Objective: To assess the association of REM sleep behavior disorder (RBD) with the development of impulse compulsive behaviors (ICBs) in patients with early Parkinson’s disease (PD) using longitudinally collected data from the Parkinson’s Progression Markers Initiative.

Background: We previously observed that patients with probable RBD assessed by questionnaire (pRBD) have an increased prevalence of ICB symptoms compared with PD patients without pRBD. A recent meta-analysis including 10 studies found that RBD was associated with a more than two-fold higher risk of developing ICBs in PD. To date no longitudinal study has assessed whether RBD is a possible risk factor for the development of ICBs.

Method: 401 newly diagnosed PD patients were prospectively evaluated at month six and then annually for 5 years. Probable RBD (pRBD, not confirmed by video-polysomnography) was assessed with the RBD Screening Questionnaire and dichotomized using a cut-off value of ≥6. The association of baseline and time-dependent (TD) pRBD with the development of ICB symptoms, according to the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP), was modeled using Cox proportional hazards regression. Models considered adjustment for age, sex, MDS-UPDRS III, geriatric depression scale (GDS), RBD medication use, total Levodopa equivalent daily dose (LEDD), Dopamine Agonist (DA) use, and antidepressant use.

Results: Baseline pRBD did not exhibit a strong association with increased risk of ICB symptoms (unadjusted hazard ratio (HR)=1.36, 95% CI (0.92, 2.02), p=0.125 and adjusted HR=1.17, 95% CI (0.77, 1.77), p=0.458). In the TD pRBD model, the risk for incident ICBs was slightly increased in pRBD patients (unadjusted HR=1.43, 95% CI (0.97, 2.10), p=0.069), but only trended towards an increase risk after adjustment for covariates (HR=1.27, 95% CI (0.84, 1.90), p=0.257). TD DA use (HR=1.64, 95% CI (1.03, 2.64), p=0.039), TD GDS (HR=1.12, 95% CI (1.06, 1.19), p<0.001), and sex (year 3: HR=2.10, 95% CI (1.20, 3.67), p=0.009; year 4: HR=3.04, 95% CI (1.37, 6.73), p=0.006; year 5: HR=4.40, 95% CI (1.51, 12.85), p=0.007) were associated with increased ICB symptom risk.

Conclusion: pRBD was not strongly associated with ICB symptoms development in contrast to DA use, GDS, and sex

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-probable-rem-sleep-behavior-disorder-a-risk-factor-of-impulsive-compulsive-behaviors-in-parkinsons-disease-ppmi-study/