Cicero Calogero Edoardo, Terravecchia Claudio, Tabbì Silvia, Garofalo Rossella, Luca Antonina, Mostile Giovanni, Donzuso Giulia, Contrafatto Donatella, Zappia Mario, Nicoletti Alessandra
Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
Department of Medicine and Surgery, Kore University of Enna, Enna, Italy.
J Neurol. 2024 Dec 16;272(1):75. doi: 10.1007/s00415-024-12799-y.
The α-Synuclein Origin and Connectome (SOC) model recently proposed two different Parkinson's Disease (PD) phenotypes clinically based on the relationship between REM sleep behavior disorder (RBD) and motor symptoms' onset: a "body first" phenotype and a "brain first" phenotype in which RBD precedes or may follow the motor onset, respectively. A higher burden of non-motor symptoms as well as a more symmetrical clinical presentation have also been predicted in the body-first phenotype. This point has been poorly assessed through semi-quantitative striatal dopaminergic functional imaging to date.
To explore the relation between RBD onset and striatal dysfunction in PD.
PD patients were retrospectively enrolled and clinical follow-up data were gathered. Presence and onset of probable RBD were evaluated classifying patients into PD-RBDpre (onset before motor symptoms), PD-RBDpost (onset after motor symptoms) and PD-RBD-. Semi-quantitative I-FP-CIT-DAT-SPECT imaging was performed at baseline. Mean putamen and caudate-specific binding ratios (SBR) and asymmetry index (AI) were computed.
Fifty-six PD patients were enrolled (10 PD-RBDpre, 19 PD-RBDpost and 27 PD-RBD-). A more symmetrical motor impairment, higher mild cognitive impairment (MCI) prevalence, lower caudate SBR and lower putamen AI were found in PD-RBDpre. A negative trend in MCI prevalence as well as a positive trend in both caudate SBR and putamen AI were found across PD-RBDpre, PD-RBDpost and PD-RBD-.
Different patterns of striatal dopaminergic dysfunction and cognitive impairment based on RBD onset were unraveled, supporting the SOC model's predictions.
α-突触核蛋白起源与连接组（SOC）模型最近基于快速眼动睡眠行为障碍（RBD）与运动症状发作之间的关系，从临床上提出了两种不同的帕金森病（PD）表型：一种是“身体优先”表型，另一种是“大脑优先”表型，其中RBD分别先于或可能跟随运动症状发作。“身体优先”表型还被预测具有更高的非运动症状负担以及更对称的临床表现。迄今为止，通过半定量纹状体多巴胺能功能成像对这一点的评估还很少。
探讨PD患者中RBD发作与纹状体功能障碍之间的关系。
对PD患者进行回顾性纳入，并收集临床随访数据。通过将患者分为PD-RBDpre（运动症状发作前发作）、PD-RBDpost（运动症状发作后发作）和PD-RBD-，评估可能的RBD的存在和发作情况。在基线时进行半定量I-FP-CIT-DAT-SPECT成像。计算壳核和尾状核的平均特异性结合率（SBR）和不对称指数（AI）。
共纳入56例PD患者（10例PD-RBDpre，19例PD-RBDpost和27例PD-RBD-）。PD-RBDpre患者存在更对称的运动障碍、更高的轻度认知障碍（MCI）患病率、更低的尾状核SBR和更低的壳核AI。在PD-RBDpre、PD-RBDpost和PD-RBD-患者中，MCI患病率呈负趋势，尾状核SBR和壳核AI均呈正趋势。
基于RBD发作揭示了纹状体多巴胺能功能障碍和认知障碍的不同模式，支持了SOC模型的预测。
