RBD Group Research Articles

The correlation between rapid eye movement sleep behavior disorder and the progress of Parkinson's disease: a systematic review and meta-analysis.

This meta-analysis was conducted to evaluate potential differences in symptoms between PD patients with or without RBD. A systematic search was conducted in PubMed, Cochrane, Embase, and Web of Science databases (as of August 16, 2023), to identify relevant studies on PD and RBD. Statistical analysis was performed using Stata 15.0. Continuous variables were analyzed using the standardized mean difference (SMD) and 95% confidence interval (95% CI), while count data were assessed using the odds ratio (OR) and 95% CI as statistical effect sizes. Heterogeneity among all included studies was tested; for studies with low heterogeneity (I2 < 50%), a fixed-effects model was used to calculate statistical results. For studies with relatively high heterogeneity (I2 > 50%), a random-effects model was applied, followed by sensitivity and subgroup analyses to identify sources of heterogeneity. A total of 5,672 subjects were involved in this study. Compared to the NRBD group, the UPDRS-III score in the RBD group was significantly higher (SMD = 0.20, 95% CI: [0.11, 0.29], P < 0.001), and the Hoehn-Yahr score in the RBD group was also significantly higher (SMD = 0.29, 95% CI: [0.03, 0.55], P < 0.001). Patients with PD in the RBD group had more severe cognitive impairments than those in the NRBD group (SMD = -0.30, 95% CI: [-0.48, -0.11], P < 0.001). The incidence of hallucination in PD patients in the RBD group was 3.0 times that of the NRBD group (OR = 3.0, 95% CI: [2.15, 4.20], P = 0.110). PD patients in the RBD group also experienced more severe anxiety symptoms (SMD = 0.13, 95% CI: [-0.26, 0.51], P < 0.001), had higher scores in depression scales (SMD = 0.22, 95% CI: [0.02, 0.43], P < 0.001), and higher scores in sleep disorder scales than those in NRBD group (SMD = 0.10, 95% CI: [-0.11, 0.31], P < 0.001). Results show PD patients with co-occurring RBD have more severe motor and non-motor symptoms likely due to overlapping affected regions in RBD and PD-related pathology, plus broader neurodegeneration seen in PD patients with RBD. https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier CRD42023476331.

Ginseng Polysaccharide Enhances the Humoral and Cellular Immune Responses to SARS-CoV-2 RBD Protein Subunit Vaccines.

The COVID-19 pandemic remarkably accelerated vaccine research progress. The role of adjuvants in enhancing vaccine immune intensity and influencing immune types has been considered. Ginseng polysaccharide (GPS) has been demonstrated to have strong immunoregulatory properties. It is important to explore the feasibility of adding GPS to vaccine adjuvant components to improve the immune response effect of RBD vaccines. Here, we prepared a SARS-CoV-2 RBD antigen using the Escherichia coli expression system and determined that subcutaneous administration of GPS at a dose of 40 mg/kg could effectively activate dendritic cells (DCs) and macrophages (MΦ) in mice. Compared with the RBD group, the RBD+GPS triggered stronger and persistent antibody responses. It is also notable that higher levels of RBD-specific IgG and IgA were distributed in the lungs of RBD+GPS-immunized BALB/c mice. In addition, the RBD+GPS also resulted in lower percentages of IFN-γ+ CD4+ T cells and higher percentages of IFN-γ+ CD8+ T cells and CD8+ Tcm cells. These results suggest that GPS could be a promising vaccine immuno-enhancer for SARS-CoV-2 RBD subunit vaccines to establish stronger systemic and pulmonary mucosal protective immunity.

Estimating brainstem dysfunction with video Head-impulse test(vHIT) in idiopathic REM sleep behavior disorder(iRBD) patients (P6-13.006)

<h3>Objective:</h3> In this study, we aimed to differentiate the characteristics of video nystamnography, including vHIT, in iRBD patients from healthy controls, which in known as the prodrome of degenerative disease. <h3>Background:</h3> iRBD is known as the prodrome of alpha-synucleionopathies. Pons plays a pivotal role in the control of gaze. The VOR is a reflex stabilizing gaze during head movement. VOR gain in vHIT is calculate as the ratio of eye velocity to head velocity and reduced by VOR pathway disease. <h3>Design/Methods:</h3> Along 32 iRBD patients confirmed through overnight PSG, 16 patients with AHI of less than 15 were grouped in RBD group and 19 with AHI of 15 or higher as RBD with OSA group. 24 participants without sleep disturbance and underwent VNG were classified into normal group. The VOR gains as well as parameters of pursuit and saccade were measured. These results were compared by Kruskal-Wallis one-way analysis. <h3>Results:</h3> In the horizontal canal, the gain of normal group was 1.02 and the RBD group was 1.00 and the RBD with OSA group was 0.98 in right side, and it was measured as 0.98 in the normal, 0.85 in the RBD group, and 0.88 in the RBD with OSA group in left side. In the right anterior canal, values was 1.14 in the normal group, 1.02 in the RBD group, and 1.00 in the RBD with OSA group. In the left posterior canal, value was 1.10 for the normal group, 1.03 for the RBD group, and 0.97 for the RBD with OSA group. vHIT parameters were not different between RBD and RBD with OSA group. <h3>Conclusions:</h3> We found that VOR gains in iRBD patients were reduced compared to normal controls. AHI did not affect the VOR gains iRBD patients. This study suggests that VOR gains may be crucial determinants estimating brainstem dysfunction in iRBD patients. <b>Disclosure:</b> Dr. Kim has nothing to disclose. Dr. Joo has nothing to disclose. Prof. Joo has nothing to disclose. Hyujin Jo has nothing to disclose.

Rapid Eye Movement Sleep Behavior Disorder in Parkinson's Disease: A Survey-Based Study.

To characterize Parkinson's disease (PD) symptoms based on the presence, onset time, and severity of rapid eye movement sleep behavior disorder (RBD) and their association with impulse control disorders (ICD). RBD is a frequent non-motor symptom in PD, usually described as prodromal. The severity of RBD according to the start time and its relationship with ICD in PD needs further clarification. A survey-based study was performed to determine the presence of RBD symptoms, their severity, and the temporal relationship with the PD onset. The survey included RBD1Q, the Mayo Sleep, and the RBDQ-HK questionnaires and questions about clinical characteristics, including ICD. Only PD patients with care partners spending night hours in the same room were included. 410 PD patients were included: 206 with RBD (50.2%) and 204 non-RBD (49.8%). The PD-RBD patients were younger and their daily levodopa dose was higher than the non-RBD group. Most of these patients developed RBD symptoms after the onset of clinical PD were younger at motor symptom onset and had higher scores in the hallucinations and psychosis subsection of MDS-UPDRS-I. RBD group had a more severe non-motor phenotype, including more ICD than those without RBD, mainly due to higher compulsive eating. In our study, most patients recognized RBD symptoms after the onset of the PD motor symptoms and the clinical features of PD with and without RBD were distinctive, supporting the hypothesis that PD-RBD might represent a variant pattern of neurodegeneration.

Imaging of the nigrostriatal system for evaluating the preclinical phase of Parkinson's disease development: the utility of neuromelanin, diffusion MRI, and DAT-SPECT.

To assess the utility of examining the nigrostriatal system with MRI and dopamine transporter (DAT) imaging for evaluating the preclinical phase of Parkinson's disease (PD). The subjects were 32 patients with early PD and a history of probable rapid eye movement sleep behavior disorder (RBD; PD group), 15 patients with idiopathic RBD (RBD group), and 24 age-matched healthy controls (HC group) who underwent neuromelanin and diffusion tensor MRI for analysis of the substantia nigra pars compacta (SNpc). The RBD and PD groups underwent DAT imaging. In the RBD group, totals of 39 MRI and 27 DAT imaging examinations were obtained longitudinally. For each value, intergroup differences and receiver operating characteristic analysis for diagnostic performance were examined statistically. The neuromelanin value was significantly lower and the diffusion tensor values except fractional anisotropy were significantly higher in the RBD and PD groups than in the HC group. The DAT specific binding ratio (SBR) was significantly lower in the PD group than in the RBD group. The areas under the receiver operating characteristic curves (AUCs) for neuromelanin/mean diffusivity value in the SNpc were 0.76/0.82 for diagnosing RBD and 0.83/0.80 for diagnosing PD. The area under the receiver operating characteristic curves for the SBR for discriminating PD from RBD was 0.87. MRI and DAT imaging may be useful for evaluating sequential nigrostriatal changes during the preclinical phase of PD. MRI detects nigrostriatal changes in both RBD and early PD, and DAT imaging detects nigrostriatal changes during the transition to PD in RBD.

Compromised Dynamic Cerebral Autoregulation in Patients With Central Disorders of Hypersomnolence.

Objective: We aimed to investigate the dynamic cerebral autoregulation (dCA) in patients with central disorders of hypersomnolence during wakefulness.Methods: Thirty-six patients with central disorders of hypersomnolence were divided into three groups according to polysomnography and multiple sleep latency test results: the idiopathic hypersomnia group (IH), narcolepsy type 1 without rapid-eye-movement sleep behavior disorder group (NT1-RBD), and narcolepsy type 1 with rapid-eye-movement sleep behavior disorder group (NT1 + RBD), with 12 patients in each group. Twelve sex- and age-matched healthy controls were recruited. We assessed the Epworth sleepiness scale (ESS) and dCA of all subjects. dCA was assessed by analyzing the phase difference (PD) using transfer function analysis. The ESS and dCA were analyzed before and after standardized treatment in 24 patients with narcolepsy type 1.Results: The overall PD of the IH, NT1-RBD, and NT1 + RBD groups were lower than that of the control group (P < 0.001). There were no significant differences between the overall PD of the NT1-RBD and NT1 + RBD group (P > 0.05). The ESS scores decreased and the overall PD increased after treatment in 24 patients with narcolepsy type 1 (P < 0.001). Multivariable analysis showed that mean sleep latency in multiple sleep latency test was independently associated with impaired overall PD (P < 0.05).Conclusions: The dCA is impaired in patients with central disorders of hypersomnolence. The impairment of dCA occurs irrespective of NT1-RBD/+RBD. The ESS score and dCA improved in patients with narcolepsy type 1 after medication treatment. The mean sleep latency in multiple sleep latency test was independently associated with impaired dCA.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02752139.

The role of pedunculopontine nucleus in isolated REM sleep behavior disorder and REM sleep without atonia

IntroductionThe aim of this study was to analyze the functions of pedunculopontine nucleus (PPN) in isolated REM sleep behavior disorder (iRBD) and REM sleep without atonia (RSWA) to investigate the role of PPN in dream-enacting motor behaviors in RBD. We evaluated the activity of PPN through the prepulse modulation (PPM) together with other brainstem reflexes to investigate the differences in changes at brainstem. MethodsWe included nine patients with isolated RSWA and 10 patients with iRBD. For diagnosis, all patients underwent polysomnography. None of the patients had parkinsonism or dementia. We also included 17 healthy participants with similar age and sex. Blink reflex (BR), PPM of BR, recovery excitability of BR, and auditory startle reflex (ASR) were recorded in all participants. ResultsThere was a prepulse inhibition deficit in iRBD and RSWA groups compared to healthy subjects. The BR-R2 recovery at 200 ms interval was also higher in patients with iRBD and RSWA. In ASR recordings, the response probabilities were higher in the RBD group compared to RSWA and control groups. ConclusionThe PPM was abnormal in both iRBD and RSWA whereas ASR was enhanced in iRBD. We suggest that there are certain similarities and differences in the pathophysiologies of iRBD and RSWA.

Clinical Correlates of Rapid Eyeball Movement Sleep Behaviour Disorder with Clomipramine: A Case Control Study

Introduction: Antidepressants have been implicated in causing Rapid eyeball movement sleep Behaviour Disorder (RBD). While Selective Serotonin Reuptake Inhibitor (SSRI) and Serotonin Norepinephrine Reuptake Inhibitors (SNRI) are more frequently implicated, Tricyclic Antidepressants (TCA) have been less studied. Aim: To characterise the clinical correlates of RBD on Clomipramine and to compare these parameters with those who didn’t develop RBD on treatment with clomipramine. Materials and Methods: It was a case control study in which participants who were on clomipramine and had developed RBD were studied, and a comparison was made with those participants who were on clomipramine but didn’t develop RBD. All the assessments were done in a single sitting. Patients who were on clomipramine, for any reason, were screened for presence of sleep disorder. Detailed interview was done for diagnosis and Statistical Manual of Mental Disorders (DSM-5) diagnosis of RBD to form the case group. From the group of participants, who didn’t meet the criteria for RBD, every 7th case was included to form the control group (NRBD group). Both the groups were interviewed for socio-demographic and clinical profile and Mini International Neuropsychiatric Interview (MINI Version 5) was applied for International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) of diagnosis of psychiatric disorders. Chi-square and Independent t-test were used to make the group comparisons. Pearson’s coefficient was used for correlation analysis. Results: A total of 164 participants, on clomipramine, were evaluated for presence of RBD, which was found in 20 and were included in the RBD group and 20 participants, were included in the NRBD group. Mean age of the participants in RBD group was 36.650±7.882 years. Mean duration of RBD development was 16.4 days (Range: 3-40 days). In comparison to the NRBD group, in the RBD group mean dosages (p=0.016), and mean duration of treatment (p=0.026) with clomipramine was significantly higher. Correlational analysis showed that duration of development of RBD correlated negatively with age (r=-0.479, p=0.034) and dosage of clomipramine (r=-0.095, p=0.690). Conclusion: RBD has higher prevalence and younger age of onset with clomipramine usage than earlier reported. Higher dosage increases the chance of developing RBD. Clinicians should be alert for identifying and managing RBD in all patients on antidepressants.

Disturbances of spatial reference frame and postural asymmetry after a chronic stroke

Asymmetrical postural behaviours are frequently observed after a stroke. They are due in part to the sensorimotor deficit, but could also be related to a disorder of the representation of the body in space. The objective was to determine whether the asymmetrical postural behaviours of chronic stroke patients are related to a disruption of the perception of spatial frame. Thirty chronic stroke patients (mean age 60.3 y ± 10, mean delay post-stroke 4.78 y ± 3) 15 patients with right brain damage (RDB) and 15 patients with left brain damage (LBD) and 20 healthy subjects participated in the study. Postural asymmetry was detected by the evaluation of body weight repartition on a force platform (weight body asymmetry) and was related to the longitudinal body axis (LBA) and the subjective straight ahead (SSA) (egocentric space representation) and also to the subjective visual vertical (SVV) (allocentric space representation) by means of a multivariate analysis of variance (MANOVA) which was adjusted with motor function and sensitivity as covariables. Both patients with RBD (35% ± 8) and LBD (39% ± 4) had a body weight asymmetry and there was still space misperception at this stage of recovery, especially in the RBD group. WBA was related to LBA when considering both patients with RDB and LDB ( P = 0.03). However, this relation was dependent on the side of the lesion ( P = 0.0006) with a stronger relation in the RBD group (58.26%). No relation with WBA was found neither with SSA ( P = 0.58) nor with SVV ( P = 0.47). This study pointed out a strong relationship between disturbance in the perception of the longitudinal body axis and postural asymmetry in chronic strokes, and predominantly within the RBD group. Whereas other spatial perturbations did not seem to be involved in this particular postural behaviour.

Difference in severity of sleep apnea in patients with rapid eye movement sleep behavior disorder with or without parkinsonism

ObjectiveRapid eye movement sleep behavior disorder (RBD) is a common sleep disturbance in patients with neurodegenerative disorders. We aimed to compare sleep parameters among the different types of RBD patients. MethodsA total of 122 patients with dream enactment behavior were screened. Of these, 92 patients who were diagnosed with RBD by polysomnography were included in this study. Enrolled patients with RBD were classified into four groups based on the following diagnoses: idiopathic RBD (iRBD); RBD with Parkinson disease (PD-RBD); multiple system atrophy (MSA) with RBD (MSA-RBD); and dementia with Lewy bodies (DLB) with RBD (DLB-RBD). Various clinical and polysomnographic parameters were compared. ResultsAmong the 92 patients with RBD, 35 had iRBD, 25 had PD-RBD, 17 had MSA-RBD, and 15 had DLB-RBD. The mean apnea−hypopnea index of atypical parkinsonism with RBD (AP-RBD) group was 16.2 ± 17.7 events/h (MSA-RBD, 14.0 ± 16.6; DLB-RBD, 18.8 ± 19.1), which was significantly higher than the other groups (p < 0.05). The proportion of patients with 100% supine sleep in the AP-RBD group (44%) was higher than that in the iRBD group (14%; p = 0.030). The proportion of OSA with 100% supine sleep position was significantly higher in the MSA-RBD and DLB-RBD groups than in the iRBD group (p = 0.042 and p = 0.029, respectively). ConclusionOur study demonstrated that patients in the MSA-RBD and DLB-RBD groups had a tendency to sleeping in the supine position and a higher vulnerability to OSA compared to other RBD groups. Further cohort studies are needed to evaluate the influence of these factors on the development of parkinsonism.

Early diagnosis of Lewy body disease in patients with late-onset psychiatric disorders using clinical history of rapid eye movement sleep behavior disorder and [123 I]-metaiodobenzylguanidine cardiac scintigraphy.

Rapid eye movement sleep behavior disorder (RBD) and psychiatric symptoms often antedate the clinical diagnosis of Parkinson's disease or dementia with Lewy bodies. The purpose of this study was to investigate RBD and its relevance to Lewy body disease (LBD) in patients with late-onset psychiatric disorders. Study subjects included 19 patients with late-onset psychiatric disorders who exhibited REM sleep without atonia (RWA), which is a hallmark of RBD on polysomnography, at our psychiatric ward. Clinical profiles and radiological findings by cardiac [123 I]-metaiodobenzylguanidine ([123 I]-MIBG) scintigraphy and imaging for the dopamine transporter (DAT) were compared between patients with and without RBD symptoms. The correlations between the percentage of RWA in the total rapid eye movement sleep (%RWA) and radiological findings were also investigated. Nine patients reported RBD symptoms only on specific questioning, but clinical profiles, including the prevalence of antipsychotropic usage, did not differ when compared to the remaining 10 patients without RBD (incidental RWA group). The median %RWA was significantly higher in the definite RBD group than in the incidental RWA group. Although the cardiac [123 I]-MIBG uptake was significantly lower in the definite RBD group than in the incidental RWA group, there was overlap in the specific binding ratio on DAT scan. The severity of %RWA was highly correlated with the value of cardiac [123 I]-MIBG uptake, but not with specific binding ratio on DAT scan. Clinical history of RBD and cardiac [123 I]-MIBG scintigraphy are helpful for an early differential diagnosis of LBD from late-onset psychiatric disorders, even before parkinsonism or dementia appears.

Low omega-6/omega-3 ratio in a maternal protein-deficient diet promotes histone-3 changes in progeny neural cells and favors leukemia inhibitory factor genetranscription

Omega-3 (n-3) fatty acids modulate epigenetic changes critical to genesis and differentiation of neural cells. Conversely, maternal protein-malnutrition can negatively modify these changes. This study investigated whether a low n-6/n-3 ratio in a maternal diet could favor histone-3 (H3) modifications, gene transcription and differentiation in the offspring neural cells even under protein-deficiency. Female rats fed a control (Ct), or 3 types of multideficient diets differing in protein levels or linoleic/alpha-linolenic fatty acid ratios (RBD, RBD-C, RBD-SO) from 30 days prior to mating and during pregnancy. Cerebral cortex tissue and cortical cultures of progeny embryonic neurons and postnatal astrocytes were analyzed. H3K9 acetylation and H3K27 or H3K4 di-methylation levels were assessed by flow cytometry and/or immunocytochemistry. In astrocyte cultures and cortical tissue, the GFAP protein levels were assessed. Glial derived neurotrophic factor (GDNF) and leukemia inhibitory factor (LIF) gene expression were evaluated in the cortical tissue. GFAP levels were similar in astrocytes of Ct, RBD and RBD-C, but 65% lower in RBD-SO group. Higher levels of H3K9Ac were found in the neurons and H3K4Me2 in the astrocytes of the RBD group. No intergroup difference in the cortical GDNF mRNA expression or the H3K27Me2 levels in astrocytes was detected. LIF mRNA levels were higher in the RDB (P=.002) or RBD-C (P=.004) groups than in the control. The findings indicate the importance of dietary n-3 availability for the brain, even under a protein-deficient condition, inducing Histone modifications and increasing LIF gene transcription, involved in neural cell differentiation and reactivity.

The long-lasting effects of repetitive neck muscle vibration on postural disturbances in standing position in chronic patients

Introduction Asymmetrical postural behaviours are frequent and related to poor equilibrium after a stroke. Proprioceptive neck vibration could correct the postural asymmetry through a sensory recalibration but the long lasting effect has not yet tested. Objective To test the long-lasting effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in chronic patients. Methods Twenty chronic stroke patients (mean age: 61.4 y11, mean delay since stroke: 5.5y3), 10 right (RDB) and 10 left (LDB) brain damage, underwent a program of 10 vibrations of 10 min sessions during two weeks–the evaluation of postural asymmetry on force platform (weight body asymmetry WBA), spatial frames (subjective straight ahead SSA, longitudinal body axis LBA, subjective visual vertical SVV) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, time up and go) were ascertained before (D−15, D0) and at the end of the vibrations (D + 15, D + 22, D + 45). Results In the post-test, a significant reduction in WBA was established in the RBD (P = 0.009) and was maintained at D + 15 (P = 0.01) and D + 22 (P = 0.05), no effect was observed in the LBD. In addition, no significant modification was found on the spatial frame in both group. A significant improvement was found for the motricity and time up and go in the RBD. Discussion rNMV causes a reduction of postural asymmetry in the RBD group independently of the space representation improvement. Likewise, rNMV can modify the postural asymmetry in chronic patients but this result was not maintained at D + 45.

Study on the relation of brain functional connectivity to movement disorders and cognitive impairment in patients with rapid eye movement sleep behavior disorder

Objective To explore the relation between abnormal functional connectivity of substantia nigra and impairment of movement and cognition in patients with rapid eye movement sleep behavior disorder (RBD). Methods A total of 22 subjects, including 14 patients with RBD and 8 sex, age, education-matched healthy controls, were enrolled in this study according to international diagnostic criteria. Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) and Hoehn-Yahr Stage were used to evaluate motor function. Digit Ordering Test - Attention (DOT - A), Symbol Digit Modalities Test (SDMT), Stroop Color-Word Test (SCWT), Trail Making Test (TMT), Rey-Osterrieth Complex Figure Test (ROCFT), Clock Drawing Test (CDT), Boston Naming Test (BNT) and Auditory Verbal Learning Test (AVLT) were used to evaluate cognitive function. The functional connectivity from left and right substantia nigra to brain region were examined. Results There were no statistical differences of UPDRSⅢ and Hoehn?Yahr Stage between 2 groups ( P > 0.05, for all). In comparison with control group, SDMT ( P = 0.001), ROCFT-copy ( P = 0.013) and AVLT-N2 ( P = 0.032) were significantly lower, while TMT-B test was significantly higher ( P =0.005) in RBD group. Compared with control group, the functional connectivity of right substantia nigra to left precentral gyrus ( P < 0.005) and right angular gyrus ( P < 0.005) were all decreased in RBD group. Conclusions The results suggest that cognitive impairment occurs earlier than movement disorders in RBD, and there are abnormal functional connectivity from right substantia nigra to left precentral gyrus and right angular gyrus, proving that abnormal functional connectivity is the base of behavior disorders in RBD. DOI: 10.3969/j.issn.1672-6731.2017.09.005

The long-lasting effects of repetitive neck muscle vibrations on postural disturbances in standing position in chronic patients

The objective of this preliminary study is to test the long-lasting effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in chronic patients. Twenty chronic stroke patients (mean age 61.4y ± 11, mean delay since stroke 5.5y ± 3), 10 right (RDB) and 10 left (LDB) brain damage, having gained the capacity to stand for more than 30 s were included. They underwent 10 vibrations of 10 min sessions during two weeks – the evaluation of postural asymmetry on force platform (weight body asymmetry [WBA]), spatial frames (subjective straight ahead [SSA], longitudinal body axis [LBA], subjective visual vertical [SVV]) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, Time Up and Go) were ascertained twice before (D-15, D0) and ultimately at the end of the vibrations (D + 15, D + 22, D + 45). In the posttest, a significant reduction in WBA was established in the RBD ( P = 0.009) and was maintained at D + 15 ( P = 0.01) and D + 22 ( P = 0.05) on the contrary, no effect was observed in the LBD group. In addition, no significant modification was found on the spatial frame in both RBD and LBD. A significant improvement was found for the Motricity and Time Up and Go at D + 22 in the RBD group whereas no modifications were found in the LBD. rNMV causes a reduction of postural asymmetry in the RBD group independently of the space representation improvement. Likewise, rNMV can modify the postural asymmetry of patients at distance from their stroke but this result was not maintained at D + 45.

Cognitive Function Characteristics of Parkinson's Disease with Sleep Disorders.

Objective. The aim of this study was to investigate the cognitive function characteristics of Parkinson's disease (PD) with sleep disorders. Methods. Consecutive patients with PD (n = 96), patients with primary sleep disorders (n = 76), and healthy control subjects (n = 66) were assessed. The patients with PD were classified into sleep disorder (PD-SD) and non-sleep disorder (PD-NSD) groups. Results. Among 96 patients with PD, 69 were diagnosed with a sleep disorder. There were 38 sleep disorder cases, 31 RBD cases, and 27 NSD cases. On the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and MoCA subtests, patients in the PD-SD, primary sleep disorder, and PD-NSD groups exhibited lower scores than those in the control group. Moreover, the PD-SD patients exhibited more significant cognitive impairment than was observed in the primary sleep disorder patients. In the PD-SD subgroup, the attention scores on the MoCA and on MoCA subtests were lower in the PD with RBD group than in the PD with insomnia group. Conclusion. PD with sleep disorders may exacerbate cognitive dysfunction in patients. PD associated with different types of sleep disorders differentially affects cognitive functions, and patients with PD with RBD exhibited poorer cognitive function than was seen in patients with PD with insomnia.

National validation and proposed revision of REM sleep behavior disorder screening questionnaire (RBDSQ).

We validated the Italian version of the rapid eye movement sleep behavior disorder (RBD) screening questionnaire (RBDSQ) and calculated its cut-off value for discriminating RBD group from other sleep disorders and healthy controls (HC). 380 patients with sleep disorders and 101 HC were enrolled. RBDSQ achieved an acceptable Cronbach's α value of 0.787 and item 10 was the only one with a very low item-total biserial correlation (0.141). At ROC analysis, we obtained an AUC of 0.888, denoting a good performance of the RBDSQ total score for predicting the RBD status. The optimal cut-off value was 8 and it achieved good values of both sensitivity and specificity (0.842 and 0.780, respectively). Due to the poor performance of item 10 in our sample, we analyzed the RBDSQ without this item (called "revised RBDSQ"). We obtained a good Cronbach's α of 0.802. When evaluating the performance of the revised score in predicting the RBD status, we obtained an increased value of AUC (0.899). The optimal cut-off value was still 8 (sensitivity=0.829; specificity=0.820). The Italian version of RBDSQ is a sensitive tool for the identification of RBD patients. An improvement of the instrument could be obtained by removing item 10 and define a higher cut-off value of 8. The "revised RBDSQ" represents a reliable screening questionnaire for primary care physicians and neurologists and its employment may facilitate the choice of subjects that should undergo a PSG that confirms the diagnosis of RBD, thus avoiding polysomnographic exams when not needed.

Quantitative assessment of motor speech abnormalities in idiopathic rapid eye movement sleep behaviour disorder

ObjectivePatients with idiopathic rapid eye movement sleep behaviour disorder (RBD) are at substantial risk for developing Parkinson's disease (PD) or related neurodegenerative disorders. Speech is an important indicator of motor function and movement coordination, and therefore may be an extremely sensitive early marker of changes due to prodromal neurodegeneration. MethodsSpeech data were acquired from 16 RBD subjects and 16 age- and sex-matched healthy control subjects. Objective acoustic assessment of 15 speech dimensions representing various phonatory, articulatory, and prosodic deviations was performed. Statistical models were applied to characterise speech disorders in RBD and to estimate sensitivity and specificity in differentiating between RBD and control subjects. ResultsSome form of speech impairment was revealed in 88% of RBD subjects. Articulatory deficits were the most prominent findings in RBD. In comparison to controls, the RBD group showed significant alterations in irregular alternating motion rates (p = 0.009) and articulatory decay (p = 0.01). The combination of four distinctive speech dimensions, including aperiodicity, irregular alternating motion rates, articulatory decay, and dysfluency, led to 96% sensitivity and 79% specificity in discriminating between RBD and control subjects. Speech impairment was significantly more pronounced in RBD subjects with the motor score of the Unified Parkinson's Disease Rating Scale greater than 4 points when compared to other RBD individuals. ConclusionSimple quantitative speech motor measures may be suitable for the reliable detection of prodromal neurodegeneration in subjects with RBD, and therefore may provide important outcomes for future therapy trials.

Rapid eye movement sleep behavior disorder after bilateral subthalamic stimulation in Parkinson’s disease

The effect of subthalamic nucleus (STN) deep brain stimulation (DBS) on rapid eye movement sleep behavior disorder (RBD) in Parkinson’s disease (PD) is not well known. We evaluated the change in the incidence of probable RBD after bilateral STN DBS in PD patients. Ninety patients with PD treated with bilateral STN DBS underwent retrospective assessment of RBD by interview before and after DBS. Forty-seven (52.2%) of the 90 patients had RBD preoperatively. RBD was resolved only in one patient and persisted in 46 patients at 1year after DBS. RBD developed de novo in 16 patients (de novo RBD group) within 1year after DBS, resulting in 62 (68.9%) of the 90 patients having RBD 1year after DBS. Patients with RBD at any time within 1year after DBS (RBD group, n=63) were older than the patients without RBD (non-RBD group, n=27). The sum of the Unified Parkinson Disease Rating Scale (UPDRS) axial score for the “on” state was lower in the RBD group than in the non-RBD group after DBS (p=0.029). Comparing the de novo RBD group and non-RBD group, the UPDRS Part III and total score and the levodopa equivalent daily doses for the “on” states decreased more in the de novo RBD group than in the non-RBD group (p<0.05). The incidence of clinical RBD increased after bilateral STN DBS because de novo RBD developed and pre-existing RBD persisted after DBS.

Parkinson’s disease and REM sleep behavior disorder result in increased non-motor symptoms

ObjectiveRapid eye movement (REM)-sleep behavior disorder (RBD) is often comorbid with Parkinson’s disease (PD). The current study aimed to provide a detailed understanding of the impact of having RBD on multiple non-motor symptoms (NMS) in patients with PD. MethodsA total of 86 participants were evaluated for RBD and assessed for multiple NMS of PD. Principal component analysis was utilized to model multiple measures of NMS in PD, and a multivariate analysis of variance was used to assess the relationship between RBD and the multiple NMS measures. Seven NMS measures were assessed: cognition, quality of life, fatigue, sleepiness, overall sleep, mood, and overall NMS of PD. ResultsAmong the PD patients, 36 were classified as having RBD (objective polysomnography and subjective findings), 26 as not having RBD (neither objective nor subjective findings), and 24 as probably having RBD (either subjective or objective findings). RBD was a significant predictor of increased NMS in PD while controlling for dopaminergic therapy and age (p=0.01). The RBD group reported more NMS of depression (p=0.012), fatigue (p=0.036), overall sleep (p=0.018), and overall NMS (p=0.002). ConclusionIn PD, RBD is associated with more NMS, particularly increased depressive symptoms, sleep disturbances, and fatigue. More research is needed to assess whether PD patients with RBD represent a subtype of PD with different disease progression and phenomenological presentation.