Objective: To examine association of clinical and neurophysiological characteristics associated with synucleinopathies in a cohort of adult subjects with REM sleep Behavior Disorder (RBD) and REM Sleep Without Atonia (RWSA).

Background: RBD is a risk factor for developing synucleinopathies, including Parkinson’s disease, multiple system atrophy, and dementia with Lewy bodies. RSWA is a related condition but its association with neurodegenerative disorders is much less well understood. There remains a need to establish the best approach to predicting prognosis in RBD and RSWA patients. We therefore implemented a longitudinal study, the REM Behavior Disorder Associations with Parkinson’s Disease Study (RAPiDS), to enroll and track a target of 100 patients with RBD and 30 with RWSA. Here we report baseline data on our initial 25 participants recruited from May 2017-March 2018.

Methods: Participants with polysomnography-confirmed RBD and/or RSWA were prospectively recruited from the Weill Cornell Center for Sleep Medicine, New York NY. Those with a diagnosed neurodegenerative disorder and with medical conditions leading to dysautonomia were excluded. Evaluations comprised polysomnography, medical and neurological history, standardized rating scales and examination focused on neurologic, neuropsychiatric, and autonomic function. Biosamples were collected for future study.

Results: Participants evaluated comprise 22 with RBD and 3 with RWSA, with mean 4.4 ± 6.28 (range 0.5-24) years since diagnosis. For RBD, mean age was 61.2 ± 17.1 (range 26-79) years, and 4/22 were women. “Soft” motor signs included subtle tremor and/or parkinsonism (5). In RBD, participants reported depression/anxiety (9) (7 treated with medication); constipation (7); and urinary dysfunction (7). Cognition and odor discrimination measured below normal limits in 5 each (3 had both). None had orthostasis. Of those with RSWA (ages 28, 46, 63 years) one suffered anxiety but no other findings were elicited.

Conclusions: In this well-characterized cohort with RSWA/RBD, despite excluding patients with a known neurodegenerative disorder, we detected frequent subtle neuropsychiatric and neurological symptoms and signs in RBD individuals, that might be considered “RBD-plus”. While it is too early to confirm their role in phenoconversion in our study, cohort expansion and longitudinal follow up is in place to improve characterization of which patients are at risk.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rem-sleep-behavior-disorder-associations-with-parkinsons-disease-study-rapids-initial-baseline-data/