Objective: We aim to longitudinally evaluate clinical and neurophysiological features of REM sleep behavior disorder (RBD), including REM Sleep Without Atonia (RSWA) in Parkinson’s Disease (PD) patients with RBD (PDRBD) at baseline and after 3-years-follow-up, in order to ascertain whether or not RBD is a stable feature in PD. Moreover, we aim to assess whether the changes of RSWA parallel the clinical progression of PD.

Background: RBD in PD may be associated with a malignant phenotypecharacterized by a heavier burden of disease, in both motor and non-motor domains, and by an increased risk of dementia.(1)However, a remission of RBD symptoms is occasionally observed in PD patients over time. Despite its prognostic value, little is known about the evolution of RBD in PD, regarding both its clinical and neurophysiological features.

Method: Twenty-two (17M, mean age 64.0±6.9years) moderate-to-advanced PD patients (mean PD duration at baseline: 7.6±4.8years) with RBD, underwent one-night video-polysomnographic recording and an extensive clinical and neuropsychological assessment at baseline and after 3-years. RSWA changes were correlated (Pearson or Spearman) to the evolution of clinical and neuropsychological data.

Results: At follow-up, the self-assessed frequency of RBD symptoms increased in 6 patients, decreased in 6 and remained stable in 10, while RSWA measures significantly increased in all subjects. Patients also had worse Hoehn and Yahr stages (p=0.02), higher dopaminergic doses (p=0.05) and they performed significantly worse in phonetic and semantic fluency tests (p=0.02;p=0.04). Changes in RSWA correlated significantly with the increase in dyskinesia (r=0.61,p=0.05) and motor fluctuation (r:0.54,p=0.03) scores, and with the worsening of executive functions (r0.78,p=0.001) and visuo-spatial perception (r=-0.57, p=0.04).

Conclusion: Despite the subjective improvement of RBD symptoms in one-fourth of PD patients, all RSWA measures increased significantly at follow up, and their change correlated with the clinical evolution of motor and non-motor symptoms. Thus, RBD may represent a long-lasting feature in PD and RSWA may be a marker of the disease’s progression.In light of the stability of RBD and its prognostic implication in PD, early PDRBD patients may represent ideal candidates for neuroprotective and disease-modifying trials, when they will be hopefully available.

References: 1.Fereshtehnejad S-M, Romenets SR, Anang JBM, Latreille V, Gagnon J-F, Postuma RB. New Clinical Subtypes of Parkinson Disease and Their Longitudinal Progression: A Prospective Cohort Comparison With Other Phenotypes. JAMA Neurol. 2015 Aug 1;72(8):863.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-rem-sleep-behavior-disorder-change-in-the-progression-of-parkinsons-disease/