Longitudinal study of cognitive function in idiopathic REM sleep behavior disorder (original) (raw)
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Sleep
Study Objectives To search for a specific neuropsychological profile in idiopathic REM sleep behavior disorder (iRBD), able to predict the onset of neurodegenerative disorders. Methods In a longitudinal follow-up study of 63 consecutive iRBD patients (follow-up duration 6.7 ± 3.8 years), the baseline cognitive profile of converters to neurodegenerative disease was compared with that of the nonconverters. Five cognitive domains were assessed: memory, attention-working memory, executive functions, visuospatial abilities, language. Mild cognitive impairment (MCI) was diagnosed according to the Movement Disorder Society’s diagnostic criteria for Parkinson’s disease. Results 30 subjects (47.6%) developed a neurodegenerative disease (latency to conversion 60.33 ± 44.81 months). MCI was found in 50% of the converters and 12% of the nonconverters (p = .001), and its presence conferred a neurodegenerative disease risk of 10% at 3 years, 36% at 5 years, and 73% at 10 years (p = .002). Patholo...
Sleep Medicine, 2008
Rapid eye movement [REM] sleep behaviour disorder (RBD) may herald neurodegenerative diseases. Neurobiological deficits similar to those identified in neurodegenerative diseases have been reported in idiopathic RBD. Researchers are looking for early markers supporting a possible role of RBD as a harbinger of impending neurodegenerative disease. To examine the neuropsychological functions in idiopathic RBD subjects. Should they be found to present a neuropsychological dysfunction that overlaps that reported in neurodegenerative diseases, it would be possible to consider cognitive deficits as possible early markers of an underlying degenerative process. Twenty-three subjects with idiopathic RBD (21 males, mean age 67.0+/-7.0 years) and a group of healthy controls matched for sex, age and education underwent a neuropsychological battery evaluating different cognitive domains. Considering mean values, poorer performances were observed in the Word Span (p<.001), Rey-Osterrieth's complex figure recall (p=.003), Digit Span (p=.003) and Logic Memory (p=.003) tests. On the basis of equivalent scores, the RBD subjects performed significantly more poorly on tests of visuo-constructional learning abilities (p<.001). Our data show the possible presence of cognitive deficits in RBD defined as idiopathic, sharing common features in particular with Lewy body disease. Neuropsychological evaluation in RBD could lead to presymptomatic identification of neurodegenerative disease, but until more prolonged long-term follow-up data are available, the true neurobiological significance of cognitive deficits in RBD will remain unknown.
Decision Making and Executive Functions in REM Sleep Behavior Disorder
Sleep, 2012
Decision Making in RBD-Delazer et al patients with RBD. The main subtype of MCI in iRBD patients was non-amnestic with impaired executive functions. As a group, iRBD patients performed lower than controls in tasks of working memory, set shifting, verbal fluency, and verbal memory. 12,13 Massicotte-Marquez et al. 14 reported reduced executive functions, attention, and verbal memory, as well as EEG slowing during wakefulness in 14 iRBD patients. A recent investigation 15 found marked EEG slowing in iRBD patients with MCI and suggested that slowing of cortical EEG may indicate the short-term development of cognitive dysfunction. Summing up, neuropsychological investigations yielded only partially consistent results as regards a specific pattern of dysfunction. While three studies emphasized impairments in visuo-constructive abilities, visuo-spatial learning, or visuospatial memory, 9-11 other investigations stressed deficits in executive functions. 12-14 Despite these differences, all neuropsychological studies so far point to the similarities between the neuropsychological profile of RBD patients and the cognitive deficits typically associated with PD or DLB. They also agree that cognitive deficits might serve as early markers and could lead to presymptomatic identification of an underlying neurodegenerative disease in the future. 9,12 Decision making is often found to be impaired in PD. 16-21 Deficits in decision making under ambiguity have been attributed to a dysfunction of the limbic fronto-striatal loop, 22 which is involved in risk and reward processing, learning from feedback, emotional regulation, and control. It is important to note, however, that performance in decision making is influenced by several factors including the stage of the disease, basal levels of dopamine function, 23 dopaminergic treatment, 23,24 as well as the presence or absence of executive function deficits. 25 Moreover, the nature of the decision situation (decision under ambiguity INTRODUCTION REM sleep behavior disorder (RBD) is a parasomnia characterized by loss of normal skeletal muscle atonia during REM sleep with prominent motor activity and dreaming. 1 Typically, RBD patients show dream-enacting behaviors (e.g., shouting, punching) related to unpleasant and sometimes violent dreams. Clinical and pathological data suggest that iRBD may be the earliest manifestation of neurodegenerative disorders such as Parkinson disease (PD), 2,3 Lewy body dementia (DLB), 4 or multiple system atrophy (MSA), 5 which may evolve in iRBD patients at a variable delay. 6-8 Since both PD and DLB are associated with cognitive dysfunction, subtle cognitive changes might also be expected in subjects with iRBD. So far, a few studies have assessed neuropsychological functions of iRBD patients. Ferini-Strambi et al. 9 found impairments in tasks of visuo-constructive abilities and visuo-spatial learning in a group of 17 iRBD patients. A 2-year follow-up study in 24 cognitively asymptomatic iRBD patients revealed worsening in memory and visuo-constructive functions over time. 10 Terzaghi et al. 11 reported low performance of 23 iRBD patients in working memory, complex figure recall, and logical memory. Gagnon et al. 12 found a high incidence of mild cognitive impairment (MCI) in 32 iRBD patients and 22 PD DECISION MAKING AND EXECUTIVE FUNCTIONS IN REM SLEEP BEHAVIOR DISORDER
Cortical and subcortical gray matter bases of cognitive deficits in REM sleep behavior disorder
Neurology, 2018
ObjectiveTo investigate cortical and subcortical gray matter abnormalities underlying cognitive impairment in patients with REM sleep behavior disorder (RBD) with or without mild cognitive impairment (MCI).MethodsFifty-two patients with RBD, including 17 patients with MCI, were recruited and compared to 41 controls. All participants underwent extensive clinical assessments, neuropsychological examination, and 3-tesla MRI acquisition of T1 anatomical images. Vertex-based cortical analyses of volume, thickness, and surface area were performed to investigate cortical abnormalities between groups, whereas vertex-based shape analysis was performed to investigate subcortical structure surfaces. Correlations were performed to investigate associations between cortical and subcortical metrics, cognitive domains, and other markers of neurodegeneration (color discrimination, olfaction, and autonomic measures).ResultsPatients with MCI had cortical thinning in the frontal, cingulate, temporal, a...
Journal of the Neurological Sciences, 2013
Objectives: Impaired cognitive profile and electroencephalography (EEG) slowing have been reported in patients with REM sleep behavior disorder (RBD), but the neurobiological significance of these findings remains unknown. The cholinergic system is known to play a key role in all attentional processes and cognitive functions. A transcranial magnetic stimulation (TMS) protocol may give direct information about the function of some cholinergic circuits in the human brain; this technique relies on short latency afferent inhibition (SAI) of the motor cortex. The objective of this study was to test the hypothesis that cognitive performance and cortical activation in RBD patients are associated with a dysfunction of the cholinergic system. Methods: We applied the SAI technique in a group of 10 patients with idiopathic RBD (iRBD) and compared the data with those from a group of 15 age-matched healthy subjects. All the iRBD patients and the control subjects also underwent an extensive neuropsychological evaluation. Results: Mean SAI was significantly reduced in patients with iRBD when compared with controls. Neuropsychological examination showed mild cognitive impairment in six out of the 10 iRBD patients. SAI values correlated strongly with tests measuring episodic verbal memory and executive functions. Conclusions: These results support the hypothesis of cholinergic dysfunction in some patients with iRBD who develop cognitive impairment. Our findings raise the possibility that the presence of SAI abnormalities may indicate increased risk of cognitive impairment in patients diagnosed with iRBD.
Validation of a new REM sleep behavior disorder questionnaire (RBDQ-HK)
Sleep Medicine, 2010
Objectives: There are limited screening instruments for diagnosis of REM sleep behavior disorder (RBD) and none for quantifying the severity of disease. We aimed to validate a 13-item self-reported RBD questionnaire (RBDQ-HK) for diagnostic and monitoring purposes. Methods: Based on ICSD-II and our previous clinical and empirical work, the RBDQ-HK questionnaire was designed and administered in patients attending university-affiliated sleep clinic and psychiatric outpatient clinic, and subjects from the general population. ROC curve and exploratory factor analysis were employed to evaluate the scale, which had a score ranging from 0 to 100. Results: One hundred and seven RBD patients [mean age 62.6 (15.5) years; male 70.1%] and 107 control subjects [mean age 55.3 (9.0) years, male 57.9%] completed the questionnaire. The diagnoses of all the study subjects were independently ascertained by clinical interview and PSG. RBD patients had a significantly higher total RBDQ-HK score [mean (s.d.): 32.1 (16.1), range 3-71] than the control group [9.5 (10.2), range 0-55] (p < 0.005). The RBDQ-HK demonstrated robust psychometric properties with moderate sensitivity (82.2%), specificity (86.9%), positive predictive value (PPV; 86.3%), and negative predictive value (NPV; 83.0%), high internal consistency and test-retest reliability. Exploratory factor analysis revealed two components (dream-related and behavioral factors) that corresponded to the essential clinical features of RBD. The best cut-off for total score (range 0-100) was at 18/19 and the best cut-off for factor 2 (behavioral factors including sleep talking, shouting, limb movements and sleep-related injuries, range 0-70) was at 7/8. Conclusions: The RBDQ-HK has satisfactory validity and reliability as a measure of clinical RBD symptoms and severity. It may serve as an effective tool for diagnosis and evaluation of the disease course to facilitate future clinical and research studies.
REM Sleep Behavior Disorder Is Not Associated with a More Rapid Cognitive Decline in Mild Dementia
Frontiers in Neurology, 2017
Objectives: REM sleep behavior disorder (RBD) is associated with cognitive dysfunctions and is a risk factor for development of mild cognitive impairment and dementia. However, it is unknown whether RBD is associated with faster cognitive decline in already established dementia. The main goal of this study was to determine if patients with mild dementia with and without RBD differ in progression rate and in specific neuropsychological measures over 4-year follow-up. Methods: This longitudinal, prospective study based on data from the DemVest study compares neuropsychological measures in a mild dementia cohort. A diagnosis of probable RBD (pRBD) was made based on the Mayo Sleep Questionnaire. Neuropsychological domains were assessed by Mini Mental State Examination, total score and figure copying, California Verbal Learning Test-II, Visual Object and Space Perception Cube and Silhouettes, Boston Naming Test, Stroop test, Verbal Category Fluency, Trail Making Test A and B. results: Among the 246 subjects, 47 (19.1%) had pRBD at the baseline, and pRBD group was younger and with male predominance. During 4-year follow-up, we did not observe any significant differences in the rate of decline in neuropsychological measures. Patients with pRBD performed generally poorer in visuoconstructional, visuoperceptual, and executive/attention tests in comparison to RBD negative. conclusion: We did not find any significant differences in progression rate of neurocognitive outcomes between dementia patients with and without RBD.
Archives of Clinical Neuropsychology, 2019
Objective Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) frequently represents the prodromal stage of alpha-synucleinopathies, and similar to these pathologies, iRBD patients show neuropsychological deficits, particularly in the domain of visuospatial abilities and executive functions. We hypothesized that the qualitative scoring of the Mini-Mental State Examination pentagon test (QSPT) may detect subtle visuospatial deficits in these subjects, and we evaluated its relationship with indexes of sleep quality, as measured by polysomnography. Methods A total of 80 polysomnography-confirmed iRBD patients and 40 healthy controls (HCs) were retrospectively recruited. Global and specific qualitative performances were evaluated according to QSPT procedure. Comparisons between iRBD and HC regarding all QSPT parameters, neuropsychological tests, and polysomnographic recordings were performed. Results Patients displayed significantly lower scores in both “closing-in” and tota...
Cognitive Reserve in Isolated Rapid Eye-Movement Sleep Behavior Disorder
Brain Sciences
Isolated rapid-eye-movement sleep behaviour disorder (RBD) is considered the prodromal stage of α-synucleinopathies (e.g., Parkinson’s disease and dementia with Lewy bodies); however, iRBD patients show a wide variety in the progression timing (5–15 years). The model of cognitive reserve (CR) might contribute to explaining this phenomenon. Our exploratory study aimed to evaluate, for the first time, the impact of CR level on cognitive performance in polysomnography-confirmed iRBD patients. Fifty-five iRBD patients (mean age ± SD: 66.38 ± 7.51; M/F 44/11) underwent clinical and neuropsychological evaluations at the time of diagnosis. The CR Index questionnaire was part of the clinical assessment. We found that iRBD patients with high levels of CR showed: (i) the lowest percentage of mild cognitive impairment (10%), and (ii) the best performance in visuo-constructive and verbal memory functions (i.e., the recall of the Rey–Osterrieth complex figure test). Our results suggest that CR m...
REM sleep behaviour disorder (RBD) and its associations in young patients
Sleep Medicine, 2009
REM behaviour disorder RBD Narcolepsy Overlap parasomnia disorder Rem loss atonia Idiopathic RBD Secondary RBD a b s t r a c t Study objectives: To retrospectively examine the characteristics of a population of patients <50 years of age with clinical and polysomnographic features diagnostic for RBD. Methods: Review of our sleep centre's database for patients with RBD diagnosed over the last 7 years. Ninety-one patients were separated into two groups according to their age at the time of diagnosis (<50 y and P50 y). Clinical and polysomnographic data were reviewed. Results: Sixty-two were male; mean age was 52 ± 19 y. Thirty-nine were <50 y. In the group <50 y there was a male predominance but in a smaller proportion (M:F = 1.4:1) compared with the group P50 (M:F = 3:1). Seventy-six patients complained of abnormal behaviour (AB) during sleep, 12 with narcolepsy complained of excessive daytime sleepiness (EDS) with the AB being elicited only during consultation, and three complained of both EDS and AB. All patients, except one in the group P50, described AB related to vivid dreams with violent content. The majority of the patients had the idiopathic form of RBD in both groups (51.2% group <50, 63.4% group P50). The secondary form was associated with narcolepsy in 38.4% of patients in the group <50 y and with a synucleinopathy in 28.8% of patients in the group P50. A strong association was noted between RBD and non-REM parasomnias. Conclusions: In a population of patients with RBD presenting to a regional sleep laboratory, more than one-third of patients were <50 y at time of diagnosis. The commonest associated disorder was narcolepsy in patients <50 y, and synucleinopathy in those P50 y. The coexistence of RBD with a NREM parasomnia was not uncommon in cases of idiopathic RBD affecting patients <50 y.