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Fernandes M, Maio S, Eusebi P, Placidi F, Izzi F, Spanetta M, De Masi C, Lupo C, Calvello C, Nuccetelli M, Bernardini S, Mercuri NB, Liguori C. Cerebrospinal-fluid biomarkers for predicting phenoconversion in patients with isolated rapid-eye movement sleep behavior disorder. Sleep 2024; 47:zsad198. [PMID: 37542734 DOI: 10.1093/sleep/zsad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/22/2023] [Indexed: 08/07/2023] Open
Abstract
STUDY OBJECTIVES Patients with isolated rapid-eye-movement sleep behavior disorder (iRBD) have an increased risk of developing neurodegenerative diseases. This study assessed cerebrospinal-fluid (CSF) biomarkers of neurodegeneration and blood-brain barrier (BBB) alteration in patients with iRBD compared to controls and ascertain whether these biomarkers may predict phenoconversion to alpha-synucleinopathies (Parkinson's Disease (PD), Dementia with Lewy bodies (DLB), Multiple System Atrophy (MSA)). METHODS Patients and controls underwent between 2012 and 2016 a neurological assessment, a lumbar puncture for CSF biomarker analysis (β-amyloid42 - Aβ42; total-tau, and phosphorylated tau), and BBB alteration (CSF/serum albumin ratio). All patients with iRBD were followed until 2021 and then classified into patients who converted to alpha-synucleinopathies (iRBD converters, cRBD) or not (iRBD non-converters, ncRBD). RESULTS Thirty-four patients with iRBD (mean age 67.12 ± 8.14) and 33 controls (mean age 64.97 ± 8.91) were included. At follow-up (7.63 ± 3.40 years), eight patients were ncRBD and 33 patients were cRBD: eleven converted to PD, 10 to DLB, and two to MSA. Patients with iRBD showed lower CSF Aβ42 levels and higher CSF/serum albumin ratio than controls. Cox regression analysis showed that the phenoconversion rate increases with higher motor impairment (hazard ratio [HR] = 1.23, p = 0.032). CSF Aβ42 levels predicted phenoconversion to DLB (HR = 0.67, p = 0.038) and BBB alteration predicted phenoconversion to PD (HR = 1.20, p = 0.038). DISCUSSION This study showed that low CSF Aβ42 levels and high BBB alteration may predict the phenoconversion to DLB and PD in patients with iRBD, respectively. These findings highlight the possibility to discriminate phenoconversion in iRBD patients through CSF biomarkers; however, further studies are needed.
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Affiliation(s)
- Mariana Fernandes
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| | - Silvia Maio
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital "Tor Vergata", Rome, Italy
| | - Paolo Eusebi
- Department of Medicine, Neurology Clinic, University Hospital of Perugia, Italy
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital "Tor Vergata", Rome, Italy
| | - Francesca Izzi
- Sleep Medicine Centre, Neurology Unit, University Hospital "Tor Vergata", Rome, Italy
| | - Matteo Spanetta
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| | - Claudia De Masi
- Sleep Medicine Centre, Neurology Unit, University Hospital "Tor Vergata", Rome, Italy
| | - Clementina Lupo
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| | - Carmen Calvello
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
| | - Marzia Nuccetelli
- Department of Clinical Biochemistry and Molecular Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Sergio Bernardini
- Department of Clinical Biochemistry and Molecular Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital "Tor Vergata", Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy
- Sleep Medicine Centre, Neurology Unit, University Hospital "Tor Vergata", Rome, Italy
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Fiamingo G, Capittini C, De Silvestri A, Rebuffi C, Cerami C, Arnaldi D, Terzaghi M. Neuropsychological evaluation of phenoconversion risk in REM sleep behaviour disorder: A scoping review. J Sleep Res 2023; 32:e13873. [PMID: 36958793 DOI: 10.1111/jsr.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/25/2023]
Abstract
The objective of this study was to assess the role of cognitive evaluation in the prediction of phenoconversion in polysomnography-confirmed idiopathic or isolated rapid eye movement sleep behaviour disorder, through a scoping review focussing on a longitudinal comprehensive neuropsychological assessment of patients with idiopathic REM sleep behaviour disorder. A literature search (2006-2022) yielded 1034 records, and 20 were selected for analysis. The sample included 899 patients from eight different cohorts and five countries. We extracted data on clinical evolution, mild cognitive impairment diagnosis, neuropsychological tests used, and classification of cognitive domains. Tests, cognitive domains, and mild cognitive impairment definitions were heterogeneous across the studies, precluding a meta-analysis. Ten studies (50%) evaluated the presence of mild cognitive impairment; 14 studies (70%) grouped neuropsychological tests into between three (6 studies, 21.4%) and seven (1 study, 7.1%) cognitive domains. The most frequently used tests were semantic fluency, Stroop colour word test, trail making test A and B, digit span, Rey auditory verbal learning test, and Rey-Osterrieth figure. All except digit span showed a role in predicting phenoconversion. The authors did not consistently assign tests to specific cognitive domains. In conclusion, we discuss methodological differences between the studies and highlight the need for a standardised framework for neuropsychological data acquisition and presentation, based on a multilevel approach covering test selection, domain assignment, and mild cognitive impairment diagnostic criteria.
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Affiliation(s)
- Giuseppe Fiamingo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Capittini
- Clinical Epidemiology and Biometric Unit, Scientific Direction, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit, Scientific Direction, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | | | - Chiara Cerami
- Scuola Universitaria di Studi Superiori IUSS, Pavia, Italy
- Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy
- IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Terzaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Sleep Medicine and Epilepsy, IRCSS Mondino Foundation, Pavia, Italy
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Santos ABD, Thaneshwaran S, Ali LK, Leguizamón CRR, Wang Y, Kristensen MP, Langkilde AE, Kohlmeier KA. Sex-dependent neuronal effects of α-synuclein reveal that GABAergic transmission is neuroprotective of sleep-controlling neurons. Cell Biosci 2023; 13:172. [PMID: 37710341 PMCID: PMC10500827 DOI: 10.1186/s13578-023-01105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Sleep disorders (SDs) are a symptom of the prodromal phase of neurodegenerative disorders that are mechanistically linked to the protein α-synuclein (α-syn) including Parkinson's disease (PD). SDs during the prodromal phase could result from neurodegeneration induced in state-controlling neurons by accumulation of α-syn predominant early in the disease, and consistent with this, we reported the monomeric form of α-syn (monomeric α-syn; α-synM) caused cell death in the laterodorsal tegmental nucleus (LDT), which controls arousal as well as the sleep and wakefulness state. However, we only examined the male LDT, and since sex is considered a risk factor for the development of α-syn-related diseases including prodromal SDs, the possibility exists of sex-based differences in α-synM effects. Accordingly, we examined the hypothesis that α-synM exerts differential effects on membrane excitability, intracellular calcium, and cell viability in the LDT of females compared to males. METHODS Patch clamp electrophysiology, bulk load calcium imaging, and cell death histochemistry were used in LDT brain slices to monitor responses to α-synM and effects of GABA receptor acting agents. RESULTS Consistent with our hypothesis, we found differing effects of α-synM on female LDT neurons when compared to male. In females, α-synM induced a decrease in membrane excitability and heightened reductions in intracellular calcium, which were reliant on functional inhibitory acid transmission, as well as decreased the amplitude and frequency of spontaneous excitatory postsynaptic currents (sEPSCs) with a concurrent reduction in action potential firing rate. Cell viability studies showed higher α-synM-mediated neurodegeneration in males compared to females that depended on inhibitory amino acid transmission. Further, presence of GABA receptor agonists was associated with reduced cell death in males. CONCLUSIONS When taken together, we conclude that α-synM induces a sex-dependent effect on LDT neurons involving a GABA receptor-mediated mechanism that is neuroprotective. Understanding the potential sex differences in neurodegenerative processes, especially those occurring early in the disease, could enable implementation of sex-based strategies to identify prodromal PD cases, and promote efforts to illuminate new directions for tailored treatment and management of PD.
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Affiliation(s)
- Altair Brito Dos Santos
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2100 Denmark
- Dept of Neuroscience, University of Copenhagen, Copenhagen, 2200 Denmark
| | - Siganya Thaneshwaran
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2100 Denmark
| | - Lara Kamal Ali
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2100 Denmark
| | - César Ramón Romero Leguizamón
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2100 Denmark
| | - Yang Wang
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2100 Denmark
| | | | - Annette E. Langkilde
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2100 Denmark
| | - Kristi A. Kohlmeier
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2100 Denmark
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Riboldi GM, Russo MJ, Pan L, Watkins K, Kang UJ. Dysautonomia and REM sleep behavior disorder contributions to progression of Parkinson's disease phenotypes. NPJ Parkinsons Dis 2022; 8:110. [PMID: 36042235 PMCID: PMC9427762 DOI: 10.1038/s41531-022-00373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/02/2022] [Indexed: 02/06/2023] Open
Abstract
Non-motor symptoms of Parkinson's disease (PD) such as dysautonomia and REM sleep behavior disorder (RBD) are recognized to be important prodromal symptoms that may also indicate clinical subtypes of PD with different pathogenesis. Unbiased clustering analyses showed that subjects with dysautonomia and RBD symptoms, as well as early cognitive dysfunction, have faster progression of the disease. Through analysis of the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort, we tested the hypothesis that symptoms of dysautonomia and RBD, which are readily assessed by standard questionnaires in an ambulatory care setting, may help to independently prognosticate disease progression. Although these two symptoms associate closely, dysautonomia symptoms predict severe progression of motor and non-motor symptoms better than RBD symptoms across the 3-year follow-up period. Autonomic system involvement has not received as much attention and may be important to consider for stratification of subjects for clinical trials and for counseling patients.
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Affiliation(s)
- Giulietta Maria Riboldi
- Department of Neurology, the Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement Disorders, New York University Langone Health, New York, NY, 10017, USA
| | - Marco J Russo
- Department of Neurology, the Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement Disorders, New York University Langone Health, New York, NY, 10017, USA
| | - Ling Pan
- NYU Langone Neurosurgery Associates, New York, NY, 10016, USA
| | | | - Un Jung Kang
- Department of Neurology, the Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement Disorders, New York University Langone Health, New York, NY, 10017, USA.
- Department of Neuroscience and Physiology, Neuroscience Institute, The Parekh Center for Interdisciplinary Neurology, New York University Grossman School of Medicine, New York, NY, 10016, USA.
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Sumi Y, Masuda F, Kadotani H, Ozeki Y. The prevalence of depression in isolated/idiopathic rapid eye movement sleep behavior disorder: A systematic review and meta-analysis. Sleep Med Rev 2022; 65:101684. [DOI: 10.1016/j.smrv.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
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Adenosine A 2A receptor neurons in the olfactory bulb mediate odor-guided behaviors in mice. Brain Res 2021; 1768:147590. [PMID: 34310936 DOI: 10.1016/j.brainres.2021.147590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 11/21/2022]
Abstract
Depression, rapid eye movement (REM) sleep behavior disorder, and altered olfaction are often present in Parkinson's disease. Our previous studies demonstrated the role of the olfactory bulb (OB) in causing REM sleep disturbances in depression. Furthermore, adenosine A2A receptors (A2AR) which are richly expressed in the OB, play an important role in the regulation of REM sleep. Caffeine, an adenosine A1 receptors and A2AR antagonist, and other A2AR antagonists were reported to improve olfactory function and restore age-related olfactory deficits. Therefore, we hypothesized that the A2AR neurons in the OB may regulate olfaction or odor-guided behaviors in mice. In the present study, we employed chemogenetics to specifically activate or inhibit neuronal activity. Then, buried food test and olfactory habituation/dishabituation test were performed to measure the changes in the mice's olfactory ability. We demonstrated that activation of OB neurons or OB A2AR neurons shortened the latency of buried food test and enhanced olfactory habituation to the same odors and dishabituation to different odors; inhibition of these neurons showed the opposite effects. Photostimulation of ChR2-expressing OB A2AR neuron terminals evoked inward current in the olfactory tubercle (OT) and the piriform cortex (Pir), which was blocked by glutamate receptor antagonists 2-amino-5-phosphonopentanoic acid and 6-cyano-7nitroquinoxaline-2,3-dione. Collectively, these results suggest that the OB mediates olfaction via A2AR neurons in mice. Moreover, the excitatory glutamatergic release from OB neurons to the OT and the Pir were found responsible for the olfaction-mediated effects of OB A2AR neurons.
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Puligheddu M, Figorilli M, Serra A, Laccu I, Congiu P, Tamburrino L, de Natale ER, Ginatempo F, Deriu F, Loi G, Fantini ML, Schenck CH, Ferri R. REM Sleep without atonia correlates with abnormal vestibular-evoked myogenic potentials in isolated REM sleep behavior disorder. Sleep 2020; 42:5532726. [PMID: 31310647 DOI: 10.1093/sleep/zsz128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/14/2019] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES The neurophysiological hallmark of REM sleep behavior disorder (RBD) is loss of atonia during REM sleep. Indeed, signs and symptoms of neurodegeneration can occur after years, even decades, from its beginning. This study aimed to measure neurophysiological alterations of the brainstem that potentially correlate with the severity of atonia loss, and determining whether a prodromal neurodegenerative disorder underlines this condition when it occurs as an isolated condition (iRBD). METHODS Subjects with iRBD and matched healthy controls were recruited. The study included the recording of one-night polysomnography, vestibular-evoked myogenic potentials (VEMPs), and a [123I]-FP-CIT dopamine transporter (DAT) scan. The quantification of REM sleep without atonia (RSWA) was made according to two previously published manual methods and one automated method. RESULTS The rate of alteration of VEMPs and VEMP score were significantly higher in iRBD patients than controls. Moreover, VEMP score was negatively correlated with the automated REM atonia index; a marginal statistical significance was also reached for the positive correlation with the visual tonic electromyographic parameter, while the other correlations, including that with DAT-scan score were not statistically significant. CONCLUSIONS Brainstem neurophysiology in iRBD can be assessed by VEMPs and their alterations may possibly indicate an early expression of the neurodegenerative process underlying this disorder at the brainstem level, which awaits future longitudinal confirmation. The correlation between RSWA and VEMP alteration might also represent a prodromal aspect anticipating the possible evolution from iRBD to neurodegeneration, whereas DAT-scan abnormalities might represent a later step in this evolution.
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Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Michela Figorilli
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessandra Serra
- Nuclear Medicine Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ilaria Laccu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Patrizia Congiu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Gianluigi Loi
- Nuclear Medicine Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Livia Fantini
- EEG and Sleep Unit, Neurology Department, CHU Clermont Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
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Fereshtehnejad SM, Yao C, Pelletier A, Montplaisir JY, Gagnon JF, Postuma RB. Evolution of prodromal Parkinson's disease and dementia with Lewy bodies: a prospective study. Brain 2020; 142:2051-2067. [PMID: 31111143 DOI: 10.1093/brain/awz111] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/26/2018] [Accepted: 02/27/2019] [Indexed: 11/13/2022] Open
Abstract
Parkinson's disease has a long prodromal stage with various subclinical motor and non-motor manifestations; however, their evolution in the years before Parkinson's disease is diagnosed is unclear. We traced the evolution of early motor and non-motor manifestations of synucleinopathy from the stage of idiopathic rapid eye movement (REM) sleep behaviour disorder until defined neurodegenerative disease. During 2004-16, we recruited and then annually followed 154 polysomnography-proven patients with idiopathic REM sleep behaviour disorder, of whom 55 phenoconverted to defined parkinsonism or dementia. Longitudinal data on multiple prodromal features, including the Unified Parkinson's Disease Rating Scale parts I-III, quantitative motor tests, olfaction, colour vision, cognition, and autonomic functions were gathered annually (average = five follow-up visits, range: 2-12 years). The same measures were also assessed in 102 age- and sex-matched healthy control subjects. By looking backward from the time of dementia or parkinsonism diagnosis, we examined trajectories of each prodromal feature using mixed effect models. Based on analysis, olfactory loss was first to develop, with predicted onset >20 years before phenoconversion. This was followed by impaired colour vision, constipation, and erectile dysfunction, starting 10-16 years prior to phenoconversion. At 7-9 years before phenoconversion, slight urinary dysfunction and subtle cognitive decline could be detected. Among motor symptoms altered handwriting, turning in bed, walking, salivation, speech, and facial expression began to be disrupted starting 7-11 years prior to parkinsonism diagnosis, but remained mild until soon before phenoconversion. Motor examination abnormalities began 5-7 years before phenoconversion, with the alternate tap test having the longest interval (8 years before phenoconversion). Among cardinal motor phenotypes, bradykinesia appeared first, ∼5-6 years prior to phenoconversion, followed by rigidity (Year -3) and tremor (Year -2). With direct prospective evaluation of an idiopathic REM sleep behaviour disorder cohort during phenoconversion, we documented an evolution of prodromal manifestations similar to that predicted by pathological staging models, with predicted prodromal intervals as long as 20 years.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Chun Yao
- Integrated Program in Neuroscience, McGill University, QC, Canada
| | - Amelie Pelletier
- Research Institute of the McGill University Health Centre, Montreal General Hospital, Department of Neurology, Montreal, QC, Canada
| | - Jacques Y Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada.,Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Ronald B Postuma
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
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Figorilli M, Marques AR, Meloni M, Zibetti M, Pereira B, Lambert C, Puligheddu M, Cicolin A, Lopiano L, Durif F, Fantini ML. Diagnosing REM sleep behavior disorder in Parkinson’s disease without a gold standard: a latent-class model study. Sleep 2020; 43:5815830. [DOI: 10.1093/sleep/zsz323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/21/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
To ascertain whether current diagnostic criteria for REM sleep behavior disorder (RBD) are appropriate in patients with Parkinson’s disease (PD) consulting a movement disorder center, to evaluate the accuracy of REM sleep without atonia (RSWA) thresholds and determine the value of screening questionnaires to discriminate PD patients with RBD.
Methods
One hundred twenty-eight consecutive PD patients (M = 80; mean age: 65.6 ± 8.3 years) underwent screening questionnaires, followed by a sleep-focused interview and a full-night video-polysomnography (vPSG). Without a gold standard, latent class models (LCMs) were applied to create an unobserved (“latent”) variable. Sensitivity analysis was performed using RSWA cutoff derived from two visual scoring methods. Finally, we assessed the respective diagnostic performance of each diagnostic criterion for RBD and of the screening questionnaires.
Results
According to the best LCM-derived model, patients having either “history” or “video” with RSWA or alternatively showing both “history” and “video” without RSWA were classified as having RBD. Using both SINBAR and Montreal scoring methods, RSWA criterion showed the highest sensitivity while concomitant history of RBD and vPSG-documented behaviors, regardless to presence of RSWA, displayed the highest specificity. Currently recommended diagnostic threshold of RSWA was found to be optimal in our large cohort of PD patients. Both the RBD screening questionnaire (RBDSQ) and the RBD single question (RBD1Q) showed poor sensitivity and specificity.
Conclusions
Results of the best LCM for diagnosis of RBD in PD were consistent with the current diagnostic criteria. Moreover, RBD might be considered in those PD patients with both history and vPSG-documented dream enactment behaviors, but with RSWA values within the normal range.
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Affiliation(s)
- Michela Figorilli
- EA 7280, UFR Medicine, University of Clermont Auvergne, Clermont-Ferrand, France
- Sleep Disorder Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Ana R Marques
- EA 7280, UFR Medicine, University of Clermont Auvergne, Clermont-Ferrand, France
- Neurology Department, CHU Clermont-Ferrand, France
| | - Mario Meloni
- Sleep Disorder Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | | | | | | | - Monica Puligheddu
- Sleep Disorder Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Alessandro Cicolin
- Sleep Disorder Center, Department of Neuroscience, University of Turin, Italy
| | | | - Franck Durif
- EA 7280, UFR Medicine, University of Clermont Auvergne, Clermont-Ferrand, France
- Neurology Department, CHU Clermont-Ferrand, France
| | - Maria L Fantini
- EA 7280, UFR Medicine, University of Clermont Auvergne, Clermont-Ferrand, France
- Neurology Department, CHU Clermont-Ferrand, France
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10
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Barone DA, Wang F, Ravdin L, Vo M, Lee A, Sarva H, Hellmers N, Krieger AC, Henchcliffe C. Comorbid neuropsychiatric and autonomic features in REM sleep behavior disorder. Clin Park Relat Disord 2020; 3:100044. [PMID: 34316629 PMCID: PMC8298794 DOI: 10.1016/j.prdoa.2020.100044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 11/28/2022] Open
Abstract
Objective Our aim is to define the extent of comorbidities in order to improve clinical care of patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) utilizing the REM Sleep Behavior Disorder Associations with Parkinson's Disease Study (RAPiDS) cohort. Methods Consecutive adult study participants with iRBD confirmed on polysomnogram (PSG) were prospectively recruited from the Weill Cornell Center for Sleep Medicine. Evaluations comprised multiple facets of sleep, neurological, autonomic, and psychiatric function. Results Participants evaluated included 30 individuals with iRBD, with mean 1.5 ± 2.3 years from PSG to neuropsychiatric evaluation. Mean age was 59.5 ± 16.0 years at time of PSG, and 6/30 were women. Urinary difficulties were reported in 14/30 (47%): slight 7 (23%), mild 4 (13%), moderate 2 (7%), and severe 1 (3.0%). Ten out of 29 (34%) had abnormal Montreal Cognitive Assessment (MoCA) scores and the mean was 26.5 ± 3.2. The distribution of MoCA scores was significantly associated with urinary problems insofar as the more severe urinary problems were, the lower the MoCA scores (p = 0.04). Conclusions In this RAPiDS cohort, we detected an unexpectedly high occurrence of non-motor dysfunction. Our results point to the need for screening patients with iRBD for complaints that are actionable, for example those affecting mood, cognition, urinary function, and bowel function. We propose the term RBD+ to be used to identify such individuals. For the quality of life in patients diagnosed with RBD, a closer look by the clinician should be enacted, with appropriate referrals and workup. Comorbidities in idiopathic rapid eye movement sleep behavior disorder (iRBD) is further defined. REM Sleep Behavior Disorder Associations with Parkinson's Disease Study (RAPiDS) cohort There was a high occurrence of non-motor dysfunction in this cohort. The need for screening patients with iRBD for complaints that are actionable was demonstrated. We proposed the term “RBD+” to be used to identify such individuals.
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Affiliation(s)
- Daniel A. Barone
- Corresponding author at: Weill Cornell Medical College, Center for Sleep Medicine, 425 East 61st 5th Floor, New York, NY 10065, United States of America.
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McGregor MM, Nelson AB. Circuit Mechanisms of Parkinson's Disease. Neuron 2019; 101:1042-1056. [PMID: 30897356 DOI: 10.1016/j.neuron.2019.03.004] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/11/2019] [Accepted: 03/01/2019] [Indexed: 12/27/2022]
Abstract
Parkinson's disease (PD) is a complex, multi-system neurodegenerative disorder. The second most common neurodegenerative disorder after Alzheimer's disease, it affects approximately 1% of adults over age 60. Diagnosis follows the development of one or more of the core motor features of the disease, including tremor, slowing of movement (bradykinesia), and rigidity. However, there are numerous other motor and nonmotor disease manifestations. Many PD symptoms result directly from neurodegeneration; others are driven by aberrant activity patterns in surviving neurons. This latter phenomenon, PD circuit dysfunction, is an area of intense study, as it likely underlies our ability to treat many disease symptoms in the face of (currently) irreversible neurodegeneration. This Review will discuss key clinical features of PD and their basis in neural circuit dysfunction. We will first review important disease symptoms and some of the responsible neuropathology. We will then describe the basal ganglia-thalamocortical circuit, the major locus of PD-related circuit dysfunction, and some of the models that have influenced its study. We will review PD-related changes in network activity, subdividing findings into those that touch on the rate, rhythm, or synchronization of neurons. Finally, we suggest some critical remaining questions for the field and areas for new developments.
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Affiliation(s)
- Matthew M McGregor
- Neuroscience Graduate Program, UCSF, San Francisco, CA 94158, USA; Department of Neurology, UCSF, San Francisco, CA 94158, USA
| | - Alexandra B Nelson
- Neuroscience Graduate Program, UCSF, San Francisco, CA 94158, USA; Department of Neurology, UCSF, San Francisco, CA 94158, USA; Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA; Kavli Institute for Fundamental Neuroscience, UCSF, San Francisco, CA 94158, USA.
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12
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The risk of neurodegeneration in REM sleep behavior disorder: A systematic review and meta-analysis of longitudinal studies. Sleep Med Rev 2019; 43:37-46. [DOI: 10.1016/j.smrv.2018.09.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 01/23/2023]
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13
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Bedard MA, Aghourian M, Legault-Denis C, Postuma RB, Soucy JP, Gagnon JF, Pelletier A, Montplaisir J. Brain cholinergic alterations in idiopathic REM sleep behaviour disorder: a PET imaging study with 18F-FEOBV. Sleep Med 2019; 58:35-41. [PMID: 31078078 DOI: 10.1016/j.sleep.2018.12.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND REM sleep behaviour disorder (RBD) occurs frequently in patients with synucleinopathies such as Parkinson's disease, dementia with Lewy body, or multiple system atrophy, but may also occur as a prodromal stage of those diseases; and is termed idiopathic RBD (iRBD) when not accompanied by other symptoms. Cholinergic degeneration of the mesopontine nuclei have been described in synucleinopathies with or without RBD, but this has not yet been explored in iRBD. We sought to assess cholinergic neuronal integrity in iRBD using PET neuroimaging with the 18F-fluoroethoxybenzovesamicol (FEOBV). METHODS The sample included 10 participants evenly divided between healthy subjects and patients with iRBD. Polysomnography and PET imaging with FEOBV were performed in all participants. Standardized uptake value ratios (SUVRs) were compared between the two groups using voxel wise t-tests. Non-parametric correlations were also computed in patients with iRBD between FEOBV uptake and muscle tonic and phasic activity during REM sleep. RESULTS Compared with healthy participants, significantly higher FEOBV uptakes were observed in patients with iRBD. The largest differences were observed in specific brainstem areas corresponding to the bulbar reticular formation, pontine coeruleus/subcoeruleus complex, tegmental periacqueductal grey, and mesopontine cholinergic nuclei. FEOBV uptake in iRBD was also higher than in controls in the ventromedial area of the thalamus, deep cerebellar nuclei, and some cortical territories (including the paracentral lobule, anterior cingulate, and orbitofrontal cortex). Significant correlation was found between muscle activity during REM sleep, and SUVR increases in both the mesopontine area and paracentral cortex. CONCLUSION We showed here for the first time the brain cholinergic alterations in patients with iRBD. As opposed to the cholinergic depletion described previously in RBD associated with clinical Parkinson's disease, increased cholinergic innervation was found in multiple areas in iRBD. The most significant changes were observed in brainstem areas containing structures involved in the promotion of REM sleep and muscle atonia. This suggests that iRBD might be a clinical condition in which compensatory cholinergic upregulation in those areas occurs in association with the initial phases of a neurodegenerative process leading to a clinically observable synucleinopathy.
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Affiliation(s)
- Marc-Andre Bedard
- NeuroQAM Centre, Université du Québec à Montréal (UQAM), Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute, Canada
| | - Meghmik Aghourian
- NeuroQAM Centre, Université du Québec à Montréal (UQAM), Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute, Canada
| | - Camille Legault-Denis
- NeuroQAM Centre, Université du Québec à Montréal (UQAM), Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Canada; Department of Neurology and Neurosurgery, McGill University, Canada
| | - Jean-Paul Soucy
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Canada; Department of Radiology and Nuclear Medicine, Université de Montréal, Canada; PERFORM Centre, Concordia University, Canada
| | - Jean-François Gagnon
- NeuroQAM Centre, Université du Québec à Montréal (UQAM), Canada; Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Canada
| | - Amélie Pelletier
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Canada; Department of Psychiatry, Université de Montréal, Canada.
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de Natale ER, Ginatempo F, Laccu I, Figorilli M, Manca A, Mercante B, Puligheddu M, Deriu F. Vestibular Evoked Myogenic Potentials Are Abnormal in Idiopathic REM Sleep Behavior Disorder. Front Neurol 2018; 9:911. [PMID: 30420831 PMCID: PMC6215837 DOI: 10.3389/fneur.2018.00911] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives: To investigate brainstem function in idiopathic REM sleep Behavior Disorder (iRBD), a condition occurring as a result of a derangement of connections within brainstem structures, with a battery of Vestibular Evoked Myogenic Potentials (VEMPs), neurophysiological tools suited for the functional investigation of the brainstem. Neurophysiological data were correlated with clinical characteristics of patients. Methods: Twenty patients with iRBD and 22 healthy controls underwent cervical (cVEMP), masseter (mVEMP) and ocular (oVEMP) VEMP recording. Patients were assessed clinically according to presence of motor as well as non-motor symptoms such as constipation, depression, and hyposmia. Also, they were screened for postural instability through the Berg Balance Scale (BBS). VEMPs were categorized as for increasing degrees of abnormalities, namely latency delay, amplitude reduction and absence; a VEMP score was built accordingly. Results: Compared with controls, iRBD had higher rates of abnormalities both in the VEMP battery (iRBD 75%, Controls 23%; p < 0.01) as well as in each single VEMP (cVEMP: 45 vs. 5%; mVEMP: 65 vs. 13.6%; oVEMP: 50 vs. 5%; p < 0.01), which exhibited significantly lower amplitudes (cVEMP and oVEMP: p < 0.0001; mVEMP: p = 0.001) in iRBD. Within altered reflexes, absence was predominant in oVEMP (81%), amplitude reduction in mVEMP (50%) and cVEMP (70%). Severity of VEMP alterations was significantly higher in iRBD compared with controls (p < 0.05 for all VEMPs), as indicated by the larger VEMP scores in the former. The oVEMP score correlated inversely with poor performances on the BBS. Conclusion: VEMPs unveil consistent and extensive brainstem abnormalities in iRBD patients. Further studies are warranted for testing the potential of VEMPs in the monitoring of the evolution of iRBD over time.
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Affiliation(s)
| | | | - Ilaria Laccu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Michela Figorilli
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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15
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Yao C, Fereshtehnejad SM, Dawson BK, Pelletier A, Gan-Or Z, Gagnon JF, Montplaisir JY, Postuma RB. Longstanding disease-free survival in idiopathic REM sleep behavior disorder: Is neurodegeneration inevitable? Parkinsonism Relat Disord 2018; 54:99-102. [DOI: 10.1016/j.parkreldis.2018.04.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022]
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16
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Barone DA, Henchcliffe C. Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clin Neurophysiol 2018; 129:1551-1564. [PMID: 29883833 DOI: 10.1016/j.clinph.2018.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) involves REM sleep without atonia in conjunction with a recurrent nocturnal dream enactment behavior, with vocalizations such as shouting and screaming, and motor behaviors such as punching and kicking. Secondary RBD is well described in association with neurological disorders including Parkinson's disease (PD), multiple system atrophy (MSA), and other conditions involving brainstem structures such as tumors. However, RBD alone is now considered to be a potential harbinger of later development of neurodegenerative disorders, in particular PD, MSA, dementia with Lewy bodies (DLB), and pure autonomic failure. These conditions are linked by their underpinning pathology of alpha-synuclein protein aggregation. In RBD, it is therefore important to recognize the potential risk for later development of an alpha-synucleinopathy, and to investigate for other potential causes such as medications. Other signs and symptoms have been described in RBD, such as orthostatic hypotension, or depression. While it is important to recognize these features to improve patient management, they may ultimately provide clinical clues that will lead to risk stratification for phenoconversion. A critical need is to improve our ability to counsel patients, particularly with regard to prognosis. The ability to identify who, of those with RBD, is at high risk for later neurodegenerative disorders will be paramount, and would in addition advance our understanding of the prodromal stages of the alpha-synucleinopathies. Moreover, recognition of at-risk individuals for neurodegenerative disorders may ultimately provide a platform for the testing of possible neuroprotective agents for these neurodegenerative disorders.
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17
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Génier Marchand D, Montplaisir J, Postuma RB, Rahayel S, Gagnon JF. Detecting the Cognitive Prodrome of Dementia with Lewy Bodies: A Prospective Study of REM Sleep Behavior Disorder. Sleep 2017; 40:2660407. [PMID: 28364450 DOI: 10.1093/sleep/zsw014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2016] [Indexed: 11/12/2022] Open
Abstract
Study Objectives Long-term studies in REM sleep behavior disorder (RBD) have shown a high rate of conversion into synucleinopathies. We aimed to prospectively follow-up a large cohort of RBD patients to identify cognitive markers for early detection of prodromal dementia. Methods Seventy-six idiopathic RBD patients underwent polysomnography and a complete neuropsychological and neurological assessment and were then followed for a mean of 3.6 years. Cognitive characteristics at baseline were compared between patients who remained disease-free and those who developed a synucleinopathy, and between those who developed dementia first and those who developed parkinsonism first. Receiver operating characteristic curves were calculated to assess the diagnostic value of cognitive tests for detecting prodromal dementia. Results At follow-up, 34 patients developed a neurodegenerative disease: 19 parkinsonism-first and 15 dementia-first. RBD patients who first developed dementia were impaired at baseline in all cognitive domains (attention/executive functions, learning/memory, and visuospatial) compared to patients who developed parkinsonism. Moreover, 93% of patients who first developed dementia had mild cognitive impairment at baseline compared to 42% of patients who developed parkinsonism. RBD patients who developed parkinsonism first were similar at baseline to disease-free RBD patients on cognition. In dementia-first patients, two cognitive tests assessing attention and executive functions (Stroop Color Word Test and Trail Making Test) reliably predicted dementia (area under the curve ≥0.85) compared to parkinsonism-first patients or controls. Conclusions This study shows that cognitive tests assessing attention and executive functions strongly predict conversion to dementia in RBD patients, and may be useful endpoints to determine the effectiveness of interventions to prevent cognitive deterioration in RBD patients.
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Affiliation(s)
- Daphné Génier Marchand
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Shady Rahayel
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
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18
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Chiaro G, Calandra-Buonaura G, Cecere A, Mignani F, Sambati L, Loddo G, Cortelli P, Provini F. REM sleep behavior disorder, autonomic dysfunction and synuclein-related neurodegeneration: where do we stand? Clin Auton Res 2017; 28:519-533. [PMID: 28871332 DOI: 10.1007/s10286-017-0460-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/20/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION From newfound parasomnia to a marker of future synucleinopathy, since its first description in 1986, REM sleep behavior disorder (RBD) has been systematically tackled from virtually many viewpoints in basic, translational, and clinical studies. The time delay between RBD and synucleinopathy onset offers an exceptional window for observation and design of neuroprotective trials. In the last few years, research has focused on characterizing possible differences within RBD patients in order to draw potential profiles more or less susceptible to further neurodegeneration. Attention has been drawn towards autonomic dysfunction in RBD as one of such variables. OVERVIEW In this review, REM sleep physiology and relevant brain anatomy is briefly mentioned and integrated with neuroanatomical and physiological concepts regarding the central autonomic network. A detailed summary of works showing the presence of autonomic dysfunction in RBD is provided, and clinical and electrophysiological features of RBD in synucleinopathies are discussed. A short overview of RBD in other neurodegenerative diseases is also provided.
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Affiliation(s)
- Giacomo Chiaro
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3, 40139, Bologna, Italy.,Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3, 40139, Bologna, Italy.,IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Annagrazia Cecere
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Francesco Mignani
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Luisa Sambati
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3, 40139, Bologna, Italy.,IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3, 40139, Bologna, Italy.,IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3, 40139, Bologna, Italy. .,IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy.
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19
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Fereshtehnejad SM, Montplaisir JY, Pelletier A, Gagnon JF, Berg D, Postuma RB. Validation of the MDS research criteria for prodromal Parkinson's disease: Longitudinal assessment in a REM sleep behavior disorder (RBD) cohort. Mov Disord 2017; 32:865-873. [DOI: 10.1002/mds.26989] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Department of Neurology and Neurosurgery; McGill University; Montreal Québec Canada
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet; Stockholm Sweden
| | - Jacques Y. Montplaisir
- Centre for Advanced Research in Sleep Medicine; Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
- Department of Psychiatry; Université de Montréal; Montreal Québec Canada
| | - Amelie Pelletier
- Research Institute of the McGill University Health Centre, Montreal General Hospital, Department of Neurology; Montreal Québec Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine; Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
- Department of Psychology; Université du Québec à Montréal; Montreal Québec Canada
| | - Daniela Berg
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research, University of Tuebingen; Tuebingen Germany
| | - Ronald B. Postuma
- Department of Neurology and Neurosurgery; McGill University; Montreal Québec Canada
- Centre for Advanced Research in Sleep Medicine; Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
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20
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Blesa J, Trigo-Damas I, del Rey NLG, Obeso JA. The use of nonhuman primate models to understand processes in Parkinson’s disease. J Neural Transm (Vienna) 2017; 125:325-335. [DOI: 10.1007/s00702-017-1715-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
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21
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Szatmari S, Illigens BMW, Siepmann T, Pinter A, Takats A, Bereczki D. Neuropsychiatric symptoms in untreated Parkinson's disease. Neuropsychiatr Dis Treat 2017; 13:815-826. [PMID: 28352181 PMCID: PMC5360401 DOI: 10.2147/ndt.s130997] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neuropsychiatric and cognitive symptoms are common in Parkinson's disease (PD) and may precede and exceed motor symptoms as major factors impacting disease course and quality of life. Neuropsychiatric symptoms (NPS) in PD are various and are attributed to pathologic changes within multiple brain regions, to psychological stress, and to adverse effects of dopamine replacement therapy. Sleep disorders and mood symptoms such as apathy, depression, and anxiety may antedate the development of motor symptoms by years, while other NPS such as impulse control disorders, psychosis, and cognitive impairment are more common in later stages of the disease. Few studies report on NPS in the early, untreated phase of PD. We reviewed the current literature on NPS in PD with a focus on the early, drug-naive stages of PD. Among these early disease stages, premotor and early motor phases were separately addressed in our review, highlighting the underlying pathophysiological mechanisms as well as epidemiological characteristics, clinical features, risk factors, and available techniques of clinical assessment.
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Affiliation(s)
- Szabolcs Szatmari
- Department of Neurology, Sibiu County Emergency Hospital, Sibiu; 2nd Department of Neurology, Targu Mures Emergency Clinical County Hospital, Targu Mures, Romania; János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Alexandra Pinter
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Family Medicine
| | - Annamaria Takats
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
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22
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Figorilli M, Ferri R, Zibetti M, Beudin P, Puligheddu M, Lopiano L, Cicolin A, Durif F, Marques A, Fantini ML. Comparison Between Automatic and Visual Scorings of REM Sleep Without Atonia for the Diagnosis of REM Sleep Behavior Disorder in Parkinson Disease. Sleep 2016; 40:2666712. [DOI: 10.1093/sleep/zsw060] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Wan Y, Luo Y, Gan J, Hu R, Zhou M, Liu Z. Clinical markers of neurodegeneration in Chinese patients with idiopathic rapid eye movement sleep behavior disorder. Clin Neurol Neurosurg 2016; 150:105-109. [PMID: 27614794 DOI: 10.1016/j.clineuro.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 08/30/2016] [Accepted: 09/02/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE It is reported that neurodegenerative markers of Parkinson's disease occur in patients with idiopathic rapid eye movement sleep behavior disorder (idiopathic RBD); however, it has been unknown in Chinese patients. This study aims to provide a detailed understanding of the clinical features of Chinese patients with idiopathic RBD. METHODS We conducted a series of Parkinson related motor and non-motor assessments in 181 participants including 41 patients with idiopathic RBD, 35 Parkinson's patients without RBD, 42 Parkinson's patients with RBD, and 63 healthy controls. The RBD questionnaire -Hong Kong (RBDQ-HK) was used to confirm clinical RBD symptoms and evaluate the severity. Motor function including Unified Parkinson's disease Rating Scale (UPDRS), alternative tap test, Purdue Pegboard test and Timed Up and Go test, and non-motor functions including olfaction, cognition, and autonomic function were assessed in each group. RESULTS Motor assessments of UPDRS, Purdue Pegboard, and Timed Up and Go, and the systolic blood pressure (BP) drop in patients with idiopathic RBD were intermediate between controls and Parkinson's patients. However, the alternative tap test and some non- motor functions including olfaction and orthostatic symptoms in idiopathic RBD were impaired as seriously as in Parkinson's disease. No difference was found in urinary and bowel function between idiopathic RBD and controls. In idiopathic RBD, functional impairment was associated with age and the severity of RBD symptoms (p<0.05). In addition, systolic BP drops closely correlated to motor function and bowel function (p<0.05). CONCLUSIONS Chinese patients with idiopathic RBD demonstrated an extensive and heterogeneous functional impairment. The association between functional impairment and age and the severity of RBD symptoms needs to be determined in future studies.
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Affiliation(s)
- Ying Wan
- Department of Neurology, Xinhua Hospital affiliated to Shanghai, JiaoTong University School of Medicine, Shanghai, 200092, China
| | - Yi Luo
- Department of Neurology, Xinhua Hospital affiliated to Shanghai, JiaoTong University School of Medicine, Shanghai, 200092, China
| | - Jing Gan
- Department of Neurology, Xinhua Hospital affiliated to Shanghai, JiaoTong University School of Medicine, Shanghai, 200092, China
| | - Rongguo Hu
- Department of Neurology, Xinhua Hospital affiliated to Shanghai, JiaoTong University School of Medicine, Shanghai, 200092, China
| | - Mingzhu Zhou
- Department of Neurology, Xinhua Hospital affiliated to Shanghai, JiaoTong University School of Medicine, Shanghai, 200092, China
| | - Zhenguo Liu
- Department of Neurology, Xinhua Hospital affiliated to Shanghai, JiaoTong University School of Medicine, Shanghai, 200092, China.
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Lu S, Shaffery JP, Pang Y, Tien LT, Fan LW. Rapid Eye Movement Sleep Homeostatic Response: A Potential Marker for Early Detection of Parkinson's Disease. ACTA ACUST UNITED AC 2016; 6. [PMID: 27713856 DOI: 10.4172/2161-0460.1000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Silu Lu
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - James P Shaffery
- Department of Psychiatry and Human Behavior, Animal Behavior Core, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Yi Pang
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Lu-Tai Tien
- School of Medicine, Fu Jen Catholic University, Xinzhuang Dist, New Taipei City 24205, Taiwan
| | - Lir-Wan Fan
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
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25
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Adenosine A2A receptors in the olfactory bulb suppress rapid eye movement sleep in rodents. Brain Struct Funct 2016; 222:1351-1366. [DOI: 10.1007/s00429-016-1281-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 07/26/2016] [Indexed: 12/25/2022]
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Berg D, Postuma RB, Adler CH, Bloem BR, Chan P, Dubois B, Gasser T, Goetz CG, Halliday G, Joseph L, Lang AE, Liepelt-Scarfone I, Litvan I, Marek K, Obeso J, Oertel W, Olanow CW, Poewe W, Stern M, Deuschl G. MDS research criteria for prodromal Parkinson's disease. Mov Disord 2016; 30:1600-11. [PMID: 26474317 DOI: 10.1002/mds.26431] [Citation(s) in RCA: 815] [Impact Index Per Article: 101.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
This article describes research criteria and probability methodology for the diagnosis of prodromal PD. Prodromal disease refers to the stage wherein early symptoms or signs of PD neurodegeneration are present, but classic clinical diagnosis based on fully evolved motor parkinsonism is not yet possible. Given the lack of clear neuroprotective/disease-modifying therapy for prodromal PD, these criteria were developed for research purposes only. The criteria are based upon the likelihood of prodromal disease being present with probable prodromal PD defined as ≥80% certainty. Certainty estimates rely upon calculation of an individual's risk of having prodromal PD, using a Bayesian naïve classifier. In this methodology, a previous probability of prodromal disease is delineated based upon age. Then, the probability of prodromal PD is calculated by adding diagnostic information, expressed as likelihood ratios. This diagnostic information combines estimates of background risk (from environmental risk factors and genetic findings) and results of diagnostic marker testing. In order to be included, diagnostic markers had to have prospective evidence documenting ability to predict clinical PD. They include motor and nonmotor clinical symptoms, clinical signs, and ancillary diagnostic tests. These criteria represent a first step in the formal delineation of early stages of PD and will require constant updating as more information becomes available.
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Affiliation(s)
- Daniela Berg
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Charles H Adler
- The Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Piu Chan
- Xuanwu Hospital of Capitol of Medical University, Beijing, China
| | | | - Thomas Gasser
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | | | - Glenda Halliday
- Neuroscience Research Australia & University of NSW, Randwick, Australia
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Anthony E Lang
- Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - José Obeso
- University of Navarra-FIMA, Pamplona, Spain
| | - Wolfgang Oertel
- Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - C Warren Olanow
- Department of Neurology, The Mount Sinai Hospital, New York, New York, USA
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Matthew Stern
- Penn Neurological Institute, Philadelphia, Pennsylvania, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
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Network and Pathway-Based Analyses of Genes Associated with Parkinson's Disease. Mol Neurobiol 2016; 54:4452-4465. [PMID: 27349437 DOI: 10.1007/s12035-016-9998-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/14/2016] [Indexed: 01/08/2023]
Abstract
Parkinson's disease (PD) is a major neurodegenerative disease influenced by both genetic and environmental factors. Although previous studies have provided insights into the significant impacts of genetic factors on PD, the molecular mechanism underlying PD remains largely unclear. Under such situation, a comprehensive analysis focusing on biological function and interactions of PD-related genes will provide us valuable information to understand the pathogenesis of PD. In the current study, by reviewing the literatures deposited in PUBMED, we identified 242 genes genetically associated with PD, referred to as PD-related genes gene set (PDgset). Functional analysis revealed that biological processes and biochemical pathways related to neurodevelopment, metabolism, and immune system were enriched in PDgset. Then, pathway crosstalk analysis indicated that the enriched pathways could be grouped into two modules, with one module consisted of pathways mainly involved in neuronal signaling and another in immune response. Further, based on a global human interactome, we found that PDgset tended to have more moderate degree compared with cancer-related genes. Moreover, PD-specific molecular network was inferred using Steiner minimal tree algorithm and some potential related genes associated with PD were identified. In summary, by using network- and pathway-based methods to explore pathogenetic mechanism underlying PD, results from our work may have important implications for understanding the molecular mechanism underlying PD. Also, the framework proposed in our current work can be used to infer pathological molecular network and genes related to a specific disease.
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Postuma RB, Pelletier A, Berg D, Gagnon JF, Escudier F, Montplaisir J. Screening for prodromal Parkinson's disease in the general community: a sleep-based approach. Sleep Med 2016; 21:101-5. [PMID: 27448479 DOI: 10.1016/j.sleep.2015.12.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE/BACKGROUND Neuroprotective therapy for Parkinson's disease (PD) is most likely to be effective if provided in its prodromal stages. However, identifying prodromal PD is difficult because PD is relatively uncommon, and most markers are nonspecific. Rapid eye movement (REM) sleep behavior disorder (RBD) is by far the strongest clinical marker of prodromal PD, but most patients do not seek out medical attention. Developing an efficient way of diagnosing RBD from the general community may be the most practical method to detect prodromal PD. METHODS We developed a screening strategy that began with a newspaper advertisement containing a single-question screen for RBD. All screen-positive subjects underwent an interview based on the Innsbruck RBD inventory aimed to optimize the positive predictive value. Those who passed both screens underwent confirmatory polysomnography. The proportion of screened RBD patients who met the International Parkinson and Movement Disorder Society (MDS) criteria for prodromal PD was assessed. A broad array of clinical markers of neurodegeneration was compared between newspaper-screened RBD patients and 130 RBD patients clinically referred to the sleep center. RESULTS Of 111 RBD-screen-positive participants, 40 (36%) passed the secondary screen, and 29 underwent full polysomnography. Of these 29 patients, 19 were ultimately proven to have RBD (PPV = 66%), 12 (63%) of whom met the criteria for prodromal PD. Compared to patients referred to the sleep center, newspaper-screened patients had similar age, sex, olfaction, autonomic function, and color vision. However, motor and cognitive assessments were slightly better in newspaper-screened patients. CONCLUSIONS A multistep screening approach using RBD screening questionnaires and telephone follow-up can efficiently identify prodromal PD in the general community.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada; Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Amelie Pelletier
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada; Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Daniela Berg
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jean-Francois Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Frédérique Escudier
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Jacques Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada.
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Abstract
OBJECTIVES The aim of this article is to draw attention to the clinical importance of disordered sleep in psychiatry and to demonstrate the growing awareness of medical illness as a complication of disordered sleep. As background to these main objectives, some general points are made to illustrate present-day approaches to the common and often serious problem of sleep disturbance. METHODS The review is based on a literature search from which key publications were selected to illustrate, in turn, main connections between disordered sleep and psychiatric and medical conditions. RESULTS Many such connections are described. Throughout psychiatry, regarding patients whatever their age, these connections have implications for clinical assessment and management. Emphasis is placed on the risk of misdiagnosis of sleep disorders as psychiatric or medical conditions. Examples of this are provided. The growing evidence that disordered sleep can predispose to medical illness is discussed. CONCLUSION As the subject of sleep and its disorders is particular relevant in psychiatry, a working knowledge of modern sleep medicine is important in all branches of psychiatric and other medical practice as well as in clinical research.
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Postuma RB, Gagnon JF, Bertrand JA, Génier Marchand D, Montplaisir JY. Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials. Neurology 2015; 84:1104-13. [PMID: 25681454 PMCID: PMC4371408 DOI: 10.1212/wnl.0000000000001364] [Citation(s) in RCA: 307] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 11/19/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To precisely delineate clinical risk factors for conversion from idiopathic REM sleep behavior disorder (RBD) to Parkinson disease, dementia with Lewy bodies, and multiple system atrophy, in order to enable practical planning and stratification of neuroprotective trials against neurodegenerative synucleinopathy. METHODS In a 10-year prospective cohort, we tested prodromal Parkinson disease markers in 89 patients with idiopathic RBD. With Kaplan-Meier analysis, we calculated risk of neurodegenerative synucleinopathy, and using Cox proportional hazards, tested the ability of prodromal markers to identify patients at higher disease risk. By combining predictive markers, we then designed stratification strategies to optimally select patients for definitive neuroprotective trials. RESULTS The risk of defined neurodegenerative synucleinopathy was high: 30% developed disease at 3 years, rising to 66% at 7.5 years. Advanced age (hazard ratio [HR] = 1.07), olfactory loss (HR = 2.8), abnormal color vision (HR = 3.1), subtle motor dysfunction (HR = 3.9), and nonuse of antidepressants (HR = 3.5) identified higher risk of disease conversion. However, mild cognitive impairment (HR = 1.8), depression (HR = 0.63), Parkinson personality, treatment with clonazepam (HR = 1.3) or melatonin (HR = 0.55), autonomic markers, and sex (HR = 1.37) did not clearly predict clinical neurodegeneration. Stratification with prodromal markers increased risk of neurodegenerative disease conversion by 200%, and combining markers allowed sample size reduction in neuroprotective trials by >40%. With a moderately effective agent (HR = 0.5), trials with fewer than 80 subjects per group can demonstrate definitive reductions in neurodegenerative disease. CONCLUSIONS Using stratification with simply assessed markers, it is now not only possible, but practical to include patients with RBD in neuroprotective trials against Parkinson disease, multiple system atrophy, and dementia with Lewy bodies.
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Affiliation(s)
- Ronald B Postuma
- From the Department of Neurology (R.B.P.), McGill University, Montreal General Hospital; Centre d'Études Avancées en Médecine du Sommeil (R.B.P., J.-F.G., J.-A.B., D.G.M., J.Y.M.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (J.-F.G.), Université du Québec à Montréal; and Department of Psychiatry (J.Y.M.), Université de Montréal, Canada
| | - Jean-Francois Gagnon
- From the Department of Neurology (R.B.P.), McGill University, Montreal General Hospital; Centre d'Études Avancées en Médecine du Sommeil (R.B.P., J.-F.G., J.-A.B., D.G.M., J.Y.M.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (J.-F.G.), Université du Québec à Montréal; and Department of Psychiatry (J.Y.M.), Université de Montréal, Canada
| | - Josie-Anne Bertrand
- From the Department of Neurology (R.B.P.), McGill University, Montreal General Hospital; Centre d'Études Avancées en Médecine du Sommeil (R.B.P., J.-F.G., J.-A.B., D.G.M., J.Y.M.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (J.-F.G.), Université du Québec à Montréal; and Department of Psychiatry (J.Y.M.), Université de Montréal, Canada
| | - Daphné Génier Marchand
- From the Department of Neurology (R.B.P.), McGill University, Montreal General Hospital; Centre d'Études Avancées en Médecine du Sommeil (R.B.P., J.-F.G., J.-A.B., D.G.M., J.Y.M.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (J.-F.G.), Université du Québec à Montréal; and Department of Psychiatry (J.Y.M.), Université de Montréal, Canada
| | - Jacques Y Montplaisir
- From the Department of Neurology (R.B.P.), McGill University, Montreal General Hospital; Centre d'Études Avancées en Médecine du Sommeil (R.B.P., J.-F.G., J.-A.B., D.G.M., J.Y.M.), Hôpital du Sacré-Cœur de Montréal; Department of Psychology (J.-F.G.), Université du Québec à Montréal; and Department of Psychiatry (J.Y.M.), Université de Montréal, Canada.
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Oh YS, Kim JS, Park IS, Shim YS, Song IU, Park JW, Lee PH, Lyoo CH, Ahn TB, Ma HI, Kim YD, Koh SB, Lee SJ, Lee KS. Prevalence and treatment pattern of Parkinson's disease dementia in Korea. Geriatr Gerontol Int 2015; 16:230-6. [DOI: 10.1111/ggi.12457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Yoon-Sang Oh
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Joong-Seok Kim
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - In-Seok Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Yong-Soo Shim
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - In-Uk Song
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Jeong-Wook Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Phil-Hyu Lee
- Department of Neurology; Yonsei University College of Medicine; Seoul Korea
| | - Chul-Hyung Lyoo
- Department of Neurology; Yonsei University College of Medicine; Seoul Korea
| | - Tae-Beom Ahn
- Department of Neurology; School of Medicine; Kyung Hee University; Seoul Korea
| | - Hyo-Il Ma
- Department of Neurology; Hallym University College of Medicine; Anyang Korea
| | - Yong-Duk Kim
- Department of Neurology; Konyang University Hospital; College of Medicine; Konyang University; Daejeon Korea
| | - Seong-Beom Koh
- Department of Neurology; Korea University College of Medicine; Seoul Korea
| | - Seung-Jae Lee
- Department of Neurology; Sejong General Hospital; Bucheon Korea
| | - Kwang-Soo Lee
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
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Grover S, Somaiya M, Kumar S, Avasthi A. Psychiatric aspects of Parkinson's disease. J Neurosci Rural Pract 2015; 6:65-76. [PMID: 25552854 PMCID: PMC4244792 DOI: 10.4103/0976-3147.143197] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Somaiya
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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dos Santos AB, Kohlmeier KA, Barreto GE. Are Sleep Disturbances Preclinical Markers of Parkinson’s Disease? Neurochem Res 2014; 40:421-7. [DOI: 10.1007/s11064-014-1488-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Sleep/wake problems in Parkinson’s disease: pathophysiology and clinicopathologic correlations. J Neural Transm (Vienna) 2014; 121 Suppl 1:S3-13. [DOI: 10.1007/s00702-014-1239-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/06/2014] [Indexed: 11/25/2022]
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Berg D, Postuma RB, Bloem B, Chan P, Dubois B, Gasser T, Goetz CG, Halliday GM, Hardy J, Lang AE, Litvan I, Marek K, Obeso J, Oertel W, Olanow CW, Poewe W, Stern M, Deuschl G. Time to redefine PD? Introductory statement of the MDS Task Force on the definition of Parkinson's disease. Mov Disord 2014; 29:454-62. [PMID: 24619848 PMCID: PMC4204150 DOI: 10.1002/mds.25844] [Citation(s) in RCA: 314] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 12/12/2022] Open
Abstract
With advances in knowledge disease, boundaries may change. Occasionally, these changes are of such a magnitude that they require redefinition of the disease. In recognition of the profound changes in our understanding of Parkinson's disease (PD), the International Parkinson and Movement Disorders Society (MDS) commissioned a task force to consider a redefinition of PD. This review is a discussion article, intended as the introductory statement of the task force. Several critical issues were identified that challenge current PD definitions. First, new findings challenge the central role of the classical pathologic criteria as the arbiter of diagnosis, notably genetic cases without synuclein deposition, the high prevalence of incidental Lewy body (LB) deposition, and the nonmotor prodrome of PD. It remains unclear, however, whether these challenges merit a change in the pathologic gold standard, especially considering the limitations of alternate gold standards. Second, the increasing recognition of dementia in PD challenges the distinction between diffuse LB disease and PD. Consideration might be given to removing dementia as an exclusion criterion for PD diagnosis. Third, there is increasing recognition of disease heterogeneity, suggesting that PD subtypes should be formally identified; however, current subtype classifications may not be sufficiently robust to warrant formal delineation. Fourth, the recognition of a nonmotor prodrome of PD requires that new diagnostic criteria for early-stage and prodromal PD should be created; here, essential features of these criteria are proposed. Finally, there is a need to create new MDS diagnostic criteria that take these changes in disease definition into consideration.
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Affiliation(s)
- Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Center of Neurodegenerative DiseasesTuebingen, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal General HospitalMontreal, Quebec, Canada
| | - Bastiaan Bloem
- Department of Neurology, Radboud University Nijmegen Medical CenterNijmegen, the Netherlands
| | - Piu Chan
- Xuanwu Hospital of Capital Medical UniversityBeijing, People's Republic of China
| | - Bruno Dubois
- Department of neurology, Salpêtrière Hospital, APHP, University Paris 6UPMC, Paris, France
| | - Thomas Gasser
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Center of Neurodegenerative DiseasesTuebingen, Germany
| | | | - Glenda M Halliday
- Neuroscience Research, Randwick, Australia and the University of New South WalesSydney, Australia
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of NeurologyLondon, UK
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital and the University of TorontoToronto, Canada
| | - Irene Litvan
- Department of Neurosciences, University of California San DiegoLa Jolla, California, USA
| | - Kenneth Marek
- Institute for Neurodegenerative DisordersNew Haven, Connecticut, USA
| | - José Obeso
- University of Navarra-FIMAPamplona, Spain
| | - Wolfgang Oertel
- Department of Neurology, Philipps University of MarburgMarburg, Germany
| | - C Warren Olanow
- Department of Neurology, The Mount Sinai HospitalNew York, New York, USA
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical UniversityInnsbruck, Austria
| | - Matthew Stern
- Penn Neurological InstitutePhiladelphia, Pennsylvania, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts UniversityKiel, Germany
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Postuma RB, Gagnon JF, Tuineaig M, Bertrand JA, Latreille V, Desjardins C, Montplaisir JY. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? Sleep 2013; 36:1579-85. [PMID: 24179289 PMCID: PMC3792373 DOI: 10.5665/sleep.3102] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Antidepressants, among the most commonly prescribed medications, trigger symptoms of REM sleep behavior disorder (RBD) in up to 6% of users. Idiopathic RBD is a very strong prodromal marker of Parkinson disease and other synuclein-mediated neurodegenerative syndromes. It is therefore critically important to understand whether antidepressant-associated RBD is an independent pharmacologic syndrome or a sign of possible prodromal neurodegeneration. DESIGN Prospective cohort study. SETTING Tertiary sleep disorders center. PARTICIPANTS 100 patients with idiopathic RBD, all with diagnosis confirmed on polysomnography, stratified to baseline antidepressant use, with 45 matched controls. MEASUREMENTS/RESULTS Of 100 patients, 27 were taking antidepressants. Compared to matched controls, RBD patients taking antidepressants demonstrated significant abnormalities of 12/14 neurodegenerative markers tested, including olfaction (P = 0.007), color vision (P = 0.004), Unified Parkinson Disease Rating Scale II and III (P < 0.001 and 0.007), timed up-and-go (P = 0.003), alternate tap test (P = 0.002), Purdue Pegboard (P = 0.007), systolic blood pressure drop (P = 0.029), erectile dysfunction (P = 0.002), constipation (P = 0.003), depression indices (P < 0.001), and prevalence of mild cognitive impairment (13% vs. 60%, P < 0.001). All these abnormalities were indistinguishable in severity from RBD patients not taking antidepressants. However, on prospective follow-up, RBD patients taking antidepressants had a lower risk of developing neurodegenerative disease than those without antidepressant use (5-year risk = 22% vs. 59%, RR = 0.22, 95%CI = 0.06, 0.74). CONCLUSIONS Although patients with antidepressant-associated RBD have a lower risk of neurodegeneration than patients with "purely-idiopathic" RBD, markers of prodromal neurodegeneration are still clearly present. Development of RBD with antidepressants can be an early signal of an underlying neurodegenerative disease.
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Affiliation(s)
- Ronald B. Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Québec, Canada
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Jean-Francois Gagnon
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Maria Tuineaig
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Josie-Anne Bertrand
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montreal, Québec, Canada
| | - Veronique Latreille
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montreal, Québec, Canada
| | - Catherine Desjardins
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Jacques Y. Montplaisir
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montreal, Québec, Canada
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Kovalzon VM, Zavalko IM. The neurochemistry of the sleep-wakefulness cycle and Parkinson’s disease. NEUROCHEM J+ 2013. [DOI: 10.1134/s1819712413030069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Postuma RB, Gagnon JF, Pelletier A, Montplaisir J. Prodromal autonomic symptoms and signs in Parkinson's disease and dementia with Lewy bodies. Mov Disord 2013; 28:597-604. [PMID: 23554107 DOI: 10.1002/mds.25445] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/08/2013] [Accepted: 02/13/2013] [Indexed: 12/14/2022] Open
Abstract
Pathologic staging systems suggest that autonomic dysfunction may be an early manifestation of Parkinson's disease and dementia with Lewy bodies. However, direct evidence is limited, and no prospective studies have measured when autonomic dysfunction starts before disease. Patients with idiopathic rapid eye movement (REM) sleep behavior disorder are at very high risk of developing neurodegenerative synucleinopathy, providing an opportunity to directly observe the development of autonomic dysfunction from prodromal stages of neurodegeneration. Patients with idiopathic REM sleep behavior disorder were followed annually in a prospective cohort that was established in 2004. Urinary, orthostatic, erectile, and constipation symptoms and systolic blood pressure drop from lying to standing were assessed annually. Patients who eventually developed defined synucleinopathy were compared with age-matched controls. The evolution of autonomic measures was assessed with regression analysis to determine when markers first deviated from control values. Sensitivity and specificity of autonomic markers for identification of prodromal disease were calculated. Of 91 patients, 32 developed disease. In prodromal stages, there was substantial autonomic dysfunction observable at least 5 years before diagnosis. On regression analysis, autonomic dysfunction appeared to progress slowly over prodromal periods. The estimated onset of autonomic dysfunction ranged from 11 years to 20 years, and systolic drop (20.4 years) and constipation (15.3 years) had the earliest estimates. Systolic drop, erectile dysfunction, and constipation could identify disease up to 5 years before diagnosis with sensitivity ranging from 50% to 90%. By directly observing development of neurodegenerative synucleinopathy, we confirmed that autonomic dysfunction can occur early in neurodegenerative synucleinopathy, even as long as 20 years before defined disease. © 2013 Movement Disorder Society.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
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Postuma RB, Gagnon JF, Montplaisir JY. REM Sleep Behavior Disorder and Prodromal Neurodegeneration - Where Are We Headed? TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 23532774 PMCID: PMC3607914 DOI: 10.7916/d8n879hs] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/31/2012] [Indexed: 12/03/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of normal atonia during REM sleep, such that patients appear to act out their dreams. The most important implication of research into this area is that patients with idiopathic RBD are at very high risk of developing synuclein-mediated neurodegenerative disease (Parkinson's disease [PD], dementia with Lewy bodies [DLB], and multiple system atrophy), with risk estimates that approximate 40–65% at 10 years. Thus, RBD disorder is a very strong feature of prodromal synucleinopathy. This provides several opportunities for future research. First, patients with REM sleep behavior disorder can be studied to test other predictors of disease, which could potentially be applied to the general population. These studies have demonstrated that olfactory loss, decreased color vision, slowing on quantitative motor testing, and abnormal substantia nigra neuroimaging findings can predict clinical synucleinopathy. Second, prospectively studying patients with RBD allows a completely unprecedented opportunity to directly evaluate patients as they transition into clinical neurodegenerative disease. Studies assessing progression of markers of neurodegeneration in prodromal PD are beginning to appear. Third, RBD are very promising subjects for neuroprotective therapy trials because they have a high risk of disease conversion with a sufficiently long latency, which provides an opportunity for early intervention. As RBD research expands, collaboration between centers will become increasingly essential.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada ; Centre d'Études Avance´es en Me´decine du Sommeil, Hôpital du Sacré-Coeur, Montre´al, Canada
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Jennum P, Frandsen R, Knudsen S. Characteristics of rapid eye movement sleep behavior disorder in narcolepsy. Sleep Biol Rhythms 2013. [DOI: 10.1111/j.1479-8425.2012.00556.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Postuma RB, Gagnon JF. Parkinson's disease - how do sleep and dementia interact? Sleep Med 2013; 14:129-30. [PMID: 23312625 DOI: 10.1016/j.sleep.2012.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/12/2012] [Indexed: 11/15/2022]
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Sasai T, Matsuura M, Inoue Y. Factors associated with the effect of pramipexole on symptoms of idiopathic REM sleep behavior disorder. Parkinsonism Relat Disord 2012; 19:153-7. [PMID: 22989561 DOI: 10.1016/j.parkreldis.2012.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/02/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The clinical effectiveness of pramipexole (PPX), a candidate treatment for idiopathic rapid eye movement sleep behavior disorder (iRBD), varies among individuals. This study investigates factors associated with PPX effectiveness for treating RBD symptoms. METHODS Ninety-eight consecutive patients with RBD who had taken PPX or clonazepam (CNZP) for more than three months were enrolled. Factors associated with PPX effectiveness were examined: the ratio of REM sleep without atonia to total REM sleep (RWA/REM), length of RBD morbidity, frequency of vocalization or abnormal behavior, and Sniffin' Stick Test scores. These factors were also compared among the responders to PPX monotherapy, CNZP monotherapy, and PPX + CNZP combined therapy. RESULTS PPX was efficacious in 61.7% (50/81) of the subject patients. RWA/REM was associated with PPX effectiveness. The cut-off rate of RWA/REM for predicting PPX effectiveness was estimated as 16.8%. Responders to PPX + CNZP combined therapy showed significantly higher RWA/REM and frequency of vocalization or dream enactment behavior than either responders to monotherapy with PPX or to CNZP. CONCLUSION PPX is probably applicable as an alternative to CNZP, especially for mild iRBD cases with a lower rate of RWA. Results of this study suggest that dopaminergic dysfunction can play a role in iRBD pathophysiology.
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Affiliation(s)
- Taeko Sasai
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.
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Rothman SM, Mattson MP. Sleep disturbances in Alzheimer's and Parkinson's diseases. Neuromolecular Med 2012; 14:194-204. [PMID: 22552887 PMCID: PMC4544709 DOI: 10.1007/s12017-012-8181-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/10/2012] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative disorders and exact a burden on our society greater than cardiovascular disease and cancer combined. While cognitive and motor symptoms are used to define AD and PD, respectively, patients with both disorders exhibit sleep disturbances including insomnia, hypersomnia and excessive daytime napping. The molecular basis of perturbed sleep in AD and PD may involve damage to hypothalamic and brainstem nuclei that control sleep-wake cycles. Perturbations in neurotransmitter and hormone signaling (e.g., serotonin, norepinephrine and melatonin) and the neurotrophic factor BDNF likely contribute to the disease process. Abnormal accumulations of neurotoxic forms of amyloid β-peptide, tau and α-synuclein occur in brain regions involved in the regulation of sleep in AD and PD patients, and are sufficient to cause sleep disturbances in animal models of these neurodegenerative disorders. Disturbed regulation of sleep often occurs early in the course of AD and PD, and may contribute to the cognitive and motor symptoms. Treatments that target signaling pathways that control sleep have been shown to retard the disease process in animal models of AD and PD, suggesting a potential for such interventions in humans at risk for or in the early stages of these disorders.
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Affiliation(s)
- Sarah M Rothman
- Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA.
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Postuma RB, Aarsland D, Barone P, Burn DJ, Hawkes CH, Oertel W, Ziemssen T. Identifying prodromal Parkinson's disease: pre-motor disorders in Parkinson's disease. Mov Disord 2012; 27:617-26. [PMID: 22508280 DOI: 10.1002/mds.24996] [Citation(s) in RCA: 382] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increasing recognition that Parkinson's disease (PD) may start outside of the substantia nigra has led to a rapidly expanding effort to define prodromal stages of PD, before motor signs permit classical diagnosis. Many of these efforts center around the identification of clinical non-motor symptoms and signs of disease. There is now direct evidence that olfaction, rapid eye movement (REM) sleep behavior disorder (RBD), constipation, and depression can be present in prodromal PD. In addition, there is suggestive evidence that visual changes, other autonomic symptoms, and subtle cognitive changes may also be present at prodromal stages. A critical issue in utility of these prodromal markers will be assessment of sensitivity, specificity, and positive and negative predictive values. Although these have yet to be fully defined, olfactory deficits, some visual changes, and autonomic symptoms occur in the majority of PD patients at diagnosis, suggesting good potential sensitivity. However, with the exception of RBD and perhaps some specific autonomic measures, specificity, and positive predictive value of these markers may be insufficient to be used alone as identifiers of prodromal disease. The evidence for the utility of olfaction, RBD, autonomic markers, visual changes, mood disorders, and cognitive loss as markers of prodromal PD and the potential sensitivity and specificity of these markers are summarized.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada.
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Nardone R, Bergmann J, Brigo F, Christova M, Kunz A, Seidl M, Tezzon F, Trinka E, Golaszewski S. Functional evaluation of central cholinergic circuits in patients with Parkinson’s disease and REM sleep behavior disorder: a TMS study. J Neural Transm (Vienna) 2012; 120:413-22. [DOI: 10.1007/s00702-012-0888-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 08/03/2012] [Indexed: 01/04/2023]
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Sasai T, Matsuura M, Wing YK, Inoue Y. Validation of the Japanese version of the REM sleep behavior disorder questionnaire (RBDQ-JP). Sleep Med 2012; 13:913-8. [DOI: 10.1016/j.sleep.2012.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/20/2012] [Accepted: 04/21/2012] [Indexed: 10/28/2022]
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Ebben MR, Shahbazi M, Lange DJ, Krieger AC. REM behavior disorder associated with familial amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2012; 13:473-4. [PMID: 22670878 DOI: 10.3109/17482968.2012.673172] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The association between RBD and synucleinopathies is well known. However, the association between RBD and other neuromuscular diseases has not been as well described. Our case study describes two siblings with familial ALS, confirmed by the identification of the L84F mutation in the SOD1 gene, and RDB. We hope this case study will promote future studies on the prevalence of this association and will stimulate research in identifying the underlying pathogenic mechanism.
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Affiliation(s)
- Matthew R Ebben
- Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY 10065, USA.
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Postuma RB, Gagnon JF, Montplaisir JY. REM sleep behavior disorder: From dreams to neurodegeneration. Neurobiol Dis 2012; 46:553-8. [DOI: 10.1016/j.nbd.2011.10.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/22/2011] [Accepted: 10/06/2011] [Indexed: 02/05/2023] Open
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Barber A, Dashtipour K. Sleep Disturbances in Parkinson's Disease With Emphasis on Rapid Eye Movement Sleep Behavior Disorder. Int J Neurosci 2012; 122:407-12. [DOI: 10.3109/00207454.2012.677882] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Postuma RB, Lang AE, Gagnon JF, Pelletier A, Montplaisir JY. How does parkinsonism start? Prodromal parkinsonism motor changes in idiopathic REM sleep behaviour disorder. Brain 2012; 135:1860-70. [PMID: 22561644 DOI: 10.1093/brain/aws093] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Parkinsonism, as a gradually progressive disorder, has a prodromal interval during which neurodegeneration has begun but cardinal manifestations have not fully developed. A systematic direct assessment of this interval has never been performed. Since patients with idiopathic REM sleep behaviour disorder are at very high risk of parkinsonism, they provide a unique opportunity to observe directly the development of parkinsonism. Patients with idiopathic REM sleep behaviour disorder in an ongoing cohort study were evaluated annually with several quantitative motor measures, including the Unified Parkinson's Disease Rating Scale, Purdue Pegboard, alternate-tap test and timed up-and-go. Patients who developed parkinsonism were identified from this cohort and matched according to age to normal controls. Their results on motor testing from the preceding years were plotted, and then assessed with regression analysis, to determine when markers first deviated from normal values. Sensitivity and specificity of quantitative motor markers for diagnosing prodromal parkinsonism were assessed. Of 78 patients, 20 developed parkinsonism. On regression analysis, the Unified Parkinson's Disease Rating Scale first intersected normal values at an estimated 4.5 years before diagnosis. Voice and face akinesia intersected earliest (estimated prodromal interval = 9.8 years), followed by rigidity (4.4 years), gait abnormalities (4.4 years) and limb bradykinesia (4.2 years). Quantitative motor tests intersected normal values at longer prodromal intervals than subjective examination (Purdue Pegboard = 8.6 years, alternate-tap = 8.2, timed up-and-go = 6.3). Using Purdue Pegboard and the alternate-tap test, parkinsonism could be detected with 71-82% sensitivity and specificity 3 years before diagnosis, whereas a Unified Parkinson's Disease Rating Scale score >4 identified prodromal parkinsonism with 88% sensitivity and 94% specificity 2 years before diagnosis. Removal of action tremor scores improved sensitivity to 94% and specificity to 97% at 2 years before diagnosis (cut-off >3). Although distinction between conditions was often difficult, prodromal dementia with Lewy bodies appeared to have a slower progression than Parkinson's disease (prodromal interval = 6.0 versus 3.8 years). Using a cut-off of Unified Parkinson's Disease Rating Scale >3 (excluding action tremor), 25% of patients with 'still-idiopathic' REM sleep behaviour disorder demonstrated evidence of possible prodromal parkinsonism. Therefore, using direct assessment of motor examination before parkinsonism in a REM sleep behaviour disorder, we have estimated a prodromal interval of ∼4.5 years on the Unified Parkinson's Disease Rating Scale; other quantitative markers may detect parkinsonism earlier. Simple quantitative motor measures may be capable of reliably detecting parkinsonism, even before a clinical diagnosis can be made by experienced movement disorders neurologists.
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Affiliation(s)
- R B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
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