Acting out dreams during sleep may indicate Parkinson’s disease

We’ve all had the experience of making our dreams come true, but this can be a harbinger of dreaded neurological conditions. Actor Alan Alda, best known for his role in the comedy-drama television series M*A*S*H*, thought he was threatened while he slept and threw a sack of potatoes at the attacker. When he woke up, he was in his bedroom and the sack of potatoes turned out to be a pillow he had thrown at his wife. Such a frightening experience could indicate a brain-related disorder, such as Parkinson’s disease, which Alda turned out to be.

According to Scientific American, dream actuation marks a disorder that occurs during the rapid eye movement (REM) phase of sleep. The disorder, called REM sleep behavior disorder (RBD), is estimated to affect 0.5 to 1.25% of the population. It is more common in men and older adults and may indicate a neurodegenerative disease, usually one in which the protein alpha-synuclein forms toxic clumps in the brain. This is called synucleinopathy.

RBD can also be caused by certain medications, such as antidepressants, or caused by other underlying conditions, such as narcolepsy or a brainstem tumor. Sleepwalking and sleep talking are not behaviors associated with RBD.

When RBD occurs without these alternative explanations, the likelihood of future brain disease is high, says Scientific American. Some experts say that when dreams come true, there is a greater than 80% chance of developing a neurodegenerative disease, specifically Parkinson’s, which is characterized by progressive loss of motor control. RBD can also be the first sign of other degenerative diseases, including Lewy body dementia and multiple system atrophy.

But many clinicians are not familiar with the connection between dreams and illness. Alda had to convince his neurologist to do a brain scan for Parkinson’s after reading about the link in a 2015 news article. His scans confirmed his suspicion and the actor shared his experience with the public to warn others.

“I thought that anyone who has symptoms, even if not one of the usual ones, could get a head start on dealing with the progressive nature of the disease,” he says. “The sooner you attack it, I think, the more likely you are to hold back the symptoms.”

Dr. Daniela Berg, a neurologist at Christian-Albrechts-University in Germany, says RBD is “one of the strongest clinical prodromal markers we have” for predicting Parkinson’s disease. Scientists say understanding RBD could help them track the ways alpha-synuclein spreads throughout the body and brain. In some patients, there is evidence that the pathology begins in the gut and spreads through lower brain structures, such as the brainstem, to the higher regions that control movement and cognition. The most likely route is through the vagus nerve, and at least one study has shown that cutting the vagus nerve, a treatment used for stomach ulcers, can reduce the risk of Parkinson’s disease later in life, says Scientific American.

Alda, 86, says he is “doing everything he can to slow the progression of Parkinson’s.” According to People, he sports, plays chess with his wife, and eats his favorite TV show. “I am more convinced than ever that life is adapting, adjusting and revising,” he says.

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