Objective: To identify specific differences in motor and non-motor profile in Parkinson’s disease (PD) with or without probable REM-Sleep behaviour disorder (pRBD) based on the screening tool RBDSQ.

Background: RBD is the most robust prodromal marker for developing alpha-synucleinopathy [1]. While significant phenotypic differences were identified to be associated with idiopathic RBD, contradictory results have been reported for PD-RBD phenotype [2-6].

Method: A total of 627 PD were included into the cross-sectional study from the baseline visit in the Luxembourg Parkinson’s study with completed RBDSQ for grouping into PD-pRBD (n=154, 25%) and PD non-pRBD (n=473, 75%) by using the RBDSQ ≥ 7 and RBDSQ < 7 respectively. Multiple regression models adjusting for age and disease duration have been applied with Bonferroni correction for multiple testing in order to explore the association between pRBD and motor/non-motor symptoms as well as to explore the association between gender and frequency of pRBD in PD.

Results: PD-pRBD had significantly positive effect on autonomic dysfunction burden (SCOPA-AUT), level of depressive symptoms (BDI-I), scores in MDS-UPDRS I and II, as well as frequency of hallucinations, excessive daily sleepiness, constipation and impulse control disorder, but also PD-pRBD had a significant negative effect on quality of life (PDQ-39) and quality of sleep (PDSS). PD-pRBD had no significant effect on the motor complications (MDS-UPDRS IV and its sub-scores for dyskinesia, OFF time and dystonia), motor severity (H&Y and MDS-UPDRS III), frequency of motor symptoms, cognition (MoCA) nor LEDD. No significant association between gender and frequency of pRBD was found.

Conclusion:
In a large observational monocentric study, we identified several phenotypic differences between PD-pRBD and PD non-pRBD with more severe non-motor symptoms for PD-pRBD, while presenting similar motor and cognitive impairment. Interestingly, no significant association between pRBD and gender was found. This suggests a specific PD-RBD phenotype may exist, characterized by more pronounced dysautonomic symptoms and depression burden that is still controversial in the research community. Large longitudinal community-based studies are warranted to further determine the consistency of the PD-RBD phenotype across independent cohorts.

References: 1. Haba-Rubio, J. et al. Prevalence and determinants of REM sleep behavior disorder in the general population. Sleep 41, (2017) 2. Jozwiak N et el; REM Sleep Behavior Disorder and Cognitive Impairment in Parkinson’s Disease. Sleep. 2017 3. Neikrug, A. B. et al. Parkinson’s disease and REM leep behavior disorder result in increased non-motor symptoms. Sleep Med. 15, 959–966 (2014). 4. Suzuki, K. et al. Probable rapid eye movement sleep behavior disorder, nocturnal disturbances and quality of life in patients with Parkinson’s disease: a case-controlled study using the rapid eye movement sleep behavior disorder screening questionnaire. BMC Neurol. 13, 18 (2013). 5.Rolinski M, Szewczyk-Krolikowski K, Tomlinson PR, et al. REM sleep behaviour disorder is associated with worse quality of life and other non-motor features in early Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2014 6. Burn DJ, Anderson K. To sleep, perchance to dement: RBD and cognitive decline in Parkinson’s disease. Mov Disord. 2012 May;27(6):671-3. Epub 2012.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/increased-non-motor-impairment-in-parkinsons-disease-with-rem-sleep-behaviour-disorder-cross-sectional-analysis-in-luxembourg-parkinsons-study/