Abstract
Parkinson disease (PD) patients with rapid eye movement (REM) sleep behavior disorder (RBD) have worse motor symptoms and non-motor symptoms than patients without RBD. The aim of this study was to examine underlying differences in brain structure from a network perspective. Baseline data were obtained from Parkinson’s Progression Markers Initiative (PPMI) participants. We divided PD patients and healthy controls (HC) into RBD positive and RBD negative using a cutoff score of ≥5 on the RBD screening questionnaire. HC with probable RBD were excluded. We first carried out a region-of-interest analysis of structural MRIs using voxel-based morphometry to study volumetric differences for the putamen, thalamus and hippocampus in a cross-sectional design. Additionally, an exploratory whole-brain analysis was performed. To study group differences from a network perspective, we then performed a ‘seed-based’ analysis of structural covariance, using the bilateral dorsal-caudal putamen, mediodorsal thalamus and anterior hippocampus as seed regions. The volume of the right putamen was smaller in PD patients with RBD. RBD symptom severity correlated negatively with volume of the right putamen, left hippocampus and left thalamus. We did not find any differences in structural covariance between PD patients with and without RBD. Presence of RBD and severity of RBD symptoms in PD are associated with smaller volumes of the putamen, thalamus and hippocampus.
Highlights
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by vivid dreaming in combination with a loss of physiological muscle atonia, resulting in complex movements during rapid eye movement (REM) sleep (Olson et al 2000)
We did not find an effect of patient group (PD RBD+ versus Parkinson disease (PD) RBD- versus healthy controls (HC)) on sex, age, educational level, Epworth Sleepiness Scale (ESS), MoCA, GDS-15 or Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease (QUIP-S)
A significant effect of groups was found on State-Trait Anxiety Inventory (STAI) score (p < 0.001)
Summary
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by vivid dreaming in combination with a loss of physiological muscle atonia, resulting in complex movements during REM sleep (Olson et al 2000). Physiological muscle atonia during REM sleep is regulated by so-called ‘REM on’ and ‘REM off’ regions in the brainstem (Boeve 2010; Boeve et al 2007). Dysfunction of these regions is thought to play a role in RBD pathophysiology (Boeve 2010; Boeve et al 2007). RBD in PD is associated with worse motor function and worse non-motor symptoms, such as constipation, olfactory dysfunction, excessive daytime sleepiness, cognitive impairment and a range of neuropsychiatric symptoms, including anxiety, depression, impulse control disorders and hallucinations
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