Dario Arnaldi1, Silvia Morbelli2, Andrea Brugnolo3, Nicola Girtler3, Agnese Picco3, Michela Ferrara3, Jennifer Accardo3, Ambra Buschiazzo2, Fabrizio de Carli4, Marco Pagani5, Flavio Nobili3. 1. Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy. Electronic address: dario.arnaldi@gmail.com. 2. Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy. 3. Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy. 4. Institute of Bioimaging and Molecular Physiology, National Research Council, Genoa, Italy. 5. Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy.
Abstract
INTRODUCTION: The association between Parkinson Disease (PD) and REM sleep behavior disorder (RBD) has been related to a specific, malignant clinical phenotype. Definite RBD diagnosis requires video-polysomnography that is often unfeasible. A malignant clinical PD-RBD phenotype could be expected also in PD patients with probable RBD. Aim of this cross-sectional study was to evaluate whether a more severe neuropsychological and functional neuroimaging phenotype can be identified in PD patients with probable RBD. METHODS: Thirty-eight de novo, drug naïve PD patients underwent a first-line clinical assessment and a second-line multimodal assessment, including neuropsychological evaluation, (123)I-FP-CIT-SPECT and (18)F-FDG-PET, which were compared between PD patients with (PD + RBD+) and without (PD + RBD-) probable RBD. RESULTS: On first-line assessment, PD + RBD + patients had significantly more constipation (p = 0.02) and showed worse olfaction (p = 0.01) compared with PD + RBD-while the two groups were similar as for age, presence of orthostatic hypotension, UPDRS-III and MMSE scores. On second-line assessment, PD + RBD + patients showed a worse neuropsychological test profile, more severe nigro-striatal dopaminergic impairment, mainly at caudate level in the less affected hemisphere (p = 0.004) and impaired brain glucose metabolism, with relative hypometabolism in posterior cortical regions and relative hypermetabolism mainly in anterior regions of the more affected hemisphere (p = 0.015). CONCLUSIONS: PD patients with probable RBD are likely to have a more severe neuropsychological and functional brain-imaging phenotype already at the time of diagnosis.
INTRODUCTION: The association between Parkinson Disease (PD) and REM sleep behavior disorder (RBD) has been related to a specific, malignant clinical phenotype. Definite RBD diagnosis requires video-polysomnography that is often unfeasible. A malignant clinical PD-RBD phenotype could be expected also in PDpatients with probable RBD. Aim of this cross-sectional study was to evaluate whether a more severe neuropsychological and functional neuroimaging phenotype can be identified in PDpatients with probable RBD. METHODS: Thirty-eight de novo, drug naïve PDpatients underwent a first-line clinical assessment and a second-line multimodal assessment, including neuropsychological evaluation, (123)I-FP-CIT-SPECT and (18)F-FDG-PET, which were compared between PDpatients with (PD + RBD+) and without (PD + RBD-) probable RBD. RESULTS: On first-line assessment, PD + RBD + patients had significantly more constipation (p = 0.02) and showed worse olfaction (p = 0.01) compared with PD + RBD-while the two groups were similar as for age, presence of orthostatic hypotension, UPDRS-III and MMSE scores. On second-line assessment, PD + RBD + patients showed a worse neuropsychological test profile, more severe nigro-striatal dopaminergic impairment, mainly at caudate level in the less affected hemisphere (p = 0.004) and impaired brain glucose metabolism, with relative hypometabolism in posterior cortical regions and relative hypermetabolism mainly in anterior regions of the more affected hemisphere (p = 0.015). CONCLUSIONS:PDpatients with probable RBD are likely to have a more severe neuropsychological and functional brain-imaging phenotype already at the time of diagnosis.
Authors: Shady Rahayel; Malo Gaubert; Ronald B Postuma; Jacques Montplaisir; Julie Carrier; Oury Monchi; David Rémillard-Pelchat; Pierre-Alexandre Bourgouin; Michel Panisset; Sylvain Chouinard; Sven Joubert; Jean-François Gagnon Journal: Sleep Date: 2019-06-11 Impact factor: 5.849
Authors: Sanne K Meles; Remco J Renken; Marco Pagani; L K Teune; Dario Arnaldi; Silvia Morbelli; Flavio Nobili; Teus van Laar; Jose A Obeso; Maria C Rodríguez-Oroz; Klaus L Leenders Journal: Eur J Nucl Med Mol Imaging Date: 2019-11-25 Impact factor: 9.236