Ronald B Postuma1, Charles H Adler2, Brittany N Dugger3, Joseph G Hentz4, Holly A Shill5,6, Erika Driver-Dunckley2, Marwan N Sabbagh5, Sandra A Jacobson5, Christine M Belden5, Lucia I Sue3, Geidy Serrano3, Thomas G Beach3. 1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada, Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada. 2. Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ. 3. Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ. 4. Department of Biostatistics, Mayo Clinic, Scottsdale, AZ. 5. Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ. 6. University of Arizona College of Medicine, Phoenix, AZ.
Abstract
INTRODUCTION: Rapid eye movement (REM) sleep behavior disorder (RBD) in Parkinson's disease (PD) is associated with differences in clinical phenotype, including dementia, autonomic loss, and gait dysfunction. The pathological basis for this remains unclear. METHODS: Parkinson's disease subjects in a longitudinal clinicopathologic study were screened for probable RBD with the Mayo Sleep Questionnaire. After death, semiquantitative analyses were conducted for synuclein, amyloid, neurofibrillary tangles, and cerebrovascular lesions. RESULTS: Forty cases had probable RBD (PD+RBD), and 41 did not (PD-RBD). Despite similar age at death (∼80 y) and disease duration (∼14.5 y), PD+RBD had increased synuclein deposition in all regions examined, with nine of 10 regions significantly different. The Lewy body 10-region total score (scale = 0-40) was 29.5 in PD+RBD versus 24.5 in PD-RBD (Cohen-d effect size = 0.79, P = 0.002). Cerebrovascular lesion burden was slightly higher in PD-RBD. CONCLUSIONS: Although overlap occurs between groups, PD patients with probable RBD may have greater density and range of synuclein pathology on autopsy.
INTRODUCTION:Rapid eye movement (REM) sleep behavior disorder (RBD) in Parkinson's disease (PD) is associated with differences in clinical phenotype, including dementia, autonomic loss, and gait dysfunction. The pathological basis for this remains unclear. METHODS:Parkinson's disease subjects in a longitudinal clinicopathologic study were screened for probable RBD with the Mayo Sleep Questionnaire. After death, semiquantitative analyses were conducted for synuclein, amyloid, neurofibrillary tangles, and cerebrovascular lesions. RESULTS: Forty cases had probable RBD (PD+RBD), and 41 did not (PD-RBD). Despite similar age at death (∼80 y) and disease duration (∼14.5 y), PD+RBD had increased synuclein deposition in all regions examined, with nine of 10 regions significantly different. The Lewy body 10-region total score (scale = 0-40) was 29.5 in PD+RBD versus 24.5 in PD-RBD (Cohen-d effect size = 0.79, P = 0.002). Cerebrovascular lesion burden was slightly higher in PD-RBD. CONCLUSIONS: Although overlap occurs between groups, PDpatients with probable RBD may have greater density and range of synuclein pathology on autopsy.
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