“ASK THE DOCTOR” with Dr. Rebecca Gilbert
Q. What recommendations do you have for someone acting out vivid dreams (rolling out of bed, punching, kicking) during the night?
A. This sounds like REM sleep behavior disorder (RBD), in which a person acts out their dreams. This is a common non-motor symptom of Parkinson’s disease (PD) and sometimes predates other symptoms. Unless the acting out causes injury to the person or their bed partner, the actual behaviors do not have to be stopped. They are perceived by the person as part of a dream. Non-pharmacological options are: making sure the person is safe with bed rails, moving the mattress to the floor, moving the bed against the wall, separating the person and their bed partner, etc. If medication is required, some practitioners will prescribe melatonin or clonazepam. Talk with your neurologist about these options.
Q. Does PD ever progress quickly? In the last month, my father’s Parkinson’s symptoms have gotten much worse.
A. It is unusual for a decline in PD to be rapid. Typically, when a decline is rapid, another cause can be identified. Has your father had any new medications added or dosage changes of any kind? (Sometimes medications for urination can cause hallucinations, for example.) Could he have a urinary tract infection or other type of infection? Perhaps there is a medical illness brewing that is not an infection. Did he recently have a fall, and would brain imaging be reasonable to see if he has any injury? Is he constipated/impacted with stool? (I have seen this cause agitation.) These are all things that I would talk over with your father’s doctors in order to determine a possible cause for his increased symptoms.
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Dr. Rebecca Gilbert is the Chief Scientific Officer at APDA. She oversees APDA’s research portfolio in conjunction with APDA’s Scientific Advisory Board. She also provides medical and clinical expertise to support APDA programming as well as print and web content.