Clinical progression in Parkinson's disease with features of REM sleep behavior disorder: A population-based longitudinal study.

ABSTRACT: INTRODUCTION: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. METHODS: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. RESULTS: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. DISCUSSION: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.

SUBMITTER: Duarte Folle A 

PROVIDER: S-EPMC6589360 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature