Abstract
BackgroundTo investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer’s disease (AD) patients without any feature of dementia with Lewy bodies.MethodsWe enrolled 296 community-dwelling probable AD patients who did not meet the diagnostic criteria for possible or probable dementia with Lewy bodies. Among them, 93 were amyloid beta (Aβ) positive on 18F-florbetaben amyloid brain positron emission tomography. We measured RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as the RBDSQ of 5 or higher. We manually segmented pineal gland on 3T structural T1-weighted brain magnetic resonance imaging.ResultsThe participants with pRBD had smaller pineal parenchyma volume (VPP) than those without pRBD (p < 0.001). The smaller the VPP, the more severe the RBD symptoms (p < 0.001). VPP was inversely associated with risk of prevalent pRBD (odds ratio = 0.909, 95% confidence interval [CI] = 0.878–0.942, p < 0.001). Area under the receiver operator characteristic curve for pRBD of VPP was 0.80 (95% CI = 0.750–0.844, p < 0.0001). These results were not changed when we analyzed the 93 participants with Aβ-positive AD separately.ConclusionsIn AD patients, reduced pineal gland volume may be associated with RBD.
Highlights
To investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer’s disease (AD) patients without any feature of dementia with Lewy bodies
We investigated the association between pineal gland volume and Rapid eye movement sleep behavior disorder (RBD) symptoms in probable AD patients who did not meet the diagnostic criteria of possible and probable dementia with Lewy bodies (DLB) [25]
We examined the association between volume of pineal parenchyma (VPP) and the risk of probable RBD (pRBD) using binary logistic regression analysis that was adjusted for the same covariates
Summary
To investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer’s disease (AD) patients without any feature of dementia with Lewy bodies. Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by loss of normal skeletal muscle atonia accompanied by dream-enacting behaviors [1]. In cognitively normal older adults, the smaller pineal gland was associated with more RBD symptoms and higher risk of incident RBD symptoms, suggesting that reduction of melatonin secretion associated with the reduction of pineal gland volume may be a potential cause of RBD [16]. In a couple of clinical trials, RBD symptoms such as dream-enacting behaviors and REM sleep muscle atonia were improved by the administration of melatonin [23, 24] but relapsed by its discontinuation [23]. The association between pineal gland and RBD has never been investigated in AD patients
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