REM Sleep Behavior Disorder and Cognitive Impairment in Parkinson's Disease
REM Sleep Behavior Disorder and Cognitive Impairment in Parkinson's Disease
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DOI：
10.1093/sleep/zsx101
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发表时间：
2017-08-01
期刊：
影响因子：
5.6
通讯作者：
Gagnon, Jean-Francois
中科院分区：
文献类型：
--
作者：
Jozwiak, Natalia;Postuma, Ronald B.;Gagnon, Jean-Francois
研究目的：REM睡眠行为障碍（RBD）是一种影响33%至46%帕金森病（PD）患者的睡眠异常。PD伴RBD患者是否存在独特且特异的认知功能受损仍存在争议。我们广泛评估了认知功能，以确定RBD是否与PD非痴呆患者更严重的认知缺陷相关。162名参与者，包括53名患有RBD的PD患者，40名没有RBD的PD患者和69名健康受试者，接受了多导睡眠图，神经系统评估和广泛的神经心理学检查，以评估注意力，执行功能，情景学习和记忆，结果：与PD患者没有RBD和健康受试者相比，PD患者RBD在几项认知测试中表现较差和临床受损。后两组在所有认知指标上都相似。轻度认知功能障碍（MCI）的诊断频率在PD患者与RBD相比，几乎高出三倍PD患者没有RBD（66%对23%，p <0.001）。此外，与58%的PD患者没有RBD相比，89%的PD患者报告了主观认知下降（p = 0.024）。结论：PD中的RBD与更受损的认知特征和更高的MCI诊断频率相关，表明更严重和广泛的神经退行性变。这一患者亚组及其护理人员应得到有针对性的医疗关注，以更好地检测和监测功能障碍，并制定针对认知功能下降及其后果的管理干预措施。
Study Objectives: REM sleep behavior disorder (RBD) is a parasomnia affecting 33% to 46% of patients with Parkinson's disease (PD). The existence of a unique and specific impaired cognitive profile in PD patients with RBD is still controversial. We extensively assessed cognitive functions to identify whether RBD is associated with more severe cognitive deficits in nondemented patients with PD.Methods: One hundred sixty-two participants, including 53 PD patients with RBD, 40 PD patients without RBD, and 69 healthy subjects, underwent polysomnography, a neurological assessment and an extensive neuropsychological exam to assess attention, executive functions, episodic learning and memory, visuospatial abilities, and language.Results: PD patients with RBD had poorer and clinically impaired performance in several cognitive tests compared to PD patients without RBD and healthy subjects. These two latter groups were similar on all cognitive measures. Mild cognitive impairment (MCI) diagnosis frequency was almost threefold higher in PD patients with RBD compared to PD patients without RBD (66% vs. 23%, p < .001). Moreover, subjective cognitive decline was reported in 89% of PD patients with RBD compared to 58% of PD patients without RBD (p = .024).Conclusions: RBD in PD is associated with a more impaired cognitive profile and higher MCI diagnosis frequency, suggesting more severe and widespread neurodegeneration. This patient subgroup and their caregivers should receive targeted medical attention to better detect and monitor impairment and to enable the development of management interventions for cognitive decline and its consequences.