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Rapid eye movement sleep behavior disorder symptoms correlate with domains of cognitive impairment in Parkinson’s disease

J.R. Zhang, J. Chen, Z.J. Yang, H.J. Zhang, Y.T. Fu, Y. Shen, P.C. He, C.J. Mao, C.F. Liu (Suzhou, People's Republic of China)

Meeting: 2016 International Congress

Abstract Number: 1391

Keywords: , ,

Session Information

Date: Wednesday, June 22, 2016

Session Title: Parkinson's disease: Cognition

Session Time: 12:00pm-1:30pm

Location: Exhibit Hall located in Hall B, Level 2

Objective: To investigate (1) the domains of cognitive impairment in patients with Parkinson’s disease (PD) and rapid eye movement sleep behavior disorder (RBD). (2) To explore risk factors for PD-mild cognitive impairment (PD-MCI) and relationship between RBD severity and impairment in different cognitive domains in PD.

Background: RBD may be a risk factor for cognitive impairment in patients with PD. However, little is known regarding the relation between the severity of RBD and the different domains of cognitive impairment.

Methods: The participants were grouped as follows: PD without RBD (PD-RBD; n = 42), PD with RBD (PD + RBD; n = 32), idiopathic RBD (iRBD; n = 15), and healthy controls ([HCs]; n = 36). Demographics, clinical characteristics,neuropsychological assessment and RBD Questionnaire-Hong Kong (RBDQ-HK) and the RBD Screening Questionnaire (RBDSQ) was obtained. 35 PD and all iRBD patients completed an overnight video-polysomnography. Then we further examined associations between the severity of RBD symptoms and cognitive levels via correlation analysis.

Results: Compared to PD-RBD subjects, PD+RBD patients were more likely to have olfactory dysfunction and their Epworth Sleepiness Scale scores were higher (P<0.05). During neuropsychological testing, PD+RBD patients performed worse than PD-RBD patients, including delayed memory function, especially. The MCI rates were 33.3%, 62.5%, 33.3%, and 8.3% for PD-RBD, PD+RBD, iRBD, and HC groups, respectively. RBD was an important factor for explaining the PD-MCI variance (odds ratio=5.204, P=0.018). During correlation analysis, higher RBD Screening Questionnaire and RBD Questionnaire-Hong Kong (RBD-HK) scores were significantly associated with poorer performance on the Trail Making Test-B (errors) and Auditory Verbal Learning Test (delayed recall), and higher RBD-HK scores were also associated with Rey-Osterrieth complex figure (copy) results

Correlation analysis of cognitive scores with severity of RBD
Items RBDSQ score   RBD-HK score  
  r P r P
MMSE -0.063 0.603 0.019 0.874
MOCA -0.208 0.083 -0.151 0.211
Attention and working memory        
TMT-A, time 0.025 0.061 0.176 0.144
Digit span forward -0.001 0.992 0.015 0.903
SDMT -0.148 0.220 -0.172 0.154
Executive function        
TMT-B, time 0.210 0.081 0.141 0.245
TMT-B, errors 0.267 0.026 0.249 0.038
Digit span backward -0.048 0.694 -0.052 0.671
SCWT, time -0.060 0.620 -0.032 0.790
SCWT, errors -0.074 0.540 -0.123 0.309
Language        
SVFT, former 15 s 0.001 0.991 -0.050 0.684
SVFT, latter 45 s 0.022 0.859 -0.029 0.814
Memory        
AVLT, immediate recall -0.164 0.176 -0.119 0.328
AVLT, delayed recall -0.313 0.008 -0.246 0.040
AVLT, recognition -0.112 0.357 -0.173 0.151
Rey-O figure, recall -0.131 0.278 -0.171 0.156
Visuospatial function        
Rey-O figure, copy -0.160 0.185 -0.290 0.015
Clock Drawing Test 0.033 0.789 0.045 0.710
Adjusted for age, education, Hoehn & Yahr stage, and Unified Parkinson’s disease Rating Scale part III score Abbreviations: AVLT= Auditory Verbal Learning Test; MMSE=Mini-Mental State Examination; MOCA=Montreal Cognitive Assessment; RBD-HK=RBD Questionnaire-Hong Kong; RBDSQ=RBD Screening Questionnaire; Rey-O figure=Rey-Osterrieth complex figure; SDMT=Symbol Digit Modalities Test; SCWT=Stroop Color-Word Test; SVFT=Semantic Verbal Fluency Test; TMT-A=Trail Making Test-A; TMT-B=Trail Making Test-B“. Higher tonic density was associated with worse performance on the Symbol Digit Modalities Test and Rey-Osterrieth complex figure (recall) results

Correlation analysis of cognitive scores with PSG results
Items Tonic density   Phasic density  
  r P r P
MMSE -0.242 0.255 -0.244 0.251
MOCA -0.202 0.343 -0.167 0.436
Attention and working memory        
TMT-A, time 0.147 0.493 0.247 0.245
Digit span forward -0.009 0.967 0.010 0.963
SDMT -0.480 0.018 -0.341 0.103
Executive function        
TMT-B, time 0.150 0.485 0.177 0.409
TMT-B, errors 0.054 0.803 -0.003 0.988
Digit span backward 0.026 0.905 -0.020 0.927
SCWT, time 0.066 0.761 -0.009 0.968
SCWT, errors 0.111 0.607 -0.316 0.133
Language        
SVFT, former 15 s 0.119 0.580 -0.052 0.809
SVFT, latter 45 s -0.240 0.258 -0.256 0.227
Memory        
AVLT, immediate recall -0.091 0.671 -0.368 0.077
AVLT, delayed recall -0.229 0.282 -0.336 0.109
AVLT, recognition -0.235 0.269 0.254 0.204
Rey-O figure, recall -0.462 0.023 0.329 0.117
Visuospatial function        
Rey-O figure, copy -0.244 0.251 -0.143 0.504
Clock Drawing Test -0.193 0.367 -0.011 0.959
Adjusted for age, education, Hoehn & Yahr stage, and Unified Parkinson’s disease Rating Scale part III score Abbreviations: AVLT= Auditory Verbal Learning Test; MMSE=Mini-Mental State Examination; MOCA=Montreal Cognitive Assessment; PSG=polysomnography; RBD-HK=RBD Questionnaire-Hong Kong; RBDSQ=RBD Screening Questionnaire; Rey-O figure=Rey-Osterrieth complex figure; SDMT=Symbol Digit Modalities Test; SCWT=Stroop Color-Word Test; SVFT=Semantic Verbal Fluency Test; TMT-A=Trail Making Test-A; TMT-B=Trail Making Test-B” .

Conclusions: PD+RBD patients have more olfactory dysfunction and worse daytime somnolence. RBD is an important risk factor for MCI, including delayed memory. Deficits in attention, executive function, verbal delayed memory, and visuospatial function were consistently associated with more severe RBD symptoms.

To cite this abstract in AMA style:

J.R. Zhang, J. Chen, Z.J. Yang, H.J. Zhang, Y.T. Fu, Y. Shen, P.C. He, C.J. Mao, C.F. Liu. Rapid eye movement sleep behavior disorder symptoms correlate with domains of cognitive impairment in Parkinson’s disease [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/rapid-eye-movement-sleep-behavior-disorder-symptoms-correlate-with-domains-of-cognitive-impairment-in-parkinsons-disease/. Accessed May 25, 2025.

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