Odor identification predicts the transition of patients with isolated <scp>RBD</scp>: A retrospective study

Miyamoto, Tomoyuki; Miyamoto, Masayuki

doi:10.1002/acn3.51615

Cited by 7 publications

(3 citation statements)

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“… 37 These findings have implications for the differentiation of early stages of MSA and for the development of diagnostic criteria for prodromal MSA. In such cases, in combination with the 123 I-MIBG test, markers that may be used include an olfactory identification test, 38 differential symptoms that can be used in the clinical diagnosis of MSA, 39 stridor or sleep-disordered breathing 40 and MRI findings 41 ( Supplementary Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Reduced cardiac 123I-MIBG uptake is a robust biomarker of Lewy body disease in isolated rapid eye movement sleep behaviour disorder

Miyamoto,

Miyamoto

2024

Brain Communications

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Cardiac 123I-labeled metaiodobenzylguanidine (123I-MIBG) scintigraphy is used to assess the function of postganglionic presynaptic cardiac sympathetic nerve endings. 123I-MIBG cardiac uptake is markedly reduced in patients with isolated rapid eye movement (REM) sleep behavior disorder (IRBD), similar to Parkinson’s disease and dementia with Lewy bodies. As a result, it can be used as an early biomarker of IRBD. Most patients with IRBD develop synucleinopathies: Parkinson’s disease, dementia with Lewy bodies, or multiple system atrophy. We aimed to investigate whether cardiac postganglionic denervation is present in patients with IRBD, as well as its possible usefulness as a marker for Lewy body disease status. This retrospective cohort study examined 306 patients (236 men and 70 women; mean age: 68.2 years; age range: 43–87 years) with polysomnography-confirmed IRBD who were followed for 1–3 months and underwent 123I-MIBG scintigraphy. We retrospectively analyzed data from 306 patients with polysomnography-confirmed IRBD, and their longitudinal outcomes were documented at two centers. Among IRBD patients, reduced 123I-MIBG uptake was observed in the early and delayed images in 84.4% and 93.4% of patients, respectively, whereas 88.6% of the patients had a high washout rate. This large Japanese two-cohort study (n = 306) found that 91 patients (29.7%) developed an overt synucleinopathy (51 Parkinson’s disease, 35 dementia with Lewy bodies, 4 multiple system atrophy, and 1 cerebellar ataxia) during a mean follow-up duration of 4.72 ± 3.94 years, with a conversion risk of 14.5% at 3 years, 25.4% at 5 years, 41.4% at 8 years, and 52.5% at 10 years. On the other hand, among patients with heart-to-mediastinum ratio < 2.2 in the delayed images (n = 286), 85 (29.7%) developed Parkinson’s disease or dementia with Lewy bodies during a mean follow-up duration of 4.71 ± 3.94 years, with a conversion risk of 14.5% at 3 years, 25.6% at 5 years, 42.0% at 8 years, and 51.0% at 10 years. Among the 33 patients who underwent repeat 123I-MIBG scintigraphy, there was a progressive decline in uptake over the next 4.2 years, with patients exhibiting reduced uptake progressing to Parkinson’s disease or dementia with Lewy bodies. In contrast, patients without decreased MIBG uptake progressed to multiple system atrophy. Reduced cardiac 123I-MIBG uptake was detected in over 90% of IRBD patients, with progression to Parkinson’s disease or dementia with Lewy bodies, rather than multiple system atrophy, over time. Reduced 123I-MIBG uptake is a robust maker for Lewy body disease among IRBD patients.

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Section: Discussionmentioning

confidence: 99%

Reduced cardiac 123I-MIBG uptake is a robust biomarker of Lewy body disease in isolated rapid eye movement sleep behaviour disorder

Miyamoto,

Miyamoto

2024

Brain Communications

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“…The presence of hyposmia or anosmia is considered a low term risk factor for the development of alpha-synucleinopathy in iRBD patients, 41 , 42 but smell test did not show any changes in time, therefore this symptom should be used as a prognostic marker at the moment of RBD diagnosis, but not as a monitoring biomarker in clinical intervention trials. 41 …”

Section: Rem Sleep Behavior Disorder and Biomarkers For Phenoconversi...mentioning

confidence: 98%

Considering REM Sleep Behavior Disorder in the Management of Parkinson’s Disease

Figorilli¹,

Meloni²,

Lanza³

et al. 2023

NSS

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Rapid eye movement (REM) sleep behavior disorder (RBD) is the result of the loss of physiological inhibition of muscle tone during REM sleep, characterized by dream-enacting behavior and widely recognized as a prodromal manifestation of alpha-synucleinopathies. Indeed, patients with isolated RBD (iRBD) have an extremely high estimated risk to develop a neurodegenerative disease after a long follow up. Nevertheless, in comparison with PD patients without RBD (PDnoRBD), the occurrence of RBD in the context of PD (PDRBD) seems to identify a unique, more malignant phenotype, characterized by a more severe burden of disease in terms of both motor and non-motor symptoms and increased risk for cognitive decline. However, while some medications (eg, melatonin, clonazepam, etc.) and non-pharmacological options have been found to have some therapeutic benefits on RBD there is no available treatment able to modify the disease course or, at least, slow down the neurodegenerative process underlying phenoconversion. In this scenario, the long prodromal phase may allow an early therapeutic window and, therefore, the identification of multimodal biomarkers of disease onset and progression is becoming increasingly crucial. To date, several clinical (motor, cognitive, olfactory, visual, and autonomic features) neurophysiological, neuroimaging, biological (biofluids or tissue biopsy), and genetic biomarkers have been identified and proposed, also in combination, as possible diagnostic or prognostic markers, along with a potential role for some of them as outcome measures and index of treatment response. In this review, we provide an insight into the present knowledge on both existing and future biomarkers of iRBD and highlight the difference with PDRBD and PDnoRBD, including currently available treatment options.

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“…In fact, the assessment of olfactory impairment, and especially odor identification, may help to predict the onset of a Lewy body disease in patients with idiopathic RBD over a relatively short time period [ 28 ]. Furthermore, in RBD patients, anosmia predicts a higher short-term risk of transition to Lewy body disease, although it cannot distinguish between PD and Lewy body disease [ 29 ]. In the current study, we aim to determine the potential role of olfactory impairment and other factors (age at the onset, disease duration, sex, cognitive abilities, and motor impairment) as possible predictors of higher scores at the RBD screening questionnaire (RBDSQ) in a large population of PD patients.…”

Section: Introductionmentioning

confidence: 99%

Olfactory Impairment Is the Main Predictor of Higher Scores at REM Sleep Behavior Disorder (RBD) Screening Questionnaire in Parkinson’s Disease Patients

et al. 2023

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Introduction: Olfactory impairment and REM sleep behavior disorder (RBD) are common non-motor symptoms in Parkinson’s disease (PD) patients, often preceding the onset of the specific motor symptoms and, thus, crucial for strategies directed to anticipate PD diagnosis. In this context, the specific interaction between olfactory impairment and RBD has not been clearly defined. Objective: The aim of this study was to determine the possible role of olfactory impairment and other clinical characteristics as possible predictors of higher scores at RBD screening questionnaire (RBDSQ) in a large population of PD patients. Methods: In this study, 590 PD patients were included from the Parkinson’s Progression Markers Initiative. Demographic and clinical features were registered. All participants completed motor and non-motor evaluations at the baseline visit. For motor assessments, the disease severity was evaluated by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) pars III. Regarding non-motor symptoms assessment, Montreal Cognitive Assessments (MoCA), University of Pennsylvania Smell Identification Test (UPSIT) and RBD screening questionnaire (RBDSQ) were registered. Results: Among 590 PD patients included in this study, 111 patients with possible RBD were found (18.8%). RBD was less frequent in female PD patients (p ≤ 0.011). Among patients with or without possible RBD diagnosis, statistically significant differences in MDS-UPDRS III (23.3 ± 11.4 vs. 19.7 ± 9.1, respectively, p ≤ 0.002) and in UPSIT score (19.7 ± 8.3 vs. 22.6 ± 8.0, respectively, p ≤ 0.001) were found. Moreover, significant correlations between RBDSQ versus UPDRS III score and versus UPSIT score were observed. Multivariate linear regression analysis showed that UPSIT was the most significant predictor of higher scores at RBDSQ, while the other significant predictors were UPDRS III and age. Conclusions: The severity of olfactory impairment appears tightly correlated to RBD symptoms, highlighting the role of these biomarkers for PD patients. Additionally, according to this large study, our data confirmed that RBD in PD patients exhibits peculiar gender differences.

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Odor identification predicts the transition of patients with isolated RBD: A retrospective study

Cited by 7 publications

References 51 publications

Reduced cardiac 123I-MIBG uptake is a robust biomarker of Lewy body disease in isolated rapid eye movement sleep behaviour disorder

Reduced cardiac 123I-MIBG uptake is a robust biomarker of Lewy body disease in isolated rapid eye movement sleep behaviour disorder

Considering REM Sleep Behavior Disorder in the Management of Parkinson’s Disease

Olfactory Impairment Is the Main Predictor of Higher Scores at REM Sleep Behavior Disorder (RBD) Screening Questionnaire in Parkinson’s Disease Patients

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