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Cortical macro- and microstructural changes in isolated rapid eye movement sleep behavior disorder.

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Cortical mean diffusivity (cMD) shows early cortical changes in isolated REM sleep behavior disorder (iRBD), a precursor to Lewy body diseases. This imaging marker may be more sensitive than cortical thickness for detecting these neurodegenerative changes.

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Area of Science:

  • Neuroimaging
  • Neurodegenerative Disorders
  • Sleep Medicine

Background:

  • Isolated REM sleep behavior disorder (iRBD) is a prodromal stage for Lewy body diseases.
  • Cortical microstructural changes are implicated in neurodegeneration.
  • Cortical mean diffusivity (cMD) and cortical thickness (CTh) are potential imaging biomarkers, but their role in iRBD is unstudied.

Purpose of the Study:

  • To investigate cMD and CTh in patients with iRBD.
  • To explore the relationship between cMD, CTh, and clinical/neuropsychological features in iRBD.
  • To determine if cMD is a sensitive biomarker for early cortical changes in prodromal Lewy body diseases.

Main Methods:

  • Diffusion tensor imaging (DTI) was used to measure cMD.
  • Structural MRI was used to measure CTh.
  • Thirty-six iRBD patients and 29 healthy controls (HC) were assessed for associations with clinical and cognitive measures.

Main Results:

  • Patients with iRBD exhibited significantly increased cMD in rostral and caudal cortical regions compared to HC (Cohen's d > 0.5).
  • Cortical thinning was observed only in caudal regions of iRBD patients.
  • Elevated cMD correlated with longer iRBD duration, later disease onset, higher MDS-UPDRS III scores, apathy, and poorer performance on the Grooved Pegboard and Symbol-Digit Modality Tests.

Conclusions:

  • cMD is elevated in the cortex of individuals with iRBD, suggesting early microstructural alterations.
  • cMD appears to be a more sensitive biomarker than CTh for detecting early cortical changes in prodromal Lewy body diseases.
  • cMD holds promise as a valuable imaging biomarker for identifying individuals at high risk for neurodegeneration.