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Mild cognitive impairment and abnormal brain metabolic expression in idiopathic REM sleep behavior disorder

Dallah Yoo1, Jee-Young Lee2, Yu Kyeong Kim3

  • 1Department of Neurology and Seoul National University College of Medicine, Seoul, 07061, Republic of Korea; Department of Neurology, Kyung Hee University Hospital, Seoul, 02447, Republic of Korea.

Parkinsonism & Related Disorders
|July 27, 2021
PubMed
Abstract

Insights

Mild cognitive impairment (MCI) is common in isolated rapid-eye-movement sleep behavior disorder (iRBD). Specific brain metabolic patterns, particularly from de novo Parkinson's disease with RBD, predict cognitive decline and potential Lewy body dementia progression in iRBD patients.

Area of Science:

  • Neuroscience
  • Neurology
  • Sleep Medicine

Background:

  • Mild cognitive impairment (MCI) is frequently observed in patients with isolated rapid-eye-movement sleep behavior disorder (iRBD).
  • Understanding cognitive function and its progression in iRBD is crucial for predicting neurological outcomes.
  • Brain metabolic patterns may offer insights into the pathophysiology of cognitive decline in iRBD.

Purpose of the Study:

  • To assess cognitive functions and the prevalence of MCI in a prospective cohort of iRBD patients.
  • To investigate the association between specific brain metabolic patterns and cognitive status (MCI vs. normal cognition) in iRBD.
  • To determine if these metabolic patterns predict future cognitive deterioration in iRBD.

Main Methods:

  • A prospective cohort of 44 iRBD patients underwent regular neuropsychological testing over four years.
  • 18F-fluorodeoxyglucose PET scans were used to analyze spatial covariance patterns, specifically de novo Parkinson's disease with RBD (denovoPDRBD-RP) and iRBD (iRBD-RP) patterns.
  • Cognitive performance was compared between iRBD patients with MCI (iRBD-MCI) and normal cognition (iRBD-NC), and predictive value for cognitive deterioration was assessed.

Main Results:

  • 45% of iRBD patients had MCI at baseline; 27% experienced significant cognitive deterioration over four years.
  • While cognitive change rates were similar, iRBD-MCI patients consistently showed poorer verbal memory and executive function.
  • Elevated denovoPDRBD-RP expression was a significant predictor of cognitive deterioration (HR=5.98), but iRBD-RP expression was not.

Conclusions:

  • Increased disease-specific brain metabolic patterns are linked to MCI in iRBD.
  • These metabolic patterns, especially denovoPDRBD-RP, are associated with impending cognitive deterioration.
  • Findings suggest a potential risk of progression to Lewy body dementia in iRBD patients with these metabolic alterations.
Keywords:
Lewy body dementiaMild cognitive impairmentPositron emission tomographyREM sleep behavior disorder

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