Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder

Department of Neurology, L7-305 Montreal General Hospital, 1650 Cedar Ave., Montreal, Quebec, Canada.
Neurology (Impact Factor: 8.3). 04/2009; 72(15):1296-300. DOI: 10.1212/01.wnl.0000340980.19702.6e
Source: PubMed

ABSTRACT Idiopathic REM sleep behavior disorder (RBD) is a potential preclinical marker for the development of neurodegenerative diseases, particularly Parkinson disease (PD) and Lewy body dementia. However, the long-term risk of developing neurodegeneration in patients with idiopathic RBD has not been established. Obtaining an accurate picture of this risk is essential for counseling patients and for development of potential neuroprotective therapies.
We conducted a follow-up study of all patients seen at the sleep disorders laboratory at the Hôpital du Sacré Coeur with a diagnosis of idiopathic RBD. Diagnoses of parkinsonism and dementia were defined according to standard criteria. Survival curves were constructed to estimate the 5-, 10-, and 12-year risk of developing neurodegenerative disease.
Of 113 patients, 93 (82%) met inclusion criteria. The mean age of participants was 65.4 years and 75 patients (80.4%) were men. Over the follow-up period, 26/93 patients developed a neurodegenerative disorder. A total of 14 patients developed PD, 7 developed Lewy body dementia, 4 developed dementia that met clinical criteria for AD, and 1 developed multiple system atrophy. The estimated 5-year risk of neurodegenerative disease was 17.7%, the 10-year risk was 40.6%, and the 12-year risk was 52.4%.
Although we have found a slightly lower risk than other reports, the risk of developing neurodegenerative disease in idiopathic REM sleep behavior disorder is substantial, with the majority of patients developing Parkinson disease and Lewy body dementia.

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Available from: Maria Livia Fantini, May 27, 2014
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    • "Parkinson's disease (PD) is a neurodegenerative disorder with a multifactorial etiology, but it is primarily suggested to be due to a loss of dopaminergic function, which produces multiple neurological and psychiatric symptoms, including motor, cognitive, and emotional dysfunction. Additionally, most patients with PD experience sleep-related symptoms, including difficulty in initiating and maintaining sleep, excessive daytime sleepiness (EDS), and parasomnias such as rapid eye movement (REM) sleep behavior disorder (Kumar et al. 2002; Brotini and Gigli 2004; Postuma et al. 2009). Most studies point out that the prevalence of sleep disturbance in PD is nearly 100% (Lees et al. 1988; Kumar et al. 2002; Poryazova and Zacchariev 2005). "
    Melatonin:Therapeutic Value and Neuroprotection, Edited by Venkatramanujan Srinivasan, Gabriella Gobbi, Samuel D. Shillcutt, Sibel Suzen, 01/2015: chapter 16: pages 189-202; CRC Press., ISBN: 9781482220094
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    • "Many prospective and cross-sectional studies reveal that quite a number of idiopathic RBD (iRBD) patients will develop into neurodegenerative diseases such as Parkinson disease (PD) after several years or decades [2] [3] [4], and iRBD patients share similar changes with neurodegenerative diseases in pathological, clinical, and ancillary test findings [3,5–8]. RBD should be screened as early as possible and followed up. "
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    ABSTRACT: Objective To validate the REM Sleep Behavior Disorder (RBD) Questionnaire – Hong Kong (RBDQ-HK) in polysomnography (PSG)-confirmed RBD and non-RBD subjects, and to evaluate its usefulness in different clinical populations. Methods In total, 325 subjects (115 RBD and 210 controls) from East China were enrolled. After patients had finished the structured interview, and had completed the RBDQ-HK and video-PSG test, we evaluated the reliability of RBDQ-HK, areas under the curves (AUC), the best cut-off values, factor 2 of RBDQ-HK, and overall scale, and validated the usefulness of RBDQ-HK between the Parkinson disease (PD) and obstructive sleep apnea (OSA) groups. Results The best cut-off values for factor 2 of RBDQ-HK were located at 7/8 with a sensitivity of 90% and specificity of 82% (AUC = 0.911) and for RBDQ-HK overall scale were located at 17 with a sensitivity of 85% and specificity of 81% (AUC = 0.892) in all subjects. Both factor 2 and overall scale of RBDQ-HK are valid in all subjects (PD and OSA patients), with a higher accuracy given by factor 2 of RBDQ-HK. Conclusions RBDQ-HK and its factor 2 are useful and validated RBD screening instruments, and could be used as a tool for the screening of RBD in patients with PD and OSA.
    Sleep Medicine 08/2014; 15(8). DOI:10.1016/j.sleep.2014.03.020 · 3.10 Impact Factor
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    • "Furthermore, an independent association between SOS episodes and sleep disturbances such as RBD symptoms was observed. Cumulative evidence shows that RBD precedes the development of PD by many years [24] [25] [26] "
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    ABSTRACT: Excessive daytime sleepiness (EDS) and sudden sleep onset (SOS) episodes are frequent in Parkinson׳s disease (PD). The objectives are to identify clinical characteristics and factors associated with EDS and SOS episodes.
    03/2014; 87(1). DOI:10.1016/j.slsci.2014.07.020