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The fate of patients with REM sleep behavior disorder and mild cognitive impairment.
Sleep Medicine ( IF 4.8 ) Pub Date : 2020-02-29 , DOI: 10.1016/j.sleep.2020.02.011
Dario Arnaldi 1 , Andrea Chincarini 2 , Fabrizio De Carli 3 , Francesco Famà 1 , Nicola Girtler 1 , Andrea Brugnolo 1 , Matteo Pardini 1 , Federico Massa 1 , Riccardo Meli 1 , Cristina Schenone 1 , Matteo Bauckneht 4 , Silvia Morbelli 4 , Flavio Nobili 1
Affiliation  

Objective

To investigate clinical and dopaminergic pre-synaptic brain imaging characteristics of subjects with idiopathic rapid eye movement (REM) behavior disorder (iRBD) and mild cognitive impairment (MCI), and to evaluate the combined predictive value of risk factors for short-term conversion to synucleinopathy.

Method

In sum, 44 polysomnography (PSG)-confirmed iRBD patients (68.5 ± 7.2 years; 38 males) underwent 123I-FP-CIT-SPECT, comprehensive neuropsychological evaluation, clinical examination and clinical follow-up every six months (30.6 ± 21.5 months). Step-wise logistic regression was applied to identify those features discriminating iRBD patients with (iRBD-MCI; n = 14) and without MCI (normal cognition [NC], iRBD-NC; n = 30). The risk of neurodegeneration was estimated with Kaplan–Meier analysis. Predictors of phenoconversion were assessed with Cox proportional-hazards analysis, adjusting for age, gender and education. A generalized linear model (GLM) was applied to define the best combination of risk factors predicting conversion at follow-up.

Results

At baseline, patients with iRBD-MCI showed reduced striatal dopamine transporter (DAT) specific to non-displaceable binding ratio (SBR) and more constipation compared with iRBD-NC patients (p < 0.0001). During the follow-up, 10 patients (22.7%) develop an overt synucleinopathy. GLM analysis showed that patients with orthostatic hypotension, non-motor experiences of daily living, reduced putaminal DAT-SPECT SBR, and cognitive impairment in verbal memory/visuoconstruction abilities were at higher risk of phenoconversion (Hazard Ratio [HR] 26.05; Sensitivity 90%; Specificity 100%; Accuracy 97.73%; Positive Predictive Value 100%; Negative Predictive Value 97.14%).

Conclusions

iRBD-MCI patients showed a more severe dopaminergic neuroimaging and clinical phenotype. Combining clinical and neuroimaging markers allowed to achieve excellent ability in identifying iRBD patients at high risk of developing a synucleinopathy within about three years from diagnosis.



中文翻译:

REM睡眠行为障碍和轻度认知障碍患者的命运。

目的

调查特发性快速眼动(REM)行为障碍(iRBD)和轻度认知障碍(MCI)受试者的临床和多巴胺能突触前脑成像特征,并评估短期危险因素转化为危险因素的综合预测价值突触核蛋白病。

方法

总之,每6个月(30.6±21.5个月)对44例经多导睡眠图(PSG)确认的iRBD患者(68.5±7.2岁; 38例男性)进行123次I-FP-CIT-SPECT,全面的神经心理学评估,临床检查和临床随访。 )。应用逐步逻辑回归分析来识别那些区分(iRBD-MCI; n = 14)和没有MCI(正常认知[NC],iRBD-NC; n = 30)的iRBD患者的特征。用Kaplan–Meier分析估计了神经变性的风险。通过Cox比例风险分析评估了表型转换的预测因素,并根据年龄,性别和教育程度进行了调整。应用广义线性模型(GLM)来确定风险因素的最佳组合,以预测随访时的转化。

结果

在基线时,与iRBD-NC患者相比,iRBD-MCI患者显示出对不可替代结合比(SBR)特异的纹状体多巴胺转运蛋白(DAT)减少,便秘增加(p <0.0001)。在随访期间,有10名患者(22.7%)出现明显的突触核蛋白病。GLM分析表明,体位性低血压,非运动性日常生活经验,降低的腹泻DAT-SPECT SBR以及言语记忆/视觉构造能力的认知障碍患者发生表型转换的风险更高(危险比[HR] 26.05;敏感性90% ;特异性100%;准确性97.73%;正预测值100%;负预测值97.14%)。

结论

iRBD-MCI患者表现出更严重的多巴胺能神经影像学和临床表型。结合临床和神经影像标记物,可以在诊断后约三年内,鉴定出患有发展性突触核蛋白病高风险的iRBD患者,具有出色的能力。

更新日期:2020-02-29
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