INCIDENTAL LEWY-BODY DISEASE IN A PATIENT WITH REM-SLEEP BEHAVIOR DISORDER

We studied an 84-year-old man with a 20-year history of nocturnal violent behavior during sleep, but no other clinically evident neuropsychiatric disorders. Polysomnographic investigations confirmed that he suffered from REM sleep behavior disorder (RED). Histopathologic examination revealed that he had Lewy body disease with a marked decrease of pigmented neurons in the locus ceruleus and substantia nigra. These histologic findings represent the first documented evidence of a loss of brainstem monoaminergic neurons in clinically idiopathic RED and suggest that Lewy body disease might provide an explanation for idiopathic RED in the aged.