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Dynamic Digital Biomarkers of Motor and Cognitive Function in Parkinson's Disease

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REM sleep behavior disorder as a shared motor phenotype: A multidimensional clinical study.

Giuseppe Lanza¹, Giovanni Sorte², Rita Bella²

¹Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Oasi Research Institute-IRCCS, Troina, Italy.

|March 4, 2026

Summary

REM sleep behavior disorder (RBD) presents differently depending on its cause. Cognitive function and sex distribution help distinguish isolated RBD, antidepressant-associated RBD, and tauopathy-associated RBD.

Keywords:

Antidepressant-associated RBD Cognitive impairment Isolated RBD REM sleep behavior disorder Sleep architecture Tauopathies

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Area of Science:

Neurology
Sleep Medicine
Neurodegenerative Diseases

Background:

REM sleep behavior disorder (RBD) is a heterogeneous condition with various causes.
These include isolated RBD (often a prodromal synucleinopathy), antidepressant-induced RBD, and RBD linked to tauopathies like Alzheimer's disease.

Purpose of the Study:

To compare clinical, cognitive, neuroimaging, and polysomnographic features of isolated RBD (iRBD), antidepressant-associated RBD (iatroRBD), and tauopathy-associated RBD (tauRBD).
To identify distinguishing markers across these RBD subtypes within a single cohort.

Main Methods:

Retrospective analysis of polysomnographically confirmed RBD patients, excluding established synucleinopathies.
Classification into iRBD (n=26), iatroRBD (n=16), or tauRBD (n=6) based on established criteria.
Comparison of demographics, non-motor symptoms, MMSE, neuroimaging, and polysomnography using non-parametric statistics.

Main Results:

Cognitive performance significantly differed, with tauRBD patients exhibiting lower MMSE scores.
Sex distribution varied, showing male predominance in iRBD but a more balanced distribution in iatroRBD and tauRBD.
Polysomnography revealed differences in REM sleep architecture: reduced REM percentage in tauRBD and prolonged REM latency in iatroRBD.

Conclusions:

RBD can manifest as a shared motor phenotype across different etiological contexts.
Cognitive status, sex distribution, and specific REM sleep features are key discriminators.
Non-motor symptoms and routine PSG metrics showed limited value in differentiating RBD subtypes in this retrospective study.