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Dopaminergic Syndromes of Sleep, Mood and Mentation: Evidence from Parkinson�s Disease and Related Disorders
Patrick McNamara Ph.D, Raymon Durso M.D, Sanford Auerbach M.D
We reviewed sleep and dream-related clinical symptoms in a set of four neurologic
disorders (Parkinson�s Disease, REM Behavior Disorder, Narcolepsy and Depression)
characterized by severe reductions in dopaminergic function. Sleep findings included
excessive daytime sleepiness (EDS), increased rapid eye movement sleep times (REM%),
increased REM density or bursts of REMs, reduced REM latency periods, and sleep onset
REM (SOREM). Clinical symptoms included perseverative or rigid thinking and personality
styles, frontal lobe impairment, increased complaints of, or vulnerability to negative
affect, and increased vivid and unpleasant dreams. The increased vulnerability to
unpleasant dreams was particularly interesting as descriptions of dream content were
strikingly similar across all 4 disorders. Dreams of feeling threatened or being attacked by
animals or dangerous creatures were very frequent. We hypothesize that the cluster of
sleep, dream and cognitive changes associated with these four disorders can be
explained by assuming that lowered dopaminergic tone leads to a disinhibition of REM
physiology and amygdalar activity and that this disinhibition of REM and amygdalar
function yields unpleasant dreams, negative affect, and frontal lobe impairment. Careful
study of the cluster of co-occurring symptoms identified here may illuminate 1) the ways
in which dopamine might function in regulation of sleep states, and 2) aspects of the
neurology of dream content. (Sleep and Hypnosis 2002;4(4):119-131)
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