Minnesota Regional Sleep Disorders Center, Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, USA.
Sleep Med. 2013 Aug;14(8):744-8. doi: 10.1016/j.sleep.2012.10.009. Epub 2013 Jan 22.
To provide a 16-year update from the authors' 1996 report documenting a 38% conversion from idiopathic rapid eye movement sleep behavior disorder (iRBD) to a parkinsonian disorder at a mean interval of nearly 13 years after the onset of iRBD in a series of 29 males > or =50 years old.
The methods of evaluation, diagnosis and follow-up were previously described in the 1996 report. All patients had video-polysomnography (vPSG) confirmed RBD.
80.8% (21/26) of patients who were initially diagnosed with iRBD eventually developed parkinsonism/dementia (three of the original 29 patients were lost to follow-up). The distribution of diagnoses was as follows: n=13, Parkinson's disease (PD); n=3, dementia with Lewy bodies (DLB); n=1, dementia (unspecified; profound); n=2, multiple system atrophy (MSA); n=2, clinically diagnosed Alzheimer's Disease (AD) with autopsy-confirmed combined AD plus Lewy body disease pathology. Among the 21 iRBD "converters," the mean age (±SD) of iRBD onset was 57.7±7.7 years; mean age (±SD) of parkinsonism/dementia onset was 71.9±6.6 years; and mean interval (±SD) from iRBD onset to parkinsonism/dementia onset was 14.2±6.2 years (range: 5-29 years).
The vast majority of men > or =50 years old initially diagnosed with iRBD in this study eventually developed a parkinsonian disorder/dementia, often after a prolonged interval from onset of iRBD, with the mean interval being 14 years while the range extended to 29 years. Also, the specificity of iRBD converting to parkinsonism/dementia is striking. These findings carry important clinical and research implications in the convergent fields of sleep medicine, neurology, and neuroscience, and identify an optimal clinical group for conducting prospective research studies utilizing putative neuroprotective agents to delay the emergence of, or halt the progression to, parkinsonism and/or cognitive impairment as manifestations of either PD, DLB or MSA.
提供作者 1996 年报告的 16 年更新，该报告记录了在一系列年龄大于或等于 50 岁的 29 名男性中，从特发性快速眼动睡眠行为障碍（iRBD）到帕金森病的平均间隔近 13 年后，iRBD 转化率为 38%。
评估、诊断和随访方法在 1996 年的报告中已有描述。所有患者均通过视频多导睡眠图（vPSG）确诊为 RBD。
26 名最初诊断为 iRBD 的患者中，80.8%（21 名）最终发展为帕金森病/痴呆（29 名患者中有 3 名失访）。诊断分布如下：n=13，帕金森病（PD）；n=3，路易体痴呆（DLB）；n=1，痴呆（未特指；严重）；n=2，多系统萎缩（MSA）；n=2，临床诊断阿尔茨海默病（AD），尸检证实合并 AD 加路易体病病理学。在 21 名 iRBD“转化者”中，iRBD 发病的平均年龄（±SD）为 57.7±7.7 岁；帕金森病/痴呆发病的平均年龄（±SD）为 71.9±6.6 岁；从 iRBD 发病到帕金森病/痴呆发病的平均间隔（±SD）为 14.2±6.2 年（范围：5-29 年）。
本研究中，大多数年龄大于或等于 50 岁的男性最初被诊断为 iRBD，最终发展为帕金森病/痴呆，通常在 iRBD 发病后经过较长时间，平均间隔为 14 年，范围为 29 年。此外，iRBD 转化为帕金森病/痴呆的特异性非常显著。这些发现对睡眠医学、神经病学和神经科学等领域的研究具有重要的临床和研究意义，并确定了一个最佳的临床研究群体，可利用潜在的神经保护剂进行前瞻性研究，以延迟帕金森病、路易体痴呆或多系统萎缩的出现或阻止其进展为帕金森病和/或认知障碍的表现。
