Abstract
REM sleep behavior disorder (RBD) has a poor prognostic implication in both motor and non-motor functions in Parkinson’s disease (PD) patients. However, to the best of our knowledge no study to date investigated the longitudinal cerebral changes underlying RBD symptoms in PD. We performed the longitudinal study to investigate the association between probable RBD and cortical and subcortical changes in early, de novo PD patients. We studied 78 participants from the Parkinson’s Progression Marker Initiative who underwent structural MRI at baseline and after 2 years. The presence of probable RBD (pRBD) was evaluated using the RBD screening questionnaire. We compared the cross-sectional and longitudinal cortical thickness and subcortical volume changes, between PD patients with and without pRBD. At baseline, we found bilateral inferior temporal cortex thinning in the PD-pRBD group compared with the PD-noRBD group. Longitudinally, the PD-pRBD group revealed a significant increase in the rate of thinning in the left insula compared with the PD-noRBD group, and the increased thinning correlated with decreased cognitive performance. In subcortical volume analyses, the presence of pRBD was linked with volume decrease over time in the left caudate nucleus, pallidum and amygdala. The volume changes in the left caudate nucleus revealed correlations with global cognition. These results support the idea that RBD is an important marker of rapid progression in PD motor and non-motor symptoms and suggest that the atrophy in the left insula and caudate nucleus might be the underlying neurobiological mechanisms of the poorer prognosis in PD patients with RBD.
Highlights
Rapid eye movement (REM) sleep behavior disorder (RBD), a parasomnia manifested by vivid dreams associated with simple or complex motor behavior during REM sleep, is one of the most common non-motor symptoms in Parkinson’s disease (PD)
This study investigated the associations between REM sleep behavior disorder (RBD) and brain changes in PD cross-sectionally and longitudinally
We found bilateral inferior temporal cortex thinning in the PD with probable RBD (pRBD) group compared with the PD-noRBD group
Summary
Rapid eye movement (REM) sleep behavior disorder (RBD), a parasomnia manifested by vivid dreams associated with simple or complex motor behavior during REM sleep, is one of the most common non-motor symptoms in Parkinson’s disease (PD). Increasing evidence has suggested that the presence of RBD in PD patients is associated with severity, and a quicker evolution of motor and non-motor symptoms. The previous studies have suggested the importance of RBD as a prognostic factor of rapid progression in PD motor and non-motor symptoms and possible mechanisms of RBD in PD patients beyond brainstem structures, little is known about the cerebral changes associated with RBD in PD. In this study, we investigated the association between RBD and changes of cortical thickness and subcortical volumes in early, de novo PD patients from the Parkinson’s Progression Markers Initiative (PPMI) project[24] (http:// www.ppmi-info.org), cross-sectionally and longitudinally. We hypothesized that PD patients with RBD would reveal increased brain atrophy compared to those without RBD, cross-sectionally and longitudinally and that these changes would correlate with their motor and non-motor symptoms
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