1. RNFL Thickness

2. The ubiquitin proteasome pathway – PD genes Adapted from Eriksen et al Arch Neurol 2005, 6: 353-357

3. Sleep disturbances etiology • Degeneration of forebrain preoptic area • Thalamic dysfunction • Dopaminergic drugs

4. Sleep disturbances in PD • Insomnia • Motor • Urinary • Neuropsychiatric Vivid dreams Hallucinations REM behavior disorder - RLS

5. Sleepiness in PD – 15 % • Depression • Drugs • Disturbed sleep • Progressive disease course

6. Hedonistic dysregulation syndrome • Need for increasing dopaminergic drugs • Drug seeking behavior • Impaired social functioning • Hypomanic cyclothymic affective syndrome • Withdrawal state of depression, anxiety

7. Hedonistic homeostatic regulation • Related to DA stimulation • Young onset • Male • Drug seeking • Adventure seeking • Pathological gambling

8. Lessons form surgery

9. From Bejjani et al, NEJM, 1999

10. Limitations • Retrospective • Interview • Possible relationship between PD dementia - family history of dementia