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