Introduction: Resting-state functional MRI (rs-fMRI) has been shown by our group as a promising tool for the diagnosis of early Parkinson’s disease (PD). As REM sleep behavior disorder (RBD) is strongly associated with alpha-synucleinopathy, we aimed to investigate potential resting-state connectivity and structural changes in this promising prodromal group. Materials and methods: Twenty-six patients with polysomnography-proven idiopathic RBD and 22 age and sexmatched healthy controls were recruited from the Oxford Parkinson’s Disease Centre (OPDC) patient cohort. All subjects underwent a structural MRI protocol, including T1weighted and diffusion imaging. Blood-oxygen level dependent (BOLD) sequences were acquired during resting conditions, with the subject awake and their eyes open. Resting-state analysis was performed using probabilistic independent component analysis (ICA) as implemented in the Multivariate Exploratory Linear Optimized Decomposition into Independent Component FSL tool (MELODIC). A previously developed template of resting-sate networks typical for healthy elderly participants was used. Based on a priori hypotheses, three networks of interest (the basal ganglia network (BGN), the sensorimotor network (SMN) and the default mode network (DMN)), and one control network (the primary visual network (PVN)) were chosen for further analyses. The dual regression approach was then used to identify individual temporal dynamics and the associated spatial maps. Statistical comparisons between RBD and healthy controls were performed using permutation-based non-parametric inference. Results were corrected for age, sex and voxelwise gray matter volume, and defined as significant at p < 0.05 after FWE correction. Results: One of the RBD patients had significant cortical atrophy on their T1-weighted structural scan, and was excluded from further analyses. Patients with RBD performed marginally worse on the UPDRS part III (0.7 (1.1) vs. 3.0 (3.4), p = 0.005) and had lower cognitive scores (MMSE 29.3 (1.0) vs. 27.4 (1.7), p < 0.001). The two groups performed comparatively on the Purdue Pegboard Test (p = 0.5). At the time of the MRI investigation, none of the subjects fulfilled the UK Parkinson’s Disease Society Brain bank criteria for the diagnosis of idiopathic Parkinson’s disease and there was no clinical suspicion of any other neurological condition. There were no significant volumetric differences between patients with RBD and healthy controls. Voxel-based morphometry analysis did not yield any significant graymatter differences between the two groups. Similarly, no significant differences of fractional anisotropy were found using white matter tract analysis. Rs-fMRI revealed decreased coactivation within the BGN (involving the caudate, putamen, globus pallidus and the dorsolateral prefrontal cortex) and the SMN (precentral gyrus) of patients with RBD. No increased coactivation within these networks was seen in the RBD group, and no between-group differences were seen in the DMN and PVN. Conclusion: Rs-fMRI demonstrates significantly reduced coactivation within the BGN and SMN of patients with RBD. These results are similar to those found in early PD and are likely to represent pre-clinical basal ganglia dysfunction. This approach shows great promise as a potential biomarker for prodromal alpha-synucleinopathy. Acknowledgements: This studywas funded by theMonument Trust Discovery Award from Parkinson’s UK and supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The authors report no conflict of interest in relation to this work.