Brain MRI Biomarkers in Isolated Rapid Eye Movement Sleep Behavior Disorder: Where Are We? A Systematic Review
Stephan Grimaldi1,2,3,4, Maxime Guye2,3, Marta Bianciardi4,5
1Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 265 rue Saint-Pierre, 13005 Marseille, France.
Abstract:
The increasing number of MRI studies focused on prodromal Parkinson's Disease (PD) demonstrates a strong interest in identifying early biomarkers capable of monitoring neurodegeneration. In this systematic review, we present the latest information regarding the most promising MRI markers of neurodegeneration in relation to the most specific prodromal symptoms of PD, namely isolated rapid eye movement (REM) sleep behavior disorder (iRBD). We reviewed structural, diffusion, functional, iron-sensitive, neuro-melanin-sensitive MRI, and proton magnetic resonance spectroscopy studies conducted between 2000 and 2023, which yielded a total of 77 relevant papers. Among these markers, iron and neuromelanin emerged as the most robust and promising indicators for early neurodegenerative processes in iRBD. Atrophy was observed in several regions, including the frontal and temporal cortices, limbic cortices, and basal ganglia, suggesting that neurodegenerative processes had been underway for some time. Diffusion and functional MRI produced heterogeneous yet intriguing results. Additionally, reduced glymphatic clearance function was reported. Technological advancements, such as the development of ultra-high field MRI, have enabled the exploration of minute anatomical structures and the detection of previously undetectable anomalies. The race to achieve early detection of neurodegeneration is well underway.
Insights
Iron and neuromelanin MRI markers show promise for detecting early neurodegeneration in isolated rapid eye movement (REM) sleep behavior disorder (iRBD), a prodromal sign of Parkinson's Disease (PD). This review highlights key MRI findings for early PD detection.
Area of Science:
- Neuroimaging
- Neurology
- Biomarker Discovery
Background:
- Growing interest in identifying early biomarkers for Parkinson's Disease (PD) neurodegeneration.
- Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is a specific prodromal symptom of PD.
- Magnetic Resonance Imaging (MRI) is a key technology for in vivo neurodegeneration assessment.
Purpose of the Study:
- To systematically review promising MRI markers for neurodegeneration in iRBD.
- To correlate MRI findings with prodromal symptoms of PD.
- To assess the utility of various MRI techniques in early PD detection.
Main Methods:
- Systematic review of structural, diffusion, functional, iron-sensitive, neuromelanin-sensitive MRI, and proton magnetic resonance spectroscopy studies.
- Literature search spanning 2000-2023, yielding 77 relevant papers.
- Analysis of MRI markers associated with iRBD and early neurodegeneration.
Main Results:
- Iron and neuromelanin MRI are robust indicators of early neurodegeneration in iRBD.
- Observed atrophy in frontal, temporal, limbic cortices, and basal ganglia suggests ongoing neurodegeneration.
- Diffusion and functional MRI showed heterogeneous results; reduced glymphatic clearance was also reported.
Conclusions:
- Iron and neuromelanin MRI are highly promising for early detection of neurodegeneration in iRBD.
- Advancements in ultra-high field MRI enhance the detection of subtle neurodegenerative anomalies.
- The pursuit of early neurodegeneration detection through MRI is a rapidly advancing field.
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