Tremblay Christina, Pastor-Bernier Alexandre, Rheault François, Daneault Véronique, Ayral Violette, Filiatrault Marie, Desaulniers Liane, Vo Andrew, Gagnon Jean-François, Postuma Ronald B, Dusek Petr, Marecek Stanislav, Varga Zsoka, Klein Johannes C, Hu Michele T, Lehéricy Stéphane, Arnulf Isabelle, Dodet Pauline, Vidailhet Marie, Corvol Jean-Christophe, Rahayel Shady
Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada.
Sherbrooke Connectivity Imaging Lab, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Alzheimers Dement. 2025 Aug;21(8):e70574. doi: 10.1002/alz.70574.
Isolated rapid eye movement (REM) sleep behavior disorder (iRBD), characterized by abnormal movements during REM sleep, is a prodromal stage of dementia with Lewy bodies (DLB) and Parkinson's disease (PD). While iRBD shows emerging brain changes, their impact on structural connectivity and network efficiency, and their predictive value, remain poorly characterized.
In this international prospective study, 198 polysomnography-confirmed iRBD patients and 174 controls underwent diffusion magnetic resonance imaging and were analyzed. Cutting-edge diffusion tractography and network-based statistics were applied to reconstruct individual connectomes and assess network properties predicting DLB or PD.
Structural architecture was already disrupted in iRBD, with both reduced and compensatory increased connections. Global efficiency was decreased. Local efficiency in motor regions was altered and associated with early clinical symptoms. Altered local efficiency in the supramarginal gyrus predicted DLB only.
Early disruption of brain architecture in iRBD predicts progression to synucleinopathy-related dementia, offering a novel potential prognostic biomarker.
Isolated rapid eye movement sleep behavior disorder (iRBD) patients show significant alterations in inter-regional structural connectivity. Global efficiency is reduced in iRBD compared to controls. Areas with increased local efficiency contribute to decreased global efficiency. Altered network efficiency is associated with emerging Parkinsonian features. Higher supramarginal efficiency predicts dementia with Lewy bodies in iRBD.
孤立性快速眼球运动（REM）睡眠行为障碍（iRBD），其特征为REM睡眠期间出现异常运动，是路易体痴呆（DLB）和帕金森病（PD）的前驱阶段。虽然iRBD显示出脑部的新变化，但它们对结构连通性和网络效率的影响及其预测价值仍未得到充分表征。
在这项国际前瞻性研究中，对198例经多导睡眠图确诊的iRBD患者和174例对照者进行了扩散磁共振成像并进行分析。应用前沿的扩散张量成像和基于网络的统计方法来重建个体脑连接组，并评估预测DLB或PD的网络属性。
iRBD患者的结构架构已经受到破坏，既有连接减少，也有代偿性增加。全局效率降低。运动区域的局部效率发生改变，并与早期临床症状相关。仅缘上回局部效率的改变可预测DLB。
iRBD患者脑结构的早期破坏预示着向与α-突触核蛋白病相关的痴呆进展，提供了一种新的潜在预后生物标志物。
孤立性快速眼球运动睡眠行为障碍（iRBD）患者在区域间结构连通性方面存在显著改变。与对照组相比，iRBD患者的全局效率降低。局部效率增加的区域导致全局效率降低。网络效率的改变与帕金森特征的出现相关。较高的缘上回效率可预测iRBD患者的路易体痴呆。
