Olfactory dysfunction predicts early transition to a Lewy body disease in idiopathic RBD
Olfactory dysfunction predicts early transition to a Lewy body disease in idiopathic RBD
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DOI：
10.1212/wnl.0000000000001265
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发表时间：
2015-02-17
期刊：
影响因子：
9.9
通讯作者：
Seppi, Klaus
中科院分区：
文献类型：
--
作者：
Mahlknecht, Philipp;Iranzo, Alex;Seppi, Klaus
目的：本研究旨在通过5年的观察，确定嗅觉功能障碍对特发性快速眼动睡眠行为障碍（iRBD）受试者突触核蛋白介导的神经退行性疾病早期发展的预测价值。方法：34例多导睡眠图确诊的iRBD患者采用嗅探棒测试进行嗅觉测试，评估气味识别、气味辨别和嗅觉阈值。iRBD患者的前瞻性随访期为4.9 0.3年（平均SD）。神经退行性疾病的诊断是基于目前的临床诊断标准。结果：2.4 +/- 1.7年（平均+/- SD）后，9例（26.5%）iRBD患者发展为路易体病（6例帕金森病，3例路易体痴呆）。整个嗅探棒测试和识别子测试在预测转化方面的总体诊断准确率相同，为82.4%（95%置信区间：66.1% ~ 92.0%）。嗅觉功能最低的三分之一与嗅觉功能最高的两分之一相比，患路易体病的相对风险为7.3（95%可信区间：1.8-29.6）。结论：评估嗅觉功能，特别是气味识别，可能有助于预测iRBD患者在相对较短时间内路易体疾病的发展，从而确定适合未来疾病改良试验的患者。
Objective:The aim of the present study was to determine the predictive value of olfactory dysfunction for the early development of a synuclein-mediated neurodegenerative disease in subjects with idiopathic REM sleep behavior disorder (iRBD) over an observational period of 5 years.Methods:Thirty-four patients with polysomnography-confirmed iRBD underwent olfactory testing using the entire Sniffin' Sticks test assessing odor identification, odor discrimination, and olfactory threshold. Patients with iRBD were prospectively followed up over a period of 4.9 0.3 years (mean SD). The diagnosis of neurodegenerative diseases was based on current clinical diagnostic criteria.Results:After 2.4 +/- 1.7 years (mean +/- SD), 9 patients (26.5%) with iRBD developed a Lewy body disease (6 Parkinson disease and 3 dementia with Lewy bodies). The entire Sniffin' Sticks test and the identification subtest had the same overall diagnostic accuracy of 82.4% (95% confidence interval: 66.1%-92.0%) in predicting conversion. The relative risk for a Lewy body disease in the lowest tertile of olfactory function was 7.3 (95% confidence interval: 1.8-29.6) compared with the top 2 tertiles.Conclusions:Assessment of olfactory function, particularly odor identification, may help to predict the development of a Lewy body disease in patients with iRBD over a relatively short time period and thus to identify patients suitable for future disease modification trials.