Objective: To evaluate the DAT SPECT (Single photon emission computerized tomography of the dopamine transporter) parameters for Parkinson’s disease (PD) patients with REM Sleep Behavior Disorder (RBD) or REM Sleep behavioral Events (RBEs) compared to PD patients with normal REM Sleep.

Background: There is some evidence that PD patients with RBD suffer from a more severe course of the disease. We identified behaviors in REM not fulfilling diagnostic criteria of RBD as REM sleep behavioral events (RBE). As DAT SPECT indirectly reflects the integrity of the nigrostriatal dopaminergic pathway, we investigated whether REM sleep pathology in PD patients is mirrored by DAT SPECT results to test the hypothesis of a more severe nigrostriatal neurodegeneration in these patients at the time of diagnosis of PD.

Methods: All de novo PD patients of the DeNoPa cohort who underwent DAT SPECT in the course of their diagnostic work-up were grouped according to video-polysomnographic assessment of REM pathology: (A) with RBD, (B) with RBE as precursor of RBD and (C) with normal REM sleep. We compared radio-ligand uptake in striatum, caudatum, putamen and the asymmetry indices within the three groups.

Results: 61 PD patients with abnormal DAT SPECT were included: 16 patients were identified with full manifest RBD (A), 15 patients with RBE (B) and 34 patients showed normal REM sleep (C). No differences in radio-ligand uptake (mean and 95%CI) for striatum A:1.5 (1.23 – 1.61), B:1.46 (1.02 – 1.78), C:1.4 (1.19 – 1.77), p=0,956), caudatum (A:1.85 (1.48 – 2.05), B:1.75 (1.38 – 2.19), C:1.75 (1.55 – 2.1), p=0,982) or putamen (A:1.13 (0.82 – 1.21), B:1.17 (0.75 – 1.4), C: 1.06 (0.84 – 1.31), p=0,954) were noted. Neither did the asymmetry index differ between the groups (mean and 95%CI): striatum A: 0.11 (0.03 – 0.19), B:0.17 (0.15 – 0.24), C:0.14 (0.06 – 0.22), p=0,103, caudatum A:0.13 (0.04 – 0.17), B:0.12 (0.1 – 0.18), C:0.15 (0.08 – 0.2), p=0,487, putamen A: 0.17 (0.13 – 0.23), B: 0.23 (0.14 – 0.39), C:0.19 (0.15 – 0.28), p=0,3. There was no difference between patients with RBE and with RBD, taken together, compared to those with normal REM sleep (data not shown).

Conclusions: We failed to demonstrate either a more pronounced nigrostriatal degeneration at time of diagnosis in RBD or RBE PD patients compared to non-RBD/RBE PD patients or a specific pattern of nigrostriatal neurodegeneration in DAT SPECT.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dat-spect-data-of-parkinsons-disease-patients-with-and-without-rem-sleep-pathology-a-report-from-the-denopa-cohort/