Objective: To assess the natural history of rapid eye movement sleep behavior disorder (RBD) in patients with Parkinson´s disease (PD) and clarify its response to antiparkinsonian medications

Background: RBD is a frequent non-motor symptom in PD usually described as prodromal. The natural history of RBD and its response to antiparkinsonian treatment has not been clarified to date.

Methods: A survey-based study was performed to determine the presence of RBD symptoms, their temporal relationship with PD onset and, the natural history of this disorder. The survey included RBD1Q, the Mayo Sleep and RBDQ-HK questionnaires and questions about clinical characteristics and response to antiparkinsonian treatments. Only patients with partner/caregiver spending night hours in the same room were included

Results: 410 PD patients(p) were included: 206 with RBD (50.2%) and 204 non-RBD (49.8%). RBDp were younger [55.0(±9.6)vs.57.0(±10.7), p=0.045] and their levodopa daily dose (LD) was higher [869.4(±428.9)vs.776.2(±479.9), p=0.039]. 90p with RBD (21.6%) completed all the questionnaires. The majority of these patients developed RBD symptoms after the onset of PD(71.1 vs. 28.9%). This group reached the maximum severity of RBD symptoms faster [46.1(±55.1)vs.121.7(±106.9) months, p<0.0001], patients were younger at disease onset [53.1(±9.4)vs.57.7(±7.4), p=0.0274] and had higher scores in the hallucinations and psychosis subsection of UPDRS I [0.1(±0.3)vs.0.5 (±0.9), p=0.0144]. Comparing non-motor aspects of experiences of daily living the RBD group showed higher scores in the cognition, psychosis, depression, anxiety, apathy, sleep, daytime sleepiness, urinary problems, constipation, light headedness and fatigue subsections, than in the non-RBD group. Impulse control disorders (ICD) were more frequent in the RBD group (31.1vs.20.6%, p=0.015) mainly due to higher compulsive eating and hypersexuality in RBDp. No other differences were found in other clinical characteristics such as UPDRS III and IV. None of the antiparkinsonian medications showed a dramatic effect over RBD symptoms according to our results.

Conclusions: Although RBD has been considered as a prodromal non-motor symptom in PD, the majority of our patients showed symptoms after the onset of PD. RBDp were younger, used higher doses of LD and had more severe non-motor phenotype, including more ICD than those without RBD. Despite the controversies in the effects of dopaminergic treatment on RBD, we have not found a major benefit of this therapy in our cohort of patients; however, results are probably affected by the study design

References: 1. St Louis EK, Boeve BF. Mayo Clin Proc. REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions.2017;92(11):1723-1736. 2. Fantini ML, Figorilli M, Arnulf I et al. Sleep and REM sleep behaviour disorder in Parkinson’s disease with impulse control disorder. J Neurol Neurosurg Psychiatry. 2018;89(3):305-310.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/natural-history-of-rbd-in-parkinsons-disease-and-response-to-dopaminergic-and-non-dopaminergic-antiparkinsonian-treatment/