Parkinson's disease and sleep: from biomarkers to clinical stratification

Abstract

Introduction: The study described Parkinson's disease (PD) as a multisystemic neurodegenerative process whose diagnosis had shifted from a clinical approach to one supported by biomarkers and imaging. It noted that nigrostriatal dopaminergic degeneration, α-synuclein aggregation and propagation, and neuroinflammation explained the TRAP motor phenotype and a broad spectrum of non-motor symptoms. It emphasized that sleep disorders (SD), especially REM sleep behavior disorder (RSBD) and hyposmia, acted as early markers with prodromal relevance.
Development: The study integrated evidence from pathophysiology, diagnosis, and clinical manifestations. It showed that, in the early stages, dopaminergic involvement manifested as an asymmetric striatal pattern (greater damage in the posterior putamen and relative preservation of the caudate). It documented that SDs—insomnia, obstructive sleep apnea, excessive daytime sleepiness, restless legs syndrome, and RSDS—achieved high prevalences and were associated with cognitive impairment, falls, and poorer quality of life. He noted that polysomnography provided objective confirmation of RLS, OSA, and periodic leg movements, while standardized scales facilitated screening and follow-up when resources were limited.
He also highlighted the contribution of psychiatric and autonomic comorbidities (nocturia, bladder dysfunction) and the impact of drugs on sleep architecture.
Conclusions: The study concluded that systematically incorporating the screening for TS and other non-motor symptoms into longitudinal neurological assessment enabled early detection, risk stratification, and individualized treatment. It proposed a multidisciplinary approach combining dopaminergic optimization, specific sleep interventions, management of comorbidities, and caregiver education. Finally, it prioritized the validation of multimodal biomarkers and the exploration of modifying therapies targeting neuroinflammation and proteostasis to intervene earlier and more effectively on the course of PD.