Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School, Portugal.
Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
Sleep Med. 2021 Apr;80:273-278. doi: 10.1016/j.sleep.2021.01.042. Epub 2021 Feb 2.
Parkinson's disease (PD) and Dementia with Lewy Bodies (DLB) prognosis depends on cognitive function evolution. Sleep disorders, as objectivated by polysomnography (PSG), are intimately connected with PD and DLB pathophysiology, but have seldomly been used to predict cognitive decline.
20 DLB and 49 PD patients underwent one-night in-lab video-PSG. Sleep variables were defined, including REM sleep motor events, Tonic and phasic REM sleep muscular tone and RBD diagnosis. Cognitive state (assessed with the Global Deterioration Scale (GDS) was collected from case files for 6 months intervals, for a maximum period of 3.5 years or until death/drop-out.). The relation between PSG data at baseline and variation of GDS scores over time was tested with mixed linear regression analysis.
GDS scores were higher in DLB, than in PD. We confirmed significant cognitive decline in both disorders, but no significant differences in progression between them. There were no significant interactions between PSG data and GDS variation for the entire group and DLB separately. In PD patients, there was a significant interaction between RBD diagnosis and tonic excessive muscular tone and GDS increase.
Our data suggests that PSG data can be useful in predicting cognitive decline in PD but not in DLB patients. In PD patients, an RBD diagnosis is predictive of cognitive deterioration, confirming the notion that this non-motor symptom relates to a malignant sub-type. Tonic excessive muscular activity, but not other RBD features, had predictive value in this group, pointing to a specific relation with the disease pathophysiology.
帕金森病（PD）和路易体痴呆（DLB）的预后取决于认知功能的演变。睡眠障碍通过多导睡眠图（PSG）客观化，与 PD 和 DLB 的病理生理学密切相关，但很少用于预测认知能力下降。
20 例 DLB 和 49 例 PD 患者进行了一夜的实验室视频 PSG。定义了睡眠变量，包括 REM 睡眠运动事件、强直和阵发 REM 睡眠肌肉张力和 RBD 诊断。认知状态（用总体衰退量表（GDS）评估）从病例档案中收集，间隔 6 个月，最长 3.5 年或直至死亡/退出。使用混合线性回归分析测试 PSG 数据与 GDS 评分随时间变化的关系。
DLB 的 GDS 评分高于 PD。我们证实了两种疾病都有明显的认知能力下降，但进展没有明显差异。对于整个组和单独的 DLB，PSG 数据和 GDS 变化之间没有显著的相互作用。在 PD 患者中，RBD 诊断与强直过度肌肉张力和 GDS 增加之间存在显著的相互作用。
我们的数据表明，PSG 数据可用于预测 PD 患者的认知能力下降，但不能用于预测 DLB 患者。在 PD 患者中，RBD 诊断是认知恶化的预测因素，证实了这一非运动症状与恶性亚型有关的观点。强直过度肌肉活动，而不是其他 RBD 特征，在该组中有预测价值，表明与疾病的病理生理学有特定的关系。
