Characterization of patients with longstanding idiopathic REM sleep behavior disorder

Iranzo, Álex; Stefani, Ambra; Serradell, Mónica; Martı́, Marı́a José; Lomeña, Francisco; Mahlknecht, Philipp; Stockner, Heike; Gaig, Carles; Fernández-Arcos, Ana; Poewe, Werner; Tolosa, Eduard; Högl, Birgit; Santamaría, Joan

doi:10.1212/wnl.0000000000004121

Cited by 75 publications

(43 citation statements)

References 37 publications

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“…22, 23 Patients diagnosed with neurogenic OH who also had REM sleep behavior disorder, anosmia and/or subtle motor signs were categorized as prodromal PD/DLB or prodromal MSA, since longitudinal studies have shown that they are already affected by an underlying CNS neurodegenerative disorder. 22, 24, 25 Since it was unclear at the time of testing whether these patients would ultimately transition into PD/DLB or MSA, they were excluded from the sub-group analysis in order to understand the impact of disease-specific lesions.…”

Section: Methodsmentioning

confidence: 99%

Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies

Norcliffe‐Kaufmann

Kaufmann

Shibao

et al. 2018

Annals of Neurology

162

141

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Section: Methodsmentioning

confidence: 99%

Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies

Norcliffe‐Kaufmann

Kaufmann

Shibao

et al. 2018

Annals of Neurology

162

141

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“…36 Studies found that even long-term disease-free survivors had numerous clinical or biomarkers suggestive of ongoing neurodegeneration. 37,38 Prevalence of idiopathic RBD was finally estimated definitively in three population-based studies, all of which found a population prevalence of approximately 1%. [39][40][41] Because so many RBD patients develop PD (and DLB and MSA), RBD cohorts were used to directly measure other clinical prodromal markers.…”

Section: High-risk Cohorts Rise To the Forementioning

confidence: 99%

Prodromal Parkinson's Disease: The Decade Past, the Decade to Come

2019

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The past decade has seen a dramatic expansion of the field of prodromal PD. Ten years ago, there were only six known prodromal markers of disease, none of which had more than two studies documenting diagnostic value. We now have at least 16 markers, with as many as 10 prospective studies for a single marker. This review summarizes the major advances over the last decade and speculates about the advances we will see in the decade to come. The most notable advances over the last decade came through the study of high‐risk cohorts (REM sleep behavior disorder and later genetic and autonomic cohorts), the generation of more representative population‐based cohorts for studying prodromal PD, major advances in neuroimaging of early disease stages, the emerging likelihood that tissue biopsy will be able to diagnose prodromal PD, and the coalescence of prodromal markers into discrete criteria. As the next decade dawns, we await increasing precision of sensitivity and specificity estimates of known markers, the discovery of new biomarkers of prodromal disease, improvements in diagnosis using combined methods/criteria (with increasing recognition of prodromal PD as one stage of the full PD spectrum), and ultimately the development of neuroprotective therapy that can be provided at the earliest stages of disease. © 2019 International Parkinson and Movement Disorder Society

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“…Rapid eye movement sleep behaviour disorder has been categorized into isolated RBD (iRBD) and secondary RBD [3], when associated with other neurological/neurodegenerative disorders [4][5][6], autoimmune diseases [7], or brainstem lesions [8]. Results from long-term follow-up studies [9], investigations in patients with long-standing iRBD [10], and studies evaluating biomarkers of synuclein-related neurodegeneration (including a-synuclein accumulation outside the central nervous system) [11,12], provided consistent evidence that iRBD is an early-phase asynucleinopathy, eventually evolving into Parkinson's disease, dementia with Lewy bodies or multiple system atrophy [13].…”

Section: Introductionmentioning

confidence: 99%

Objective rest–activity cycle analysis by actigraphy identifies isolated rapid eye movement sleep behavior disorder

Filardi

Stefani

Holzknecht

et al. 2020

Euro J of Neurology

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Background and purpose Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by abnormal behaviours during REM sleep. Several studies showed that iRBD is a prodromal stage of synucleinopathies. Therefore, identifying iRBD in the general population is of utmost importance. In this study, we explore whether the assessment of rest–activity rhythm features can distinguish patients with iRBD from patients with disorders characterized by other pathological motor activity during sleep and healthy controls. Methods Nineteen patients with video‐polysomnographic diagnosis of iRBD, 39 patients with other disorders with motor activity during sleep [19 with restless leg syndrome (RLS) and 20 with untreated sleep apnea syndrome (SAS)] and 16 healthy controls underwent 2‐week actigraphy and video‐polysomnography, and completed REM sleep behavior disorder screening questionnaires. Non‐parametric analyses were applied to assess the rest–activity rhythm features. Results Patients with iRBD showed lower sleep efficiency, increased estimated wake after sleep onset and increased frequency of prolonged activity bouts compared to those with RLS and controls, while no difference emerged compared with SAS patients. Moreover, patients with iRBD presented increased occurrence of estimated nap in comparison to those with RLS, those with SAS and controls. The I < O, a 24‐h measure that expresses the relationship between nocturnal and diurnal motor activity intensity, distinguished patients with iRBD from those with RLS, those with SAS and controls, with an area under the curve greater than that of REM sleep behavior disorder screening questionnaires. An I < O of 98.32 shows the best balance between sensitivity (63.2%) and specificity (89.1%). Discussion The I < O index distinguished iRBD patients from those with other pathological motor activity during sleep and controls, confirming its use as an objective measure suitable to screen large at‐risk populations.

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Characterization of patients with longstanding idiopathic REM sleep behavior disorder

Abstract: Prodromal PD markers are common in individuals with longstanding IRBD, suggesting that they are affected by an underlying neurodegenerative process. This observation may be useful for the design of disease-modifying trials to prevent PD onset in IRBD.

Cited by 75 publications

References 37 publications

Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies

Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies

Prodromal Parkinson's Disease: The Decade Past, the Decade to Come

Objective rest–activity cycle analysis by actigraphy identifies isolated rapid eye movement sleep behavior disorder

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