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Sleep Disorders and RBD: What Would James Parkinson Think?

Except for some brief descriptions of nonmotor abnormalities like constipation, James Parkinson mainly described a motor syndrome. Ever since, Parkinson’s disease (PD) has been defined by its primary motor manifestations. Even today, it is the core of our diagnosis of clinical PD. Over 200 years, our focus on motor symptoms has led to remarkable successes in developing symptomatic dopaminergic therapy. Now, with levodopa, long-acting dopaminergic medications, skin/intestinal delivery systems, and functional neurosurgery, dopaminergic deficit is among the bestmanaged problems in PD. Especially over the last 40 years, one of the most remarkable advances in PD was the recognition that PD is much more than a motor syndrome, that it has an extremely broad and variable nonmotor profile. It is now clear that for most patients, the nonmotor symptoms, including sleep abnormalities, will eventually become the most disabling ones. James Parkinson actually did make one mention of sleep, when he wrote: