REM behavior disorder predicts motor progression and cognitive decline in Parkinson disease

Pagano, Gennaro; Micco, Rosa De; Yousaf, Tayyabah; Wilson, Heather; Chandra, Avinash; Politis, Marios

doi:10.1212/wnl.0000000000006134

Cited by 114 publications

(106 citation statements)

References 49 publications

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“…At the same time, we found that nighttime problems, EDS, pRBD, and RLS are all accompanied by cognitive decline, which was confirmed by other studies [17][18][19] . Compared with participants without RLS, those with RLS have a higher rate of a family history of PD.…”

Section: Discussionsupporting

confidence: 89%

Multiple comorbid sleep disorders adversely affect quality of life in Parkinson’s disease patients

Zhang

Zhao

Huang

et al. 2020

npj Parkinsons Dis.

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Sleep disorders are common non-motor symptoms in patients with Parkinson’s disease (PD). The characteristics and impact of multiple comorbid sleep disorders remain to be elucidated. Our goal was to investigate the characteristics of various sleep disorder comorbidities, and their association with motor complications and the impact on the quality of life in PD patients. In this multicenter, observational, cross-sectional study, data concerning the clinical characteristics of complicated sleep disorders were collected from PD patients treated at 40 different hospitals in Shanghai. Sleep disorders were evaluated using the PD Sleep Scale-2, Epworth Sleepiness Scale, Rapid Eye Movement Sleep Behavior Disorder Questionnaire-Hong Kong, and the International Restless Legs Scale. Among the 1006 subjects evaluated, 77.53% exhibited signs of sleep disorders, and most had multiple sleep disorders (n = 502, 49.9%). A smaller percentage of patients with sleep disorders had a single disorder (n = 278, 27.6%). Furthermore, an increased number of sleep disorders, including nighttime problems, excessive daytime sleepiness, rapid eye movement sleep behavior disorder, and restless legs syndrome was a significant contributor to a poor quality of life (β = 4.33, CI: 3.33–5.33, P for trend <0.001), even when controlling for multiple factors. Moreover, motor complications partially mediated this relationship (indirect effect: β = 0.355, 95% boot CI: 0.134, 0.652).Our study showed that a large proportion of PD patients suffer from multiple comorbid sleep disorders, which greatly decreases the quality of life in PD patients and is partially mediated by motor complications.

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Section: Discussionsupporting

confidence: 89%

Multiple comorbid sleep disorders adversely affect quality of life in Parkinson’s disease patients

Zhang

Zhao

Huang

et al. 2020

npj Parkinsons Dis.

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“…We focused on clinical features that capture major PD symptoms, including both motor and nonmotor symptoms, in line with previous studies. 3,7,28,29 34 and working memory capacity (letter-number sequencing). 35…”

Section: Study Setting and Patientsmentioning

confidence: 99%

Association of specific biotypes in patients with Parkinson disease and disease progression

et al. 2020

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Objective:To identify biotypes in newly diagnosed Parkinson’s disease patients and test whether these biotypes could explain inter-individual differences in longitudinal progression.Methods:In this longitudinal analysis, we use a data-driven approach clustering PD patients from the Parkinson’s Progression Markers Initiative (PPMI) (n = 314, age = 61.0 ± 9.5, 34.1% female, 5 years follow-up). Voxel-level neuroanatomical features were estimated using deformation-based morphometry (DBM) of T1-weighted MRI. Voxels whose deformation values were significantly correlated (P < 0.01) with clinical scores (MDS-UPDRS-Parts I-III, MDS-UPDRS-total, tremor score, and postural instability and gait difficulty score) at baseline were selected. Then, these neuroanatomical features were subjected to hierarchical cluster analysis. Changes in the longitudinal progression and neuroanatomical pattern were compared between different biotypes.Results:Two neuroanatomical biotypes were identified: (i) biotype 1 (n = 114) with subcortical brain volumes smaller than heathy controls; (ii) biotype 2 (n = 200) with subcortical brain volumes larger than heathy controls. Biotype 1 had more severe motor impairment, autonomic dysfunction, and very much worse REM sleep behavior disorder than biotype 2 at baseline. Although disease duration at initial visit and follow-up were similar between biotypes, PD patients with smaller subcortical brain volume had poorer prognosis, with more rapid decline in several clinical domains and in dopamine functional neuroimaging over an average of five years.Conclusion:Robust neuroanatomical biotypes exist in PD with distinct clinical and neuroanatomical pattern. These biotypes can be detected at diagnosis, and predict the course of longitudinal progression, which should benefit trial design and evaluation.Glossary:ADL = activities of daily living; ESS = Epworth Sleepiness Scale; GDS = Geriatric Depression Scale; HVLT = Hopkins Verbal Learning Test; MDS-UPDRS = Movement Disorder Society–sponsored revision of the Unified Parkinson’s Disease Rating Scale; MoCA = Montreal Cognitive Assessment; QUIP = Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease; RBD = REM sleep behavior disorder; RBDSQ = REM Sleep Behavior Disorder Screening Questionnaire; SCOPA-AUT = Scales for Outcomes in Parkinson’s Disease–Autonomic; STAI = State-Trait Anxiety Inventory; UPSIT = University of Pennsylvania Smell Identification Test.

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“…The SFGdl is located in the upper prefrontal cortex and forms the frontoparietal network. The frontoparietal network is considered to be a flexible cognitive control center, which regulates and integrates high-level emotions and consciousness (32). PD-pRBD patients have a characteristic decentralization of the SFGdl, which may weaken the frontoparietal network function and reduce the ability of emotional and cognition regulation.…”

Section: Altered Nodal Measure In Pd-prbd Compared With Ncmentioning

confidence: 99%

Altered Brain Functional Network in Parkinson Disease With Rapid Eye Movement Sleep Behavior Disorder

Zeng

Zhou

et al. 2020

Front. Neurol.

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Background and Objective: Parkinson disease (PD) with rapid eye movement (REM) sleep behavior disorder (PD-RBD) tend to be a distinct phenotype with more severe clinical characteristics and pathological lesion when compared with PD without RBD (PD-nRBD). However, the pathological mechanism underlying PD-RBD remains unclear. We aim to use the resting-state functional magnetic resonance imaging (rs-fMRI) to explore the mechanism of PD-RBD from the perspective of internal connectivity networks. Materials and Methods: A total of 92 PD patients and 20 age and sex matched normal controls (NC) were included. All participants underwent rs-fMRI scan and clinical assessment. According to the RBD screening questionnaire (RBDSQ), PD patients were divided into two groups: PD with probable RBD (PD-pRBD) and PD without probable RBD (PD-npRBD). The whole brain was divided into 90 regions using automated anatomic labeling atlas. Functional network of each subject was constructed according to the correlation of rs-fMRI blood oxygenation level dependent signals in any two brain regions and network metrics were analyzed using graph theory approaches. Network properties among three groups were compared and correlation analysis was made using distinguishing network metrics and RBDSQ scores. Results: We found both PD-pRBD and PD-npRBD patients existed small-world characteristics. PD-pRBD showed a wider range of nodal property changes in neocortex and limbic system than PD-npRBD patients when compared with NC. Besides, PD-pRBD showed significant enhanced nodal efficiency in the bilateral thalamus and betweenness centrality in the left insula, but, reduced betweenness centrality in the right dorsolateral superior frontal gyrus when compared with PD-npRBD. Moreover, nodal efficiency in the bilateral thalamus were positively correlated with RBDSQ scores. Conclusions: Both NC and PD patients displayed small-world properties and indiscriminate global measure but PD-pRBD showed more extensive changes of nodal properties than PD-npRBD. The increased centrality role in the bilateral thalamus and the left insula, and disruption in the right dorsolateral superior frontal gyrus may play as a key role in underlying pathogenesis of PD-RBD.

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REM behavior disorder predicts motor progression and cognitive decline in Parkinson disease

Cited by 114 publications

References 49 publications

Multiple comorbid sleep disorders adversely affect quality of life in Parkinson’s disease patients

Multiple comorbid sleep disorders adversely affect quality of life in Parkinson’s disease patients

Association of specific biotypes in patients with Parkinson disease and disease progression

Altered Brain Functional Network in Parkinson Disease With Rapid Eye Movement Sleep Behavior Disorder

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