Objective: To compare the age, cognitive, autonomic, and motor function of REM-Sleep Behavior Disorder (RBD) patients amongst those who believe their symptoms were triggered by a selective serotonin reuptake inhibitor (SSRI), those with SSRI exposure but who did not designate it as a trigger, and those without SSRI history. Data was taken from the North American Prodromal Synucleinopathy (NAPS) consortium registry.

Background: RBD is loss of atonic REM sleep causing dream enactment, as well as a classic prodrome of alpha-synucleinopathies. Of those with RBD, about half have used serotonergic antidepressants with some noting onset/exacerbation of RBD after starting an SSRI (5-HT RBD).

Method: A cross-sectional design comparing age, cognitive, autonomic, and motor function of subjects with 5-HT RBD to those with SSRI exposure but no sense of effect on RBD to those without SSRI exposure (presumed idiopathic RBD; iRBD). Cognitive function was measured by Montreal Cognitive Assessment (MoCA), autonomics by Scales for Outcomes in Parkinson’s Disease – Autonomic Dysfunction (SCOPA-AUT), and motor by Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Mann-Whitney tests compared group means.

Results: Of 448 subjects, 20 reported 5-HT RBD with mean age 62.45, MoCA 27.26, SCOPA-AUT 13.8, and MDS-UPDRS 3.35. 90 subjects reported past SSRI use without RBD trigger with mean age 63.83, MoCA 25.8, SCOPA-AUT 13.59, and MDS-UPDRS 5.6. 204 subjects had no past SSRI use (iRBD) with mean age 64.85, MoCA 25.46, SCOPA-AUT 11.7, and MDS-UPDRS 4.73. There was a significant difference in SCOPA-AUT scores with those with past SSRI use but no triggering of RBD having improved score compared to iRBD.

Conclusion: The lack of significant difference between age, MoCA, SCOPA-AUT, and MDS-UPDRS amongst 5-HT RBD and iRBD groups could suggest that 5-HT RBD may also be a neurodegenerative prodrome; or that SSRI’s reveal early-stage iRBD. Conclusions are unclear as to the significance of SCOPA-AUT between those who didn’t feel SSRI use affected RBD and those without SSRI exposure, though it’s interesting that dysautonomia – particularly decreased GI motility; an item in SCOPA-AUT – is also a classic parkinsonian prodrome. Further analysis of SSRI exposure as well as continued observation of the original groups is needed to better understand these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-age-cognitive-autonomic-and-motor-testing-between-serotonergic-vs-idiopathic-rem-sleep-behavior-disorder/