiple system atrophy, interferes with both movement and involuntary functions such as digestion.
Lifting the Brake Ray Merrell, a 66-year-old living in New Jersey, started acting out his dreams around 15 years ago. His dreamscapes became action-packed, like “something you’d watch on TV,” Merrell says. He often found himself either being chased by or chasing a person, animal or something else. In the real world, Merrell was flailing, kicking and jumping out of bed. Some of his violent nighttime behaviors injured him or his wife.
To test whether these bizarre behaviors may reflect damage to the brain stem, as in Jouvet’s cats, Schenck and his colleagues kept track of such patients to see whether they might develop a brain disease. In 1996 they reported that in a group of 29 RBD patients, all of whom were male and age 50 or older, 11 had developed neurodegenerative disease an average of 13 years after the onset of their RBD.
As an early manifestation of Parkinson’s and related diseases, RBD can help scientists trace the ways in which toxic synuclein spreads throughout the body and brain. Evidence is mounting that at least in some patients, pathology may begin in the gut and spread up through lower brain structures such as the brain stem to the higher regions influencing movement and cognition. One likely pathway is the vagus nerve, a bundle of nerve fibers connecting all the major organs with the brain.
Merrell, Alda and many other people with RBD often have dreams in which they face danger. In one study led by Arnulf, researchers found that among people with RBD, 60 percent reported dreams involving some kind of threat, and 75 percent confronted their attacker instead of running away. People who report more frequent distressing dreams are also at greater risk of developing Parkinson’s.
Findings such as these suggest that in people with RBD, movement is generated through a motor circuit that bypasses the basal ganglia. “This sort of shows that whatever’s going on in Parkinson’s disease in terms of your movement doesn’t apply to you when you’re asleep,” says Ronald Postuma, a professor of neurology at McGill University.
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