Cicero Calogero Edoardo, Luca Antonina, Mostile Giovanni, Donzuso Giulia, Giuliano Loretta, Zappia Mario, Nicoletti Alessandra
Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
Oasi Research Institute-IRCCS, Troina, Italy.
J Neurol. 2023 Jun;270(6):3171-3178. doi: 10.1007/s00415-023-11659-5. Epub 2023 Mar 10.
In Parkinson's disease (PD), rapid eye movement (REM) sleep behavior disorder (RBD) might either precede the appearance of motor symptoms, or develop during the disease course. PD patients with RBD are characterized by a higher burden of cognitive impairment and hallucinations. However, few studies have analyzed the clinical characteristics of PD patients according to the timeline of RBD onset.
PD patients have been retrospectively enrolled. Presence and onset of probable RBD (pRBD) has been evaluated using RBD Screening Questionnaire (score ≥ 6). Presence of Mild Cognitive Impairment (MCI) at baseline has been evaluated using the MDS criteria level II. Presence of motor complications and hallucinations has been evaluated at a 5-year follow-up.
A total of 115 PD patients (65 men, 56.5%; mean age 62.5 ± 9.7 years; mean disease duration 3.7 ± 3.9 years) have been enrolled. Out of these, 63 fulfilled the diagnosis of pRBD (54.8%) with 21 (33.3%) reporting the RBD onset before the onset of the motor symptoms (PD-RBDpre), and 42 (66.7%) after the motor symptoms (PD-RBDpost). At enrolment presence of MCI was associated with PD-RBDpre patients (OR 5.04; 95% CI 1.33-19.05; p value 0.02). At follow-up, a higher risk of developing hallucinations was also associated with PD-RBDpre (OR 4.68; 95% CI 1.24-17.63; p = 0.022).
PD patients with RBD occurring before the onset of motor symptoms represent a subgroup of patients with a more severe cognitive phenotype and with a higher risk of developing hallucinations along the disease course, with significant implications in terms of prognostic stratification and therapeutic approach.
在帕金森病（PD）中，快速眼动（REM）睡眠行为障碍（RBD）可能在运动症状出现之前就已存在，或者在疾病进程中发生。患有RBD的PD患者的特征是认知障碍和幻觉负担较重。然而，很少有研究根据RBD发病的时间线分析PD患者的临床特征。
对PD患者进行回顾性纳入。使用RBD筛查问卷（评分≥6）评估可能的RBD（pRBD）的存在和发病情况。使用MDS标准二级评估基线时轻度认知障碍（MCI）的存在情况。在5年随访时评估运动并发症和幻觉的存在情况。
共纳入115例PD患者（65例男性，占56.5%；平均年龄62.5±9.7岁；平均病程3.7±3.9年）。其中，63例符合pRBD诊断（54.8%），21例（33.3%）报告RBD在运动症状出现之前发病（PD-RBDpre），42例（66.7%）在运动症状之后发病（PD-RBDpost）。在纳入时，MCI的存在与PD-RBDpre患者相关（比值比5.04；95%置信区间1.33-19.05；p值0.02）。在随访时，发生幻觉的较高风险也与PD-RBDpre相关（比值比4.68；95%置信区间1.24-17.63；p = 0.022）。
运动症状出现之前发生RBD的PD患者代表了一个具有更严重认知表型且在疾病进程中发生幻觉风险更高的患者亚组，这对预后分层和治疗方法具有重要意义。
