Ask about REM sleep behavior disorder in every PD evaluation because enacted dreams that precede motor onset by a decade or more require prompt treatment with clonazepam or melatonin to prevent injury. When hallucinations appear, review the full medication list and reduce or stop the least effective dopaminergic agent first before adding an atypical antipsychotic.

They may also deal with REM sleep behavior disorder, periodic limb movements, restless legs syndrome, and vivid hallucinations; List is quite extensive, cases can experience akathisia, insomnia, highly fragmented sleep, and excessive daytime sleepiness; Depression is observed in up to two-thirds of these individuals, and when dementia does occur, a frontal-subcortical pattern is the most common presentation; This disorder is caused by a distinct loss of normal muscle atonia during REM sleep; Behaviorally and cognitively, cases may show bradyphrenia—which is a distinct slowing of mental processing—along with an impaired working memory, decreased attention, and poor initiation