Risk factors for neurodegeneration in idiopathic rapid eye movement sleep behavior disorder: A multicenter study

Abstract

Objective To assess whether risk factors for Parkinson’s disease and Dementia with Lewy bodies increase rate of defined neurodegenerative disease in idiopathic REM sleep behavior disorder Methods 12 centers administered a detailed questionnaire assessing risk factors for neurodegenerative synucleinopathy to patients with idiopathic REM sleep behavior disorder. Variables included demographics, lifestyle factors, pesticide exposures, occupation, co-morbid conditions, medication use, family history, and autonomic/motor symptoms. After 4-years follow-up, patients were assessed for dementia or parkinsonism. Disease risk was assessed with Kaplan-Meier analysis, and epidemiologic variables were compared between convertors and those still idiopathic using logistic regression. Results Of 305 patients, follow-up information was available for 279, of whom 93 (33.3%) developed defined neurodegenerative disease. Disease risk was 25% at 3 years, and 41% after 5 years. Patients who converted were older (difference=4.5 years, p<0.001), with similar sex distribution. Neither caffeine, smoking, nor alcohol exposure predicted conversion. Although occupation was similar between groups, those who converted had a lower likelihood of pesticide exposure (occupational insecticide=2.3% vs. 9.0%). Convertors were more likely to report family history of dementia (OR=2.09), without significant differences in Parkinson’s disease or sleep disorders. Medication exposures and medical history were similar between groups. Autonomic and motor symptoms were more common among those who converted. Risk factors for primary dementia and parkinsonism were generally similar, except for a notably higher clonazepam use in dementia convertors (OR=2.6). Interpretation Patients with idiopathic RBD are at very high risk of neurodegenerative synucleinopathy. Risk factor profiles between convertors and non-convertors have both important commonalities and differences.

What the “man in the moon” can tell us about the future of our brains

“…While certain clinical tests, like olfactory function, color discrimination and certain video-PSG and imaging tests have already indicated their potential for predict conversion (5)(6)(7)11,14,35,36), the present study from Taeko Sasai-Sakuma and the group around Professor Inoue at the Japan Somnology Center represents not only another fast and convenient test as a biomarker of potential neurodegeneration in RBD, but also has the potential to indicate a more specific pathologic profile and clinical endpoint.…”

“…However, the length of time until conversion to fully manifest alpha synuclein disease is of concern and has stimulated research into biomarkers that could potentially indicate immediacy of conversion, or progression, to other clinical and daytime manifestations of fully manifest alpha synuclein disease (5)(6)(7). In contrast, trying to identify more specific endpoints of conversion has not been a major focus in research.…”

New Perspectives in the Search for Reliable Prediction of Demen tia with Lewy Bodies

“…He strongly supported the belief that RBD, when diagnosed by Polysomnogram, might be the strongest risk factor for DLB when compared with other signs [6,7]. In a study of patients with non-amnestic mild cognitive impairment (MCI) who progressed to DLB a year later, about half of the patients had RBD which was more common than two other features of DLB, Visual Hallucinations and Parkinsonism [8].…”

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

“…The hallmark of the diagnosis of REM sleep behavior disorder is the absence of atonia during REM sleep and "dream enactment" [35][36][37][38][39][40]. Reliable history has to be obtained from caregivers in order to give such diagnosis because not all patients are aware of themselves having this disorder.…”