Arnaldi Dario, Morbelli Silvia, Brugnolo Andrea, Girtler Nicola, Picco Agnese, Ferrara Michela, Accardo Jennifer, Buschiazzo Ambra, de Carli Fabrizio, Pagani Marco, Nobili Flavio
Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
Parkinsonism Relat Disord. 2016 Aug;29:47-53. doi: 10.1016/j.parkreldis.2016.05.031. Epub 2016 May 30.
The association between Parkinson Disease (PD) and REM sleep behavior disorder (RBD) has been related to a specific, malignant clinical phenotype. Definite RBD diagnosis requires video-polysomnography that is often unfeasible. A malignant clinical PD-RBD phenotype could be expected also in PD patients with probable RBD. Aim of this cross-sectional study was to evaluate whether a more severe neuropsychological and functional neuroimaging phenotype can be identified in PD patients with probable RBD.
Thirty-eight de novo, drug naïve PD patients underwent a first-line clinical assessment and a second-line multimodal assessment, including neuropsychological evaluation, (123)I-FP-CIT-SPECT and (18)F-FDG-PET, which were compared between PD patients with (PD + RBD+) and without (PD + RBD-) probable RBD.
On first-line assessment, PD + RBD + patients had significantly more constipation (p = 0.02) and showed worse olfaction (p = 0.01) compared with PD + RBD-while the two groups were similar as for age, presence of orthostatic hypotension, UPDRS-III and MMSE scores. On second-line assessment, PD + RBD + patients showed a worse neuropsychological test profile, more severe nigro-striatal dopaminergic impairment, mainly at caudate level in the less affected hemisphere (p = 0.004) and impaired brain glucose metabolism, with relative hypometabolism in posterior cortical regions and relative hypermetabolism mainly in anterior regions of the more affected hemisphere (p = 0.015).
PD patients with probable RBD are likely to have a more severe neuropsychological and functional brain-imaging phenotype already at the time of diagnosis.
帕金森病（PD）与快速眼动睡眠行为障碍（RBD）之间的关联与一种特定的恶性临床表型有关。明确的RBD诊断需要进行视频多导睡眠图检查，但这通常不可行。在可能患有RBD的PD患者中也可能出现恶性临床PD-RBD表型。本横断面研究的目的是评估在可能患有RBD的PD患者中是否能识别出更严重的神经心理学和功能性神经影像表型。
38例初发、未用药的PD患者接受了一线临床评估和二线多模式评估，包括神经心理学评估、（123）I-FP-CIT-SPECT和（18）F-FDG-PET，并对可能患有RBD的PD患者（PD + RBD+）和未患有RBD的PD患者（PD + RBD-）进行了比较。
在一线评估中，与PD + RBD-患者相比，PD + RBD+患者便秘更为显著（p = 0.02），嗅觉更差（p = 0.01），而两组在年龄、体位性低血压的存在、UPDRS-III和MMSE评分方面相似。在二线评估中，PD + RBD+患者的神经心理学测试结果更差，黑质纹状体多巴胺能损害更严重，主要在受影响较小半球的尾状核水平（p = 0.004），脑葡萄糖代谢受损，后皮质区域相对代谢减低，主要在受影响较大半球的前部区域相对代谢增高（p = 0.015）。
可能患有RBD的PD患者在诊断时可能已经具有更严重的神经心理学和功能性脑影像表型。
