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We report longitudinal data on a group of 29 male patients 50 years of age or older who were initially diagnosed as having idiopathic REM sleep behavior disorder(RBD)after extensive polysomnographic and neurologic evaluations.RBD can be the heralding manifestation of Parkinson's disease in a substantial subgroup of older male RBD patients.However,a number of presumed Parkinson's disease patients may eventually be diagnosed with multiple system atrophy(striatonigram degeneration subtype).Our findings indicate the importance of serial neurologic evaluations after RBD is diagnosed and implicate the pedunculopontine nucleus as a likely site of pathology in combined RBD-Parkinson's disease based on experimental and theoretical considerations rather than on autopsy data. |
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