Alan Alda Reveals Unusual Early Symptom of Parkinson's Disease

Actor Alan Alda revealed that his initial symptom of Parkinson's disease was not the more commonly known tremors or stiffness, but rather acting out his dreams, a condition known as REM Sleep Behavior Disorder (RBD).

Alda, 90, shared in an interview with CBS Sunday Morning that this sleep-related symptom was his first indication of the neurodegenerative disease. "I had a symptom, which at the time was not that well-known: Acting out your dreams," he stated.

REM Sleep Behavior Disorder occurs during the rapid eye movement (REM) stage of sleep, a phase characterized by vivid dreams. Typically, the body is paralyzed during REM sleep to prevent physical movement. However, in cases of RBD, this paralysis mechanism is impaired, allowing individuals to physically enact their dreams. Alda recounted an experience where he dreamed someone was attacking him and he threw a pillow at his wife, Arlene.

This condition is often linked to Parkinson's and other neurological disorders due to the buildup of alpha-synuclein protein in the brain, which can damage the brainstem area responsible for muscle control. While not everyone with RBD develops Parkinson's, the disorder is considered a risk factor that can manifest years before a formal diagnosis.

Alda was diagnosed with Parkinson's disease in 2015. He has also previously spoken about experiencing prosopagnosia, also known as face blindness. He is one of over 1.1 million people in the U.S. affected by Parkinson's disease, a condition whose risk increases with age.

RBD can be categorized into two types: symptomatic (secondary), which stems from an underlying cause, and isolated (idiopathic). Isolated RBD develops without a clear cause and can eventually lead to neurodegenerative conditions like Lewy body dementia, multiple system atrophy, or Parkinson's. Studies indicate a significant progression from RBD diagnosis to neurodegenerative conditions over time, with rates reaching 33% after five years, 76% after 10 years, and 91% after 14 years.

Additional risk factors for RBD include being male, over the age of 50, having narcolepsy, and taking certain medications, such as newer antidepressants. It is estimated to affect about 2% of the U.S. population over 50, though actual rates may be higher due to diagnostic challenges.

Diagnosing RBD typically involves discussions about sleep behaviors with a healthcare provider and often includes a polysomnogram, an overnight sleep study monitoring heart rate, brain waves, eye movements, and muscle activity. A definitive diagnosis requires evidence of repeated vocalizations or complex movements during REM sleep, the absence of seizures, and the exclusion of other medical, mental health, or medication-related causes.

Safety precautions for individuals with RBD can include securing the sleeping environment by removing sharp objects, using pillows to cushion the bed area, placing the mattress on the floor, and using a sleeping bag. While there are no FDA-approved medications specifically for RBD, treatments such as melatonin, clonazepam, and pramipexole have shown efficacy in reducing symptoms.