Prospective memory impairment in idiopathic REM sleep behavior disorder

Neuropsychological Changes in Isolated REM Sleep Behavior Disorder: A Systematic Review and Meta-analysis of Cross-sectional and Longitudinal Studies

The aim of this meta-analysis is twofold: (a) to assess cognitive impairments in isolated rapid eye movement (REM) sleep behavior disorder (iRBD) patients compared to healthy controls (HC); (b) to quantitatively estimate the risk of developing a neurodegenerative disease in iRBD patients according to baseline cognitive assessment. To address the first aim, cross-sectional studies including polysomnography-confirmed iRBD patients, HC, and reporting neuropsychological testing were included. To address the second aim, longitudinal studies including polysomnography-confirmed iRBD patients, reporting baseline neuropsychological testing for converted and still isolated patients separately were included. The literature search was conducted based on PRISMA guidelines and the protocol was registered at PROSPERO (CRD42021253427). Cross-sectional and longitudinal studies were searched from PubMed, Web of Science, Scopus, and Embase databases. Publication bias and statistical heterogeneity were assessed respectively by funnel plot asymmetry and using I2. Finally, a random-effect model was performed to pool the included studies. 75 cross-sectional (2,398 HC and 2,460 iRBD patients) and 11 longitudinal (495 iRBD patients) studies were selected. Cross-sectional studies showed that iRBD patients performed significantly worse in cognitive screening scores (random-effects (RE) model = -0.69), memory (RE model = -0.64), and executive function (RE model = -0.50) domains compared to HC. The survival analyses conducted for longitudinal studies revealed that lower executive function and language performance, as well as the presence of mild cognitive impairment (MCI), at baseline were associated with an increased risk of conversion at follow-up. Our study underlines the importance of a comprehensive neuropsychological assessment in the context of iRBD.

Cortical and subcortical morphometric changes and their relation to cognitive impairment in isolated REM sleep behavior disorder

OBJECTIVE

To date, very few studies have focused on structural changes and their association with cognitive performance in isolated REM sleep behaviour disorder (iRBD). Moreover, the results of these studies are inconclusive. This study aims to evaluate differences in the associations between brain morphology and cognitive tests in iRBD and healthy controls.

METHODS

Sixty-three patients with iRBD and thirty-six controls underwent MRI with a 3 T scanner. The cognitive performance was assessed by a comprehensive neuropsychological battery. Based on performance, the iRBD group was divided into two subgroups with (iRBD-MCI) and without mild cognitive impairment (iRBD-NC). The high-resolution T1-weighted images were analysed using an automated atlas segmentation tool, voxel-based (VBM) and deformation-based (DBM) morphometry to identify between-group differences and correlations with cognitive performance.

RESULTS

VBM, DBM and the comparison of ROI volumes yielded no significant differences between iRBD and controls. In the iRBD group, significant correlations in VBM were found between several cortical and subcortical structures primarily located in the temporal, parietal, occipital lobe, cerebellum, and basal ganglia and three cognitive tests assessing psychomotor speed and one memory test. Between-group analysis of cognition revealed a significant difference between iRBD-MCI and iRBD-NC in tests including a processing speed component.

CONCLUSIONS

iRBD shows deficits in several cognitive tests that correlate with morphological changes, the most prominent of which is in psychomotor speed and visual attention as measured by the TMT-A and associated with the volume of striatum, insula, cerebellum, temporal lobe, pallidum and amygdala.

Cognitive and motor profiles as prodromal markers in predicting phenoconversion and phenotype in isolated REM sleep behavior disorder

OBJECTIVE

To determine the clinical markers based on cognitive and motor profiles in predicting phenoconverion and phenotype in isolated rapid eye movement sleep behavior disorder (iRBD).

METHODS

45 iRBD patients and 25 healthy controls were included in the follow-up study. All participates received comprehensive evaluations of cognitive, motor and autonomic function at baseline. Positive phenoconversion were identified according to standard diagnostic criteria during follow-up.

RESULTS

21 iRBD patients displayed phenoconversion in a mean follow-up of 2.9 ± 1.6 years, with 14 presenting motor phenotype and 7 cognitive phenotype. In iRBD, visuospatial, memory, attention-executive function, information processing speed, and motor function predicted phenoconversion, with the combination of Trail Making Test (TMT) and Alternate-tap Test (ATT) performing best (sensitivity = 95.0 %, specificity = 75.0 %); attention-executive function, information processing speed, and motor function predicted motor phenotype conversion, with the combination of TMT and ATT performing best (sensitivity = 100 %, specificity = 66.7 %); visuospatial, memory, and attention-executive function predicted cognitive phenotype conversion, with TMT performing best (sensitivity = 83.3 %, specificity = 91.7 %). Furthermore, individuals with lower z-scores of TMT, Symbol Digit Modalities Test, and ATT than the established cutoff values in iRBD exhibited a significantly higher risk for phenoconversion at follow-up (HR = 2.98, 9.53, 11.68; respectively).

CONCLUSIONS

In iRBD, the attention-executive and motor function served as optimum combined markers in predicting phenoconversion and motor phenotype, whereas the attention-executive function performed best in predicting cognitive phenotype. Poor attention-executive function, information processing speed and motor function in iRBD independently increased the risk of phenoconversion.

Aging and time-based prospective memory in the laboratory: a meta-analysis on age-related differences and possible explanatory factors

In older adults' everyday life, time-based prospective memory (TBPM) is relevant as health-related intentions are often part of daily activities. Nonetheless, it is still unclear which task-related factors can potentially moderate the magnitude of age-related differences, such as duration of the PM target time (the time-window within which an individual must complete a given TBPM task), the frequency of the TBPM tasks, and the criterion chosen to compute PM accuracy. The present meta-analysis aimed to quantify age-related differences in laboratory TBPM tasks, and to investigate how specific task-related factors potentially moderate the magnitude of age effects. The results showed that age effects consistently emerged among the studies, with older adults showing lower TBPM performance and checking the clock less often than younger adults, especially for shorter intervals (e.g., ≤ 4 min). Furthermore, the results indicated that the duration of the PM target time interacted with the frequency of the PM task, suggesting that learning effects may attenuate the magnitude of age differences in TBPM performance. The results are discussed in terms of potential implications about the possible cognitive processes involved in TBPM and aging, as well as in terms of robustness of the TBPM laboratory paradigm in aging research.

The Chinese version of the Memory for Intentions Test (MIST): development and evaluation of its reliability and concurrent validity

This study aims to develop a simplified Chinese version of the "Memory for Intentions Test" (MIST), evaluate its reliability and concurrent validity, explore the inter-relationships among the MIST variables and the relationships between the MIST variables and socio-demographic factors.

Two hundred healthy, Chinese-speaking adults of the Han community participated in this study. Form A of the Chinese MIST and two prospective items of the Rivermead Behavioural Memory Test, Second Edition (RBMT-II, Chinese version) were administered to all participants to evaluate internal consistency, split-half reliability, and concurrent validity. Twenty of these participants were assessed twice on Form A with a two-week interval to examine test-retest reliability. They were also assessed on both Form A and Form B to examine alternate-form reliability.

The findings of the study indicated good internal consistency (Cronbach's α = .833) and excellent split-half reliability (r = .924-.930) among the six subscales of the Chinese MIST, although the internal consistency was low (Cronbach's α = .129) for individual PM trials. We also found adequate concurrent validity (ρ = .722, p< .001), test-retest reliability (ρ = .716, p < .001), and alternate-form reliability (ρ= .828, p < .001).

The Chinese MIST demonstrated suitable reliability and concurrent validity in the Chinese-speaking population. The present study provides a new standardized prospective memory test for the Chinese population, which would enhance future clinical research in this field on the Chinese mainland.

Biomarkers of conversion to α-synucleinopathy in isolated rapid-eye-movement sleep behaviour disorder

Patients with isolated rapid-eye-movement sleep behaviour disorder (RBD) are commonly regarded as being in the early stages of a progressive neurodegenerative disease involving α-synuclein pathology, such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy. Abnormal α-synuclein deposition occurs early in the neurodegenerative process across the central and peripheral nervous systems and might precede the appearance of motor symptoms and cognitive decline by several decades. These findings provide the rationale to develop reliable biomarkers that can better predict conversion to clinically manifest α-synucleinopathies. In addition, biomarkers of disease progression will be essential to monitor treatment response once disease-modifying therapies become available, and biomarkers of disease subtype will be essential to enable prediction of which subtype of α-synucleinopathy patients with isolated RBD might develop.

Functional Divergence of Mammalian TFAP2a and TFAP2b Transcription Factors for Bidirectional Sleep Control

Sleep is a conserved behavioral state. Invertebrates typically show quiet sleep, whereas in mammals, sleep consists of periods of nonrapid-eye-movement sleep (NREMS) and REM sleep (REMS). We previously found that the transcription factor AP-2 promotes sleep in Caenorhabditiselegans and Drosophila In mammals, several paralogous AP-2 transcription factors exist. Sleep-controlling genes are often conserved. However, little is known about how sleep genes evolved from controlling simpler types of sleep to govern complex mammalian sleep. Here, we studied the roles of Tfap2a and Tfap2b in sleep control in mice. Consistent with our results from C. elegans and Drosophila, the AP-2 transcription factors Tfap2a and Tfap2b also control sleep in mice. Surprisingly, however, the two AP-2 paralogs play contrary roles in sleep control. Tfap2a reduction of function causes stronger delta and theta power in both baseline and homeostasis analysis, thus indicating increased sleep quality, but did not affect sleep quantity. By contrast, Tfap2b reduction of function decreased NREM sleep time specifically during the dark phase, reduced NREMS and REMS power, and caused a weaker response to sleep deprivation. Consistent with the observed signatures of decreased sleep quality, stress resistance and memory were impaired in Tfap2b mutant animals. Also, the circadian period was slightly shortened. Taken together, AP-2 transcription factors control sleep behavior also in mice, but the role of the AP-2 genes functionally diversified to allow for a bidirectional control of sleep quality. Divergence of AP-2 transcription factors might perhaps have supported the evolution of more complex types of sleep.

Instrumental analysis of finger tapping reveals a novel early biomarker of parkinsonism in idiopathic rapid eye movement sleep behaviour disorder

BACKGROUND

Idiopathic rapid eye movement sleep behaviour (iRBD) is considered as a risk factor for Parkinson's disease (PD) development. Evaluation of repetitive movements with finger tapping, which serves as a principal task to measure the extent of bradykinesia in PD, may undercover potential PD patients. The aim of this study was to explore whether finger tapping abnormalities, evaluated with a 3D motion capture system, are already present in RBD patients.

METHODS

Finger tapping data was acquired using a contactless 3D motion capture system from 40 RBD subjects and compared to 25 de-novo PD patients and 25 healthy controls. Objective assessment of amplitude decrement, maximum opening velocity and their combination representing finger tapping decrement was performed in the sequence of the first ten tapping movements. The association between instrumental finger tapping data and semi-quantitative clinical evaluation was analyzed.

RESULTS

While significant differences between PD and controls were found for all investigated finger tapping measures (p < 0.002), RBD differed from controls in finger tapping amplitude (p = 0.004) and velocity (p = 0.007) decrement but not in maximal opening velocity. A significant relationship between the motor score from the Movement Disorders Society - Unified Parkinson's Disease Rating Scale and finger tapping decrement was shown for both patient groups, ie RBD (r = 0.36, p = 0.02) and PD (r = 0.60, p = 0.002).

CONCLUSIONS

In our group of RBD patients we demonstrated amplitude decrement of repetitive movements, which may correspond with prodromal bradykinesia. Our findings suggest instrumental analysis of finger tapping abnormalities as a potential novel clinical marker reflecting subclinical motor disturbances in RBD.

Comparing different tests to detect early manifestation of prospective memory decline in aging

Objective: Prospective memory (PM) is the ability to remember to perform future intentions. Previous studies have demonstrated that, compared to a younger cohort, healthy older adults have impairments in PM. Considering the importance of early detection of age-related PM decline, the present study aims to compare the performance of healthy older adults using three well-known PM tests commonly used in clinical settings.Method: In the present study, we tested 70 older adults (65-95 years old) using the Cambridge Prospective Memory Test (CAMPROMPT), the Memory for Intentions Screening Test (MIST) and the Royal Prince Alfred Prospective Memory Test (RPA-ProMem). In order to compare performance across tests and the interaction between age and cues, we performed a linear mixed model with random intercept and random slopes. Moreover, additional mixed models with random intercept were run for analyzing the additional information provided by MIST and RPA-ProMem regarding delay responses, response modality effects and type of errors committed.Results: Our data showed a drop in PM performance as age increased detected by all three tests. Furthermore, CAMPROMPT was the most sensitive test to identify differences in PM for event-and time-based cues, at least for participants with 65-77 years old. When data were analyzed in term of delay responses, participants were more accurate for 2 min delay (MIST) and 30 in delay (RPA-ProMem). Participants were less accurate when response modality was "verbal" compared to "action" (MIST) and made more PM errors as age increased.Conclusions: Overall, the study provides important information regarding age-related PM decline and can help researchers as well as clinicians in deciding the preferred test to evaluate PM performance.

Are subjective sleepiness and sleep quality related to prospective memory?

Event-based prospective memory (PM) involves carrying out intentions when specific events occur and is ubiquitous in everyday life. It consists of a prospective component (remembering that something must be done) and a retrospective component (remembering what must be done and when). Subjective sleep-related variables may be related to PM performance and an attention-demanding prospective component. In two studies, the relationship of subjective sleepiness and subjective sleep quality with both PM components was investigated with a laboratory PM task and separation of its components via Bayesian multinomial processing tree modeling. In Study 1, neither component of PM was related to naturally occurring subjective sleepiness or sleep quality. In Study 2, sleepiness was experimentally increased by placing some participants in a supine body posture. Testing participants in upright vs. supine posture affected neither PM component. However, body posture moderated the relationship between subjective sleep quality and the prospective component: In supine posture, subjective sleep quality tended to be more positively related to the prospective component. Overall, neither subjective sleepiness nor subjective sleep quality alone was related to PM.

Prospective memory in clinical populations

OBJECTIVE

Prospective memory (PM) has emerged as a form of episodic memory that is frequently impaired in a variety of clinical populations. Neuropsychologists who routinely evaluate these populations are often unaware of the possibility of PM deficits or the impact these deficits may have on everyday functioning. The objective of this special issue is to provide an overview of the nature of prospective deficits in a range of clinical populations, to discuss neuropsychological assessment techniques, and to critically evaluate management strategies.

METHOD

We solicited papers from established researchers and issued a general call for papers for the special issue on PM in clinical populations.

RESULTS

We received submissions from the nine authors that we solicited. These submissions range from developmental disorders, including autism, attention deficit hyperactivity disorder, and dyslexia; to disorders of adulthood, such as schizophrenia, HIV, brain injury, and multiple sclerosis; and finally disorders that tend to occur at older ages, such as Parkinson's disease and mild cognitive impairment. In addition, we have included four original research articles that provide novel data on other populations. These are children and adolescents with 22q11.2 deletion syndrome, first-degree relatives of people with schizophrenia, individuals with mild brain injury, and individuals with idiopathic REM sleep behavioral disorder.

CONCLUSIONS

The issue highlights the need for clinical neuropsychologists to be aware of the possible existence of deficits in PM in a variety of clinical populations and the importance of both assessment and management strategies to reduce the impact on daily life.

Rapid eye movement sleep mediates age-related decline in prospective memory consolidation

STUDY OBJECTIVES

Prospective memory, or remembering to execute future intentions, accounts for half of everyday forgetting in older adults. Sleep intervals benefit prospective memory consolidation in young adults, but it is unknown whether age-related changes in slow wave activity, sleep spindles, and/or rapid eye movement (REM) sleep mediate hypothesized effects of aging on prospective memory consolidation.

METHODS

After an adaptation night, 76 adults aged 18-84 completed two experimental nights of in-laboratory polysomnography recording. In the evening, participants encoded and practiced a prospective memory task and were tested the next morning. On a counterbalanced night, they encoded and practiced a control task, and were tested the following morning.

RESULTS

Increasing age predicted worse prospective memory consolidation (r = -.34), even when controlling for encoding, speed, and control-task performance (all ps < .05). Frontal delta power, slow oscillations, and spindle density were not related to prospective memory consolidation. REM sleep duration, however, explained significant variance in prospective memory consolidation when controlling for age (∆R2 = .10). Bootstrapping mediation showed that less REM sleep significantly mediated the aging effect on prospective memory consolidation [b = -.0016, SE = 0.0009 (95% confidence interval [CI] = -0.0042 to -0.0004)]. REM sleep continued to mediate 24.29% of the total effect of age on prospective memory after controlling for numerous demographic, cognitive, mental health, and sleep variables.

CONCLUSION

Age-related variance in REM sleep is informative to how prospective memory consolidation changes with increasing age. Future work should consider how both REM sleep and slow wave activity contribute, perhaps in a sequential or dynamic manner, to preserving cognitive functioning with increasing age.

Accuracy of Rating Scales and Clinical Measures for Screening of Rapid Eye Movement Sleep Behavior Disorder and for Predicting Conversion to Parkinson's Disease and Other Synucleinopathies

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by repeated episodes of REM sleep-related vocalizations and/or complex motor behaviors. Definite diagnosis of RBD is based on history and polysomnography, both of which are less accessible due to the lack of trained specialists and high cost. While RBD may be associated with disorders like narcolepsy, focal brain lesions, and encephalitis, idiopathic RBD (iRBD) may convert to Parkinson's disease (PD) and other synucleinopathies in more than 80% of patients and it is to date the most specific clinical prodromal marker of PD. Identification of individuals at high risk for development of PD is becoming one of the most important topics for current PD-related research as well as for future treatment trials targeting prodromal PD. Furthermore, concomitant clinical symptoms, such as subtle motor impairment, hyposmia, autonomic dysfunction, or cognitive difficulties, in subjects with iRBD may herald its phenoconversion to clinically manifest parkinsonism. The assessment of these motor and non-motor symptoms in iRBD may increase the sensitivity and specificity in identifying prodromal PD subjects. This review evaluates the diagnostic accuracy of individual rating scales and validated single items for screening of RBD and the role and accuracy of available clinical, electrophysiological, imaging, and tissue biomarkers in predicting the phenoconversion from iRBD to clinically manifest synucleinopathies.

Relationships between Rapid Eye Movement Sleep Behavior Disorder and Neurodegenerative Diseases: Clinical Assessments, Biomarkers, and Treatment

OBJECTIVE

Rapid eye movement sleep behavior disorder (RBD) is characterized by dream enactment and loss of muscle atonia during rapid eye movement sleep. RBD is closely related to α-synucleinopathies including Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. Many studies have investigated the markers of imaging and neurophysiological, genetic, cognitive, autonomic function of RBD and their predictive value for neurodegenerative diseases. This report reviewed the progress of these studies and discussed their limitations and future research directions.

DATA SOURCES

Using the combined keywords: "RBD", "neurodegenerative disease", "Parkinson disease", and "magnetic resonance imaging", the PubMed/MEDLINE literature search was conducted up to January 1, 2018.

STUDY SELECTION

A total of 150 published articles were initially identified citations. Of the 150 articles, 92 articles were selected after further detailed review. This study referred to all the important English literature in full.

RESULTS

Single-nucleotide polymorphisms in SCARB2 (rs6812193) and MAPT (rs12185268) were significantly associated with RBD. The olfactory loss, autonomic dysfunction, marked electroencephalogram slowing during both wakefulness and rapid eye movement sleep, and cognitive impairments were potential predictive markers for RBD conversion to neurodegenerative diseases. Traditional structural imaging studies reported relatively inconsistent results, whereas reduced functional connectivity between the left putamen and substantia nigra and dopamine transporter uptake demonstrated by functional imaging techniques were relatively consistent findings.

CONCLUSIONS

More longitudinal studies should be conducted to evaluate the predictive value of biomarkers of RBD. Moreover, because the glucose and dopamine metabolisms are not specific for assessing cognitive cognition, the molecular metabolism directly related to cognition should be investigated. There is a need for more treatment trials to determine the effectiveness of interventions of RBD on preventing the conversion to neurodegenerative diseases.