Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China; The Psycho Department of Beijing Geriatric Hospital, Beijing, China.
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.
Sleep Med. 2024 Feb;114:101-108. doi: 10.1016/j.sleep.2023.12.025. Epub 2023 Dec 26.
Cognitive disorder, parkinsonism, autonomic dysfunction (AuD) and rapid eye movement sleep behavior disorder (RBD) can occur prior to or simultaneously with Dementia with Lewy Body (DLB) onset. RBD is generally linked with progressive neurodegenerative traits. However, associations between RBD with DLB, RBD without DLB, and RBD duration effects on DLB symptoms remain unclear.
To examine DLB symptom frequency and subtypes in RBD, and explore the effects of different RBD onset times on symptoms in de novo DLB patients.
In this multicenter investigation, we consecutively recruited 271 de novo DLB patients. All had standardized clinical and comprehensive neuropsychological evaluations. Subgroup analyses, performed based on the duration of RBD confirmed by polysomnography before the DLB diagnosis, we compared the proportion of patients with cognitive impairment, parkinsonism, and AuD features between groups.
Parkinsonism and AuD incidences were significantly elevated in DLB patients with RBD when compared with patients without RBD. Subgroup analyses indicated no significant differences in parkinsonism between DLB patients who developed RBD ≥10 years prior to the DLB diagnosis and DLB patients without RBD. The incidence of non-tremor-predominant parkinsonism and AuD was significantly higher in DLB patients whose RBD duration before the DLB diagnosis was <10 years when compared with DLB patients without RBD.
We identified significant symptom and phenotypic variability between DLB patients with and without RBD. Also, different RBD duration effects before the DLB diagnosis had a significant impact on symptomatic phenotypes, suggesting the existence of a slowly progressive DLB neurodegenerative subtype.
认知障碍、帕金森病、自主神经功能障碍（AuD）和快速眼动睡眠行为障碍（RBD）可在路易体痴呆（DLB）发病前或同时发生。RBD 通常与进行性神经退行性特征有关。然而，RBD 与 DLB、无 DLB 的 RBD 以及 RBD 持续时间对 DLB 症状的影响之间的关联尚不清楚。
检查 RBD 中 DLB 症状的频率和亚型，并探讨不同 RBD 发病时间对新发 DLB 患者症状的影响。
在这项多中心研究中，我们连续招募了 271 例新发 DLB 患者。所有患者均进行了标准化的临床和全面的神经心理学评估。根据 DLB 诊断前多导睡眠图证实的 RBD 持续时间进行亚组分析，我们比较了各组认知障碍、帕金森病和 AuD 特征患者的比例。
与无 RBD 的 DLB 患者相比，有 RBD 的 DLB 患者的帕金森病和 AuD 发生率显著升高。亚组分析表明，在 RBD 发病≥10 年前被诊断为 DLB 的患者和无 RBD 的 DLB 患者之间，帕金森病无显著差异。与无 RBD 的 DLB 患者相比，在 DLB 诊断前 RBD 持续时间<10 年的 DLB 患者中，非震颤为主的帕金森病和 AuD 的发生率显著升高。
我们发现有 RBD 和无 RBD 的 DLB 患者之间存在显著的症状和表型变异性。此外，DLB 诊断前不同的 RBD 持续时间对症状表型有显著影响，表明存在一种缓慢进展的 DLB 神经退行性亚型。
