Normally, rapid eye movement (REM) sleep is associated with dreams and physiologic muscle atonia—aka paralysis. But in patients with REM sleep behaviour disorder (RBD), the normal suppression of motor activity is lost, leading people to move in response to their dreams; this so-called “dream enactment behaviour” can often be violent.
The vast majority of patients with RBD eventually demonstrate signs and symptoms of Parkinson’s disease or a related disorder, often after a prolonged interval. In one study, the risk rose by about 6% each year, with three-quarters of participants converting within 12 years. Even in cases that appear not to follow that progression, imaging and autopsy studies often demonstrate changes otherwise associated with Parkinsonism.
There is no known treatment to prevent the onset or progression of Parkinson’s.
*****
“He turned 50 last week. This has happened now three times in the last year.”
She sighs. The bruise on her cheek is fading. She leans in and adds, “I don’t feel safe in bed with him. He kicks and punches. He yells. It’s 3:00 a.m. This is not him. He seems confused, goes back to sleep. Last time he nearly fell out of bed.”
“I can remember them attacking me,” he offers, somehow apologetically.
An anxious warmth rises in my belly, my face.
Chances are, he will have Parkinson’s disease within 10 years.
Would I want to know?
Where is the line between kindness and truth?
If I have this knowledge, do I disrespect him by not sharing it?
When one makes the pilgrimage to Delphi, one prepares to hear whatever answer may come.
I take a deep breath.
Ross Carne
Malvern East, Victoria, Australia