Title: Clinical progression in Parkinson's disease with features of REM sleep behavior disorder: A population-based longitudinal study.
Authors: Duarte Folle, Aline; Paul, Kimberly C; Bronstein, Jeff M; Keener, Adrienne M; Ritz, Beate
Published In Parkinsonism Relat Disord, (2019 05)
Abstract: Rapid Eye Movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment and is associated with incidence of neurodegenerative disorders, especially Parkinson's disease (PD). Whether PD with RBD constitutes a distinct subtype with unique progression is unknown. Here, we investigated motor and cognitive symptom progression in patients with self-reported RBD features in adult life.We screened for RBD in a cohort of 776 PD patients whom we ascertained using a population-based strategy. Among participants with at least one follow-up (60%), we compared those with and without probable RBD (pRBD) estimating hazard rate ratios for progression events UPDRS-III≥ 35 and MMSE≤ 24.Prevalence of pRBD at baseline was 21%. In adjusted Cox regression models among patients with a Postural Instability and Gait Dysfunction (PIGD) phenotype, those with pRBD progressed faster to a UPDRS-III≥ 35 (HR = 1.92, 95% CI = 1.12; 3.27). Also, all patients with pRBD progressed twice as fast to a MMSE score≤ 24 (HR = 2.04, 95% CI = 1.13; 3.69). In sensitivity analyses, using alternative definition of pRBD and accounting for bias due to loss to follow-up results remained similar.Employing data from one of the largest population-based studies of PD, in which movement disorder specialists assessed patients, we confirm evidence that pRBD features are a clinical marker for faster cognitive decline and possibly also motor progression in PD patients, the latter for patients with a PIGD subtype early in disease.
PubMed ID: 30833231
MeSH Terms: Adult; Aged; Aged, 80 and over; Cognitive Dysfunction/physiopathology*; Cognitive Dysfunction/psychology; Cohort Studies; Disease Progression; Female; Humans; Longitudinal Studies; Male; Middle Aged; Neurodegenerative Diseases/complications; Neurodegenerative Diseases/physiopathology*; Parkinson Disease/complications; Parkinson Disease/physiopathology*; REM Sleep Behavior Disorder/diagnosis; REM Sleep Behavior Disorder/physiopathology*; Research Design