Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Department of Neurology, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Parkinsonism Relat Disord. 2019 May;62:105-111. doi: 10.1016/j.parkreldis.2019.01.018. Epub 2019 Jan 29.
Rapid Eye Movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment and is associated with incidence of neurodegenerative disorders, especially Parkinson's disease (PD). Whether PD with RBD constitutes a distinct subtype with unique progression is unknown. Here, we investigated motor and cognitive symptom progression in patients with self-reported RBD features in adult life.
We screened for RBD in a cohort of 776 PD patients whom we ascertained using a population-based strategy. Among participants with at least one follow-up (60%), we compared those with and without probable RBD (pRBD) estimating hazard rate ratios for progression events UPDRS-III≥ 35 and MMSE≤ 24.
Prevalence of pRBD at baseline was 21%. In adjusted Cox regression models among patients with a Postural Instability and Gait Dysfunction (PIGD) phenotype, those with pRBD progressed faster to a UPDRS-III≥ 35 (HR = 1.92, 95% CI = 1.12; 3.27). Also, all patients with pRBD progressed twice as fast to a MMSE score≤ 24 (HR = 2.04, 95% CI = 1.13; 3.69). In sensitivity analyses, using alternative definition of pRBD and accounting for bias due to loss to follow-up results remained similar.
Employing data from one of the largest population-based studies of PD, in which movement disorder specialists assessed patients, we confirm evidence that pRBD features are a clinical marker for faster cognitive decline and possibly also motor progression in PD patients, the latter for patients with a PIGD subtype early in disease.
快速眼动（REM）睡眠行为障碍（RBD）的特征是梦境行为，并与神经退行性疾病的发病率有关，尤其是帕金森病（PD）。RBD 伴 PD 是否构成具有独特进展的独特亚型尚不清楚。在这里，我们研究了成年期有 RBD 特征自述的患者的运动和认知症状进展。
我们使用基于人群的策略在 776 名 PD 患者的队列中筛查 RBD。在至少有一次随访（60%）的参与者中，我们比较了有和没有可能的 RBD（pRBD）的参与者，估计 UPDRS-III≥35 和 MMSE≤24 的进展事件的风险率比。
基线时 pRBD 的患病率为 21%。在姿势不稳和步态障碍（PIGD）表型的患者中，在调整后的 Cox 回归模型中，pRBD 患者向 UPDRS-III≥35 的进展速度更快（HR=1.92，95%CI=1.12；3.27）。此外，所有 pRBD 患者的 MMSE 评分≤24 的进展速度快了一倍（HR=2.04，95%CI=1.13；3.69）。在敏感性分析中，使用替代的 pRBD 定义并考虑因随访丢失而导致的偏倚，结果仍然相似。
利用最大的 PD 人群研究之一的数据，其中运动障碍专家评估了患者，我们证实了 pRBD 特征是 PD 患者认知下降更快的临床标志物，并且可能也是运动进展的标志物，对于疾病早期的 PIGD 亚型患者来说更是如此。
