Clinical markers of early nigrostriatal neurodegeneration in idiopathic rapid eye movement sleep behavior disorder

详细信息    查看全文

• 作者：Sven Rupprecht ; Bj枚rn Walther ; Hilmar Gudziol ; J枚rg Steenbeck ; Martin Freesmeyer ; Otto W. Witte ; Albrecht G眉nther ; Matthias Schwab
• 关键词：REM sleep behavior disorder ; Olfactory dysfunction ; Mild motor abnormalities ; Transcranial sonography ; 123I-FP-CIT SPECT ; 伪-Synucleinopathy ; Diagnostic accuracy
• 刊名：Sleep Medicine
• 出版年：November, 2013
• 年：2013
• 卷：14
• 期：11
• 页码：1064-1070
• 全文大小：311 K

文摘

Background

Rapid eye movement sleep behavior disorder (RBD) is an early feature in 伪 synucleinopathies and may precede other clinical manifestations of disease for several years. Olfactory dysfunction and mild motor abnormalities (MMAs) are highly prevalent in prodromal 伪 synucleinopathies such as RBD and are suspected to be predictive neurodegenerative markers. Because both markers also are highly prevalent in the healthy elderly population, the discriminative value to detect an early neurodegenerative process is unclear.

Methods

We examined 28 patients with idiopathic RBD (iRBD) without manifest neurodegenerative disease to determine diagnostic accuracy of MMAs and olfactory dysfunction in identifying patients with early nigrostriatal degeneration in transcranial sonography (TCS) and ¹²³I-2尾-carbomethoxy-3尾-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane single-photon emission computed tomography (¹²³I-FP-CIT-SPECT).

Results

Sixty-three percent of our participants showed MMAs which were strongly associated with abnormal TCS and ¹²³I-FP-CIT-SPECT findings. The discriminative value in detecting participants with early nigrostriatal degeneration was excellent (area under the receiver operating characteristic [ROC] curve, 0.84 [P 猢?#xA0;.003] for TCS and 0.79 [P 猢?#xA0;.066] for ¹²³I-FP-CIT-SPECT). Olfactory dysfunction was present in 78% of iRBD participants, but it was not linked with neuroimaging abnormalities or MMAs. Olfactory dysfunction did not discriminate participants with early nigrostriatal degeneration (area under the ROC curve, 0.54 [P 猢?#xA0;.747] for TCS and 0.31 [P 猢?#xA0;.225] for ¹²³I-FP-CIT-SPECT). Early RBD manifestation but no demographic (e.g., age, gender) or clinical characteristics of RBD (e.g., duration, severity of RBD) were associated with neuroimaging abnormalities in TCS and ¹²³I-FP-CIT-SPECT.

Conclusions

Unlike olfactory dysfunction, MMAs discriminate patients with early nigrostriatal degeneration in iRBD. Early RBD manifestation seems to be an additional risk factor which aggravates neurodegenerative risk.