Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson's disease: A prospective study
Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson's disease: A prospective study
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DOI：
10.1002/mds.24939
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发表时间：
2012-05-01
影响因子：
8.6
通讯作者：
Gagnon, Jean-Francois
中科院分区：
文献类型：
--
作者：
Postuma, Ronald B.;Bertrand, Josie-Anne;Gagnon, Jean-Francois
PD最具破坏性的非运动表现之一是痴呆。PD中痴呆的预测因素很少。在许多横断面研究中，快速眼动（REM）睡眠行为障碍（RBD）患者在神经心理学测试中的认知障碍增加，但没有前瞻性研究评估RBD是否可以预测帕金森氏痴呆症。没有痴呆的PD患者被纳入先前发表的横断面研究的前瞻性随访。所有患者在基线时都有多导睡眠图。在平均4年的随访中，使用回归分析评估了基线时有或无RBD的患者的痴呆发生率，调整了年龄，性别，疾病持续时间和随访时间。在61例合格患者中，45例（74%）接受了评估，42例纳入全面分析。27例患者有基线RBD，15例没有。初次评估后四年，48%的RBD患者发展为痴呆，而没有RBD的患者为0%（P调整= 0.014）。所有13例发生痴呆的患者在基线检查时均存在轻度认知障碍。基线快速眼动睡眠张力缺失可预测痴呆的发生（强直性快速眼动睡眠百分比为73.2 +/- 26.7，痴呆为40.8 +/- 34.5; P = 0.029）。基线时的RBD也预测了幻觉和认知波动的新发展。在这项前瞻性研究中，RBD与痴呆风险增加有关。这表明，RBD可能是一个相对分散的，复杂的亚型PD的标志物。(C)2012运动障碍协会
One of the most devastating nonmotor manifestations of PD is dementia. There are few established predictors of dementia in PD. In numerous cross-sectional studies, patients with rapid eye movement (REM) sleep behavior disorder (RBD) have increased cognitive impairment on neuropsychological testing, but no prospective studies have assessed whether RBD can predict Parkinson's dementia. PD patients who were free of dementia were enrolled in a prospective follow-up of a previously published cross-sectional study. All patients had a polysomnogram at baseline. Over a mean 4-year follow-up, the incidence of dementia was assessed in those with or without RBD at baseline using regression analysis, adjusting for age, sex, disease duration, and follow-up duration. Of 61 eligible patients, 45 (74%) were assessed and 42 were included in a full analysis. Twenty-seven patients had baseline RBD, and 15 did not. Four years after the initial evaluation, 48% with RBD developed dementia, compared to 0% of those without (P-adjusted = 0.014). All 13 patients who developed dementia had mild cognitive impairment on baseline examination. Baseline REM sleep atonia loss predicted development of dementia (% tonic REM = 73.2 +/- 26.7 with dementia, 40.8 +/- 34.5 without; P = 0.029). RBD at baseline also predicted the new development of hallucinations and cognitive fluctuations. In this prospective study, RBD was associated with increased risk of dementia. This indicates that RBD may be a marker of a relatively diffuse, complex subtype of PD. (C) 2012 Movement Disorder Society