Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Ann Neurol. 2021 Feb;89(2):293-303. doi: 10.1002/ana.25952. Epub 2020 Nov 20.
The aim was to analyze the timeline, prevalence, and survival of rapid eye movement (REM) sleep behavior disorder (RBD) in patients who developed alpha-synucleinopathies (Parkinson disease, dementia with Lewy bodies, and Parkinson disease dementia) compared with age- and sex-matched controls in a population-based incident-cohort study.
We used a population-based, 1991 to 2010 incident-cohort study of alpha-synucleinopathies. A movement-disorder specialist reviewed medical records to confirm diagnoses. RBD was diagnosed by reported dream-enactment symptoms or polysomnography. Probable RBD and polysomnographically confirmed RBD were analyzed separately and combined.
Among the 444 incident cases of alpha-synucleinopathy, 86 were clinically diagnosed with RBD (19.8%), including 30 (35%) by polysomnography and 56 (65%) as probable. The prevalence of idiopathic RBD at alpha-synucleinopathy diagnosis was 3.4%, increasing to 23.8% after 15 years. Cumulative lifetime incidence was 53 times greater in alpha-synucleinopathy patients than in controls (odds ratio [OR] = 53.1, 95% confidence interval [CI]: 13.0-217.2, p < 0.0001), higher in dementia with Lewy bodies than in Parkinson disease (OR = 2.57, 95% CI: 1.50-4.40, p = 0.0004), and higher in men than in women with Parkinson disease, dementia with Lewy bodies, or Parkinson disease dementia (OR = 3.70, 95% CI: 2.07-6.62, p < 0.0001), but did not increase mortality risk.
Our cohort had RBD incidence of 3.4%. Overall RBD increased to 23.8% after 15 years, with an overall incidence of 2.5 cases per 100 person-years. With 53 times greater lifetime incidence in alpha-synucleinopathy patients than in controls, RBD was more likely to develop in dementia with Lewy bodies than in Parkinson disease or Parkinson disease dementia, and in men than in women, but did not increase mortality risk within our cohort. ANN NEUROL 2021;89:293-303.
本研究旨在通过一项基于人群的、1991 年至 2010 年的α-突触核蛋白病（帕金森病、路易体痴呆和帕金森病痴呆）发病队列研究，分析快速眼动（REM）睡眠行为障碍（RBD）在发生α-突触核蛋白病的患者中的时间进程、流行率和存活率，并与年龄和性别匹配的对照组进行比较。
我们使用了一项基于人群的、1991 年至 2010 年的α-突触核蛋白病发病队列研究。一名运动障碍专家对病历进行了回顾，以确认诊断。RBD 通过报告的梦境行为症状或多导睡眠图进行诊断。分别分析并结合了可能的 RBD 和多导睡眠图确诊的 RBD。
在 444 例确诊的α-突触核蛋白病患者中，86 例被临床诊断为 RBD（19.8%），其中 30 例（35%）通过多导睡眠图诊断，56 例（65%）为可能的 RBD。在诊断为α-突触核蛋白病时，特发性 RBD 的患病率为 3.4%，15 年后增加到 23.8%。与对照组相比，α-突触核蛋白病患者的终生累积发病率高 53 倍（优势比[OR] = 53.1，95%置信区间[CI]：13.0-217.2，p < 0.0001），在路易体痴呆中高于帕金森病（OR = 2.57，95% CI：1.50-4.40，p = 0.0004），在男性帕金森病、路易体痴呆或帕金森病痴呆患者中高于女性（OR = 3.70，95% CI：2.07-6.62，p < 0.0001），但并不增加死亡率风险。
本队列的 RBD 发病率为 3.4%。总的来说，15 年后，RBD 增加到 23.8%，总体发病率为每 100 人年 2.5 例。与对照组相比，α-突触核蛋白病患者的终生发病率高 53 倍，表明 RBD 更可能发生在路易体痴呆中，而不是帕金森病或帕金森病痴呆中，并且在男性中高于女性，但在本队列中并不增加死亡率风险。
