Objective: Herein we evaluated the regional selectivity of presynaptic striatal dopaminergic denervation associated with RBD in drug-naive early PD.

Background: REM sleep behavior disorder (RBD) in Parkinson’s disease (PD) is associated with characteristic clinical subtypes and prognosis. In addition, striatum formed neuronal network interplaying with several cortical and subcortical structures which may be involved in PD phenotype.

Method: 123I-FP-CIT PET was done in patients with de novo PD. Satisfaction of all following criteria: acting out of dream including motor behavior or vocal phenotype; witness by a caregiver; confirmation of REM sleep without atonia by polysomnography; and without any offending drug or disease-causing RBD like sleep behavior was considered as RBD group, and counterpart without any factors mentioned above was recruited as a non-RBD group. Specific binding ratio (SBR) of each subregion (anterior and posterior caudate; ventral striatum; posterior and ventral putamen) was measured in more or less affected side, and right or left side of the striatum.

Results: From the consecutive de novo PD patients, 16 patients with RBD and 16 patients without it who met research criteria were enrolled for this study. Age, disease duration, and severity of parkinsonism were not significantly different between patients with RBD and patients without it. SBR of the ventral striatum in the more and less affected side was significantly decreased in the RBD group than in the non-RBD group (p <.05), while other subregions of striatum did not show statistical difference between groups in each more or less affected side. SBR sum of bilateral anterior caudate showed a lower value in the RBD group than in the non-RBD group (p = .046). In the analysis dividing right and left striatum, right anterior caudate and left ventral striatum showed lower value in the RBD group compared to the non-RBD group (p <.05). Attention among the cognitive domains – attention, language, visuospatial, memory, and frontal function – were impaired in the RBD group compared to the non-RBD group.

Conclusion: The existence of RBD in early PD is associated with presynaptic dopaminergic denervation, especially in the ventral striatum and anterior caudate area among the subregions of the striatum, which may be associated with decreased attention in the RBD group.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/striatal-subregion-analysis-associated-with-rem-sleep-behavior-disorder-in-parkinsons-disease/