Category: Parkinson's Disease: Non-Motor Symptoms
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.
To cite this abstract in AMA style:
M. Berns, N. Reddy, H. Olson, R. Berns, M. Howell. Comparison of Age, Cognitive, Autonomic, and Motor Testing between Serotonergic vs Idiopathic REM-Sleep Behavior Disorder [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/comparison-of-age-cognitive-autonomic-and-motor-testing-between-serotonergic-vs-idiopathic-rem-sleep-behavior-disorder/. Accessed October 5, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-age-cognitive-autonomic-and-motor-testing-between-serotonergic-vs-idiopathic-rem-sleep-behavior-disorder/