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Risk stratification for phenoconversion in patients with isolated REM sleep behavior disorder. A follow-up study from
G Benbir-Senel1, N Albayrak2,3, I Yanik3
1Estanbul Üniversitesi-Cerrahpasa, Estanbul, Turquía.
Revista De Neurologia
|January 30, 2024
Summary
Predicting parkinsonism progression in isolated REM sleep behavior disorder (iRBD) is possible. Age over 60, anosmia, and constipation are key clinical predictors, alongside EEG changes in alpha power.
Area of Science:
- Neurology
- Sleep Medicine
- Neurodegenerative Diseases
Background:
- Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is a significant prodromal marker for alpha-synucleinopathies.
- Identifying predictors of phenoconversion from iRBD to parkinsonism is crucial for early intervention.
Purpose of the Study:
- To investigate non-invasive clinical and quantitative predictors of phenoconversion from iRBD to parkinsonism.
- To identify early markers for the progression of neurodegeneration in iRBD patients.
Main Methods:
- Prospective follow-up of 45 iRBD patients over eight years.
- Clinical assessments including smell tests, color vision, mood, and constipation.
- Analysis of polysomnography, sleep spindles, EEG spectral analysis, and heart rate variability.
Main Results:
- Eight patients (17.8%) converted to parkinsonism within 3.2 years.
- Age =60 years, anosmia, and constipation were strong predictors (OR 44.8).
- Reduced occipital alpha power during wakefulness and REM sleep, and EEG slowing, predicted phenoconversion (OR 122.5 when combined with clinical factors).
Conclusions:
- Clinical factors (age, anosmia, constipation) and neurophysiological biomarkers (EEG spectral analysis) are important predictors of phenoconversion in iRBD.
- Further research is needed to refine prediction models and understand geographical/racial influences on phenoconversion rates.
- Establishing subtypes of iRBD with varying progression risks is essential for targeted management.
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