Excessive daytime sleepiness, hallucinations and REM sleep behavior disorder are symptoms reported in both dementia with Lewy bodies (DLB) and narcolepsy. Considering the demonstration of low hypocretin-1/orexin A levels in the cerebrospinal fluid (CSF) of most patients with narcolepsy, we hypothesized the presence of a deficient hypocretinergic transmission in DLB. Hypocretin-1 was tested in the CSF of 10 DLB patients. Levels were found to be in the normal range (mean 521 pg/ml, range 382–667) when compared to controls (n = 20, mean 497 pg/ml, range 350–603) and Alzheimer’s disease patients (n = 7, mean 474 pg/ml, range 333–564). In DLB, excessive daytime sleepiness, hallucinations and REM sleep behavior may occur in the absence of a detectable hypocretin deficiency.

1.
McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, et al: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB international workshop. Neurology 1996;47:1113–1124.
2.
McKeith IG, Perry EK, Perry RH: Report on the second dementia with Lewy body international workshop: Diagnosis and treatment. Consortium on Dementia with Lewy bodies. Neurology 1999;53:902–905.
3.
Nishino N, Ripley B, Overeem S, Lammers GJ, Mignot E: Hypocretin (orexin) deficiency in human narcolepsy. Lancet 2000;355:39–40.
4.
Ripley B, Overeem N, Fujiki N, Nevsimalova S, Uchino M, Yesavage J, et al: CSF hypocretin/orexin levels in narcolepsy and other neurological conditions. Neurology 2001;57:2253–2258.
5.
Dauvilliers Y, Baumann CR, Carlander B, Bischof M, Blatter T, Lecendreux M, Maly F, Besset A, Touchon J, Billiard M, Tafti N, Bassetti CL: CSF hypocretin-1 levels in narcolepsy, Kleine-Levin syndrome and other hypersomnia and neurological conditions. J Neurol Neurochir Psychiatry 2003;74:1667–1673.
6.
American Sleep Disorders Association: International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Rochester, American Sleep Disorders Association, 1997, pp 177–180.
7.
Baumann CR, Maly F, Probst E, Bischof M, Bassetti CL: CSF orexin A (hypocretin-1) levels in sleep and neurological disorders. Neurology 2003;60(suppl 1):A34.
8.
Overeem S, van Hilten JJ, Ripley B, Mignot E, Nishino S, Lammers GJ: Normal hypocretin-1 levels in Parkinson’s disease patients with excessive daytime sleepiness. Neurology 2002;58:498–499.
9.
Dronot X, Moutereau S, Nguyen JP, et al: Low levels of ventricular CSF orexin/hypocretin in advanced PD. Neurology 2003;61:540–543.
10.
Hajak G, Geisler P: Orchestrating sleep-wake functions in the brain. Nat Med 2003;9:170–171.
11.
Kanbayashi T, Yano T, Ishiguro H, Kawanishi K, Chiba S, Aizawa R, Sawaishi Y, Hirota K, Nishino S, Shimizu T: Hypocretin-1 (orexin-A) levels in human lumbar CSF in different age groups: Infants to elderly persons. Sleep 2002;25:337–339.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.