Targeting sleep and the circadian system as a novel treatment strategy for Parkinson’s disease

There is a growing appreciation of the wide range of sleep–wake disturbances that occur frequently in Parkinson’s disease. These are known to be associated with a range of motor and non-motor symptoms and significantly impact not only on the quality of life of the patient, but also on their bed part...

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Bibliographic Details
Published in:Journal of neurology 2024-03, Vol.271 (3), p.1483-1491
Main Authors: Feigl, Beatrix, Lewis, Simon J. G., Rawashdeh, Oliver
Format: Article
Language:English
Subjects:
Brain research
Circadian rhythm
Circadian Rhythm - physiology
Circadian rhythms
Disorders of Excessive Somnolence - etiology
Humans
Light
Medicine
Medicine & Public Health
Melatonin
Movement disorders
Neural networks
Neurodegeneration
Neurodegenerative diseases
Neurological Update
Neurology
Neuropathology
Neuroradiology
Neurosciences
Orexins
Pacemakers
Parkinson Disease - complications
Parkinson Disease - diagnosis
Parkinson Disease - therapy
Parkinson's disease
Photoreceptors
Precision medicine
Quality of Life
Sleep
Sleep - physiology
Sleep and wakefulness
Sleep Initiation and Maintenance Disorders
Sleep Wake Disorders - etiology
Sleep Wake Disorders - therapy
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Summary:There is a growing appreciation of the wide range of sleep–wake disturbances that occur frequently in Parkinson’s disease. These are known to be associated with a range of motor and non-motor symptoms and significantly impact not only on the quality of life of the patient, but also on their bed partner. The underlying causes for fragmented sleep and daytime somnolence are no doubt multifactorial but there is clear evidence for circadian disruption in Parkinson’s disease. This appears to be occurring not only as a result of the neuropathological changes that occur across a distributed neural network, but even down to the cellular level. Such observations indicate that circadian changes may in fact be a driver of neurodegeneration, as well as a cause for some of the sleep–wake symptoms observed in Parkinson’s disease. Thus, efforts are now required to evaluate approaches including the prescription of precision medicine to modulate photoreceptor activation ratios that reflect daylight inputs to the circadian pacemaker, the use of small molecules to target clock genes, the manipulation of orexin pathways that could help restore the circadian system, to offer novel symptomatic and novel disease modifying strategies.
ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-023-12073-7