Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.
"Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy.
J Alzheimers Dis. 2018;63(1):1-11. doi: 10.3233/JAD-171164.
Rapid eye movement (REM) sleep behavior disorder (RBD) is a REM sleep parasomnia characterized by the loss of the typical muscular atonia present during healthy REM sleep. RBD can occur in the absence of other neurological conditions or in association with a neurodegenerative disorder. It is now well established that RBD is a strong predictor of neurodegeneration, in particular synucleinopathies, such as Parkinson's disease, Lewy body dementia (LBD), or multiple system atrophy. However, some longitudinal studies report that a minority of patients develop either overlapping form of dementia or Alzheimer disease's (AD). Although AD is reported as a possible development in patients with RBD, it is in a limited number of cases and there are concerns about the accuracy of the diagnostic criteria. Neuropsychological impairments identified in cross-sectional studies of RBD patients describe a profile similar to that observed in dementia related to synucleinopathies. However, only deficits in executive function predict the development of neurodegeneration. Longitudinal studies reported the development of AD in RBD patients in about 7% of cases with variability ranging from 3% and 11%. Since the majority of longitudinal investigations do not report AD as a possible development for RBD patients the proportion may be overestimated. The study of the relationship between RBD and AD may be confounded by two factors that lead to misdiagnosis: the use of clinical criteria alone and the overlap between the clinical features and neuropathology of AD and LBD. Future studies to investigate this association must use updated diagnostic criteria incorporating ancillary investigations.
快速眼动 (REM) 睡眠行为障碍 (RBD) 是一种 REM 睡眠睡眠障碍，其特征是在健康的 REM 睡眠期间失去典型的肌肉弛缓。RBD 可以在没有其他神经疾病的情况下发生，也可以与神经退行性疾病相关。现在已经确定 RBD 是神经退行性变的一个强有力的预测因素，特别是在突触核蛋白病中，如帕金森病、路易体痴呆 (LBD) 或多系统萎缩。然而，一些纵向研究报告说，少数患者会出现重叠形式的痴呆或阿尔茨海默病 (AD)。虽然 AD 被报道为 RBD 患者可能出现的情况，但在有限的病例中，人们对诊断标准的准确性存在担忧。在 RBD 患者的横断面研究中发现的神经心理学损伤描述了与突触核蛋白病相关的痴呆相似的特征。然而，只有执行功能的缺陷可以预测神经退行性变的发展。纵向研究报告称，在大约 7%的病例中，RBD 患者会发展为 AD，其变化范围从 3%到 11%不等。由于大多数纵向研究并未报告 AD 是 RBD 患者的可能发展，因此比例可能被高估。RBD 和 AD 之间关系的研究可能受到两个导致误诊的因素的影响：仅使用临床标准以及 AD 和 LBD 的临床特征和神经病理学之间的重叠。未来研究必须使用更新的诊断标准，结合辅助检查来研究这种关联。
