Students Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Parkinsons Dis. 2021;11(2):747-755. doi: 10.3233/JPD-202134.
REM behavior disorder (RBD) can occur in the context of neurodegenerative alpha-synucleinopathies, such as Parkinson's disease (PD). PD patients with RBD (PD-pRBD) represent more severe symptoms and signs compared with those without RBD (PD-nRBD). On another note, autonomic dysfunction in PD patients is categorized as one of the most prominent non-motor symptoms and has been lately the field of interest in research.
In the current study, we longitudinally studied autonomic dysfunction in PD-pRBD and PD-nRBD groups.
This study was conducted on 420 drug-naïve PD patients selected from the Parkinson's Progression Markers Initiative database. The RBD Screening Questionnaire was used to define the presence of probable RBD. SCOPA-AUT was used to assess autonomic dysfunction. Additionally, dopamine transporter deficits on [123I] FP-CIT SPECT imaging was performed for all of the patients.
Out of 420 PD patients, 158 individuals (37.6%) were considered to have probable RBD (PD-pRBD) and others without RBD (PD-nRBD). Except for pupillomotor function, all the autonomic symptoms were significantly more severe in PD-pRBD group. In PD-nRBD group, caudate striatal binding ratio was negatively correlated with SCOPA-AUT scores, while no significant correlation was observed in PD-pRBD group. Finally, there was a significant difference considering the longitudinal changes of SCOPA-AUT total between PD-pRBD and PD-nRBD groups, suggesting a more severe autonomic decline in PD-pRBD patients.
Our results indicate that PD-pRBD patients have more severe autonomic dysfunction. These results support the theory that PD patients can be categorized based on the clinical presentation, possibly representing differences in the disease pathophysiology.
快动眼睡眠行为障碍（RBD）可发生在神经退行性α-突触核蛋白病的背景下，如帕金森病（PD）。与无 RBD（PD-nRBD）的 PD 患者相比，有 RBD（PD-pRBD）的 PD 患者表现出更严重的症状和体征。另一方面，PD 患者的自主神经功能障碍被归类为最突出的非运动症状之一，最近已成为研究领域的关注焦点。
在本研究中，我们对 PD-pRBD 和 PD-nRBD 组进行了自主神经功能障碍的纵向研究。
这项研究是在帕金森病进展标志物倡议数据库中选择的 420 名未服用药物的 PD 患者中进行的。使用快动眼睡眠行为障碍筛查问卷来确定是否存在可能的 RBD。使用 SCOPA-AUT 评估自主神经功能障碍。此外，对所有患者进行了[123I] FP-CIT SPECT 成像以评估多巴胺转运体缺陷。
在 420 名 PD 患者中，有 158 名患者（37.6%）被认为患有可能的 RBD（PD-pRBD），其余患者无 RBD（PD-nRBD）。除瞳孔运动功能外，PD-pRBD 组的所有自主症状均明显更严重。在 PD-nRBD 组中，尾状核纹状体结合比率与 SCOPA-AUT 评分呈负相关，而在 PD-pRBD 组中未观察到显著相关性。最后，考虑到 PD-pRBD 和 PD-nRBD 组之间 SCOPA-AUT 总分的纵向变化，存在显著差异，这表明 PD-pRBD 患者的自主神经功能下降更为严重。
我们的结果表明，PD-pRBD 患者的自主神经功能障碍更为严重。这些结果支持这样一种理论，即可以根据临床表现对 PD 患者进行分类，这可能代表了疾病病理生理学的差异。
