Objective: To investigate whether PSG-proven late-onset RBD is associated with the PD symptoms in the Japanese population.

Background: Rapid eye movement sleep behavior disorder (RBD) is a non-motor symptom of Parkinson’s disease (PD) and associated with the clinical manifestations of both motor symptoms and other non-motor symptoms, such as depression, cognition, olfaction and orthostatic hypotension. Furthermore, RBD has been considered as the prodromal marker for PD. However, in some PD patients, RBD develops after the onset of motor symptoms (late-onset RBD). However, there are few reports whether the timing of the onset of RBD affects the PD symptoms, including both motor and non-motor symptoms.

Methods: Thirty-two PD patients who underwent PSG, including 21 patients with late-onset RBD (8 females) and 11 patients without RBD (6 females), were retrospectively evaluated in this study. Evaluation of depression, cognition and olfaction were evaluated by the Beck Depression Inventory-II, Montreal Cognitive Assessment (MoCA), and T&T Olfactometer, respectively. Orthostatic hypotension (OH) was evaluated by the change of blood pressure within the first 3 minutes after standing. The motor symptoms were evaluated by the modified Hoehn and Yahr (mHY) scale.

Results: The baseline demographics data regarding gender, age at the onset of PD and age at the evaluation did not show any difference between these groups. In the late-onset RBD group, RBD developed 5.6±3.8 years after the onset of PD. The score of depression (14.4±6.0 vs 8.5±6.2, p=0.013), olfactory disturbance (3.5±0.7 vs 2.4±1.1, p=0.0018), and change of systolic blood pressure after standing (-17.7±10.9mmHg vs -8.2±11.9mmHg, p=0.03) were statistically higher in PD patients with late-onset RBD. The cognitive assessment did not show the difference between these groups (25.8±3.1 vs 26.6±2.4, p=0.42). For evaluation of motor symptoms, the mHY scale and levodopa equivalent dose (LED) between these groups were not the different (mHY, 2.3±0.6 vs 2.1±1.1, p=0.57; LED 620±300mg vs 515±293mg, p=0.36).

Conclusions: Our study revealed late-onset RBD has a negative impact on psychological symptom, olfactory dysfunction and OH in PD patients. RBD should be evaluated carefully in RBD-free PD patients, and emergence of RBD should be the time to evaluate these symptoms carefully.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-late-onset-rem-sleep-behavior-disorder-on-the-symptoms-of-parkinsons-disease/