Weighing the Duty to Inform a Patient of Possible Future Illness
2008
Virtual Mentor
Mr. Watts went to see Dr. Pass, a specialist in sleep disorders, because of his history of violent behavior during sleep. Although Mr. Watts didn't have any complaints, his wife was extremely frightened by the episodes of shouting, kicking, and punching that would occur while her husband was sleeping, usually in the early morning hours. After conducting a thorough history and physical exam, Dr. Pass was certain that the diagnosis was idiopathic REM sleep behavior disorder. Although Mr. Watts
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... always been healthy, Dr. Pass had seen in the literature that, with this diagnosis, Mr. Watts-now 58 years old-had a significant chance of developing a neurodegenerative disease within the next 10-15 years. He wondered whether he should tell Mr. Watts about his risk, given that there was some chance that he would not develop neurodegenerative disease. Whether or not he developed more serious disease later, Mr. Watts, currently an active, working attorney, might experience depression and grief if he were informed of this possibility. To complicate matters even more, there was nothing Mr. Watts or Dr. Pass could do now to prevent or delay onset of the disease. Commentary REM sleep behavior disorder (RBD) is a parasomnia that occurs during REM sleep and involves loss of normal REM-related skeletal muscle atonia. It is often associated with motor activity and the acting out of one's dreams [1] . The condition is more common in men than in women and is often characterized by violent behaviors. Those with RBD have more aggressive dreams than those without the disorder, but this tendency does not carry over into the waking hours. It has been proposed that many patients with "idiopathic" RBD are actually exhibiting early clinical signs of an evolving neurodegenerative disorder [1] . Current data indicate that approximately two-thirds of men aged 50 and older who are diagnosed with this disorder go on to develop Parkinson's disease or a linked condition, dementia with Lewy bodies [2] . The average interval between the onset of RBD and the onset of classic Parkinson's disease is about 13 years, but the time span can vary greatly. Interventions are available to treat the symptomatic manifestations of RBD, but there is no reliable neuroprotective treatment to slow onset or to reduce the risk of Parkinson's disease. Ongoing research in this area could produce such protection within a decade.
doi:10.1001/virtualmentor.2008.10.9.ccas3-0809
pmid:23211105
fatcat:tjsfor34srcltpfhmkl7glv3k4