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The Prodromal Synucleinopathy Rating Scale: An Assessment in Patients With REM Sleep Behavior Disorder
Bradley F Boeve1, Yuzheng Nie2, Ruijin Lu2
1Mayo Clinic, Rochester, MN.
Neurology
|June 16, 2026
Summary
The Prodromal Synucleinopathy Rating Scale (PSRS) shows preliminary validity for measuring clinical burden in REM sleep behavior disorder (RBD). This scale is reliable for assessing synucleinopathy progression in prodromal stages of Parkinson disease and related disorders.
Area of Science:
- Neurology
- Sleep Medicine
- Clinical Assessment
Background:
- REM sleep behavior disorder (RBD) is a prodromal stage for synucleinopathies like Parkinson disease (PD), dementia with Lewy bodies (DLBs), and multiple system atrophy (MSA).
- Clinical trials are emerging to delay or prevent synucleinopathy development in individuals with RBD.
- The Prodromal Synucleinopathy Rating Scale (PSRS) was developed to assess the clinical burden in prodromal synucleinopathy.
Purpose of the Study:
- To analyze the clinicometric properties and reliability of the PSRS in the North American Prodromal Synucleinopathy (NAPS) cohort.
- To establish the validity of the PSRS for measuring synucleinopathy clinical burden in individuals with RBD.
Main Methods:
- PSRS ratings were collected from 348 participants without overt PD, DLB, or MSA.
- Clinician raters evaluated seven domains: cognitive, behavioral/psychiatric, motor-axial, motor-appendicular, autonomic, sleep, and sensory.
- Spearman correlations assessed relationships between PSRS domains/total score and independent measures; test-retest reliability was quantified using Bayesian generalized linear mixed-effects models.
Main Results:
- Statistically significant correlations (p < 0.0001) were found between PSRS domains and established measures for cognitive, psychiatric, motor, autonomic, sleep, and sensory functions.
- The PSRS total sum score correlated significantly with functional assessment scales and clinician global impression of severity.
- Inter-rater and intra-rater reliability means ranged from 0.76 to 0.98, indicating good to excellent reliability.
Conclusions:
- The PSRS demonstrated moderate to strong correlations with independent measures of clinical burden in a large, multicenter RBD cohort.
- The scale exhibited good to excellent reliability.
- These findings support the preliminary validity of the PSRS for measuring synucleinopathy clinical burden in individuals with RBD.
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