1021 Cognitive, Motor, and Autonomic Function Impairments in Idiopathic REM Sleep Behavior Disorder

Abstract Introduction The majority of patients with idiopathic REM sleep behavior disorder (iRBD) are thought to have prodromal synucleinopathy. 25–60% of iRBD patients have olfactory, orthostatic blood pressure, cognitive, or motor impairments suggestive of underlying neurodegeneration. We describe...

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Bibliographic Details
Published in:	Sleep (New York, N.Y.) Vol. 41; no. suppl_1; p. A379
Main Authors:	Teigen, L N, Boeve, A R, Feemster, J C, Timm, P C, Sandness, D J, Duwell, E J, Commers, N A, McCord, S V, McCarter, S J, Junna, M R, Lipford, M C, Tippmann-Peikert, M, Boeve, B F, Silber, M H, St. Louis, E K
Format:	Journal Article
Language:	English
Published:	US Oxford University Press 27-04-2018
Subjects:	Behavior disorders Blood pressure Parkinson's disease
Online Access:	Get full text
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Summary:	Abstract Introduction The majority of patients with idiopathic REM sleep behavior disorder (iRBD) are thought to have prodromal synucleinopathy. 25–60% of iRBD patients have olfactory, orthostatic blood pressure, cognitive, or motor impairments suggestive of underlying neurodegeneration. We describe objective measure impairments in the Mayo Clinic iRBD registry cohort at baseline and one-year follow-up. Methods We included adults diagnosed with iRBD by ICSD-3 criteria, and excluded symptomatic RBD patients with mild cognitive impairment, dementia with Lewy bodies, Parkinson disease, or multiple system atrophy. We considered clinical measures as abnormal when subjects met age-sex defined cut-offs for the brief Smell Identification Test (B-SIT) and neurocognitive assessments (Montreal Cognitive Assessment (MoCA), Kokmen Short Test of Mental Status (STMS), and King-Devick Test (KDT)), orthostatic systolic blood pressure (SBP) drop ≥ 10 mm Hg, or timed up and go (TUG) speed > 7.5 seconds. Results 59 iRBD subjects participated, with 24 (40.7%) having one-year follow-up. Mean age at baseline was 65.8 (range 21–84) years, and 18 (30.5%) were women. Dream enactment symptom duration was 9.85 ± 13.01 years. 26 (44.1%) were receiving antidepressant medications. Mean (range) measure scores were: B-SIT 8.7 (2–12); MoCA, 26.4 (20–30); STMS, 34.7 (27–38); KDT, 58.4 (39.2–125.6); SBP drop, 15.3 (1–49); and TUG, 8.3 (5.3–12.8) seconds. Patients with abnormal baseline measures included: B-SIT, 24 (33.9%); MoCA, 20 (33.4%); STMS, 2 (3.4%); KDT, 19 (32.2%); SBP drop, 24 (41.4%); and TUG, 39 (69.6%). At least one baseline measure was abnormal in 54 (91.5%) patients, and two or more in 37 (62.7%). There were no significant differences in measures for patients receiving antidepressant medications at baseline, or for serial measures at one-year follow-up. Conclusion 91.5% of iRBD patients had impairment in at least one baseline characteristic of underlying prodromal synucleinopathy. Further longitudinal analyses of this cohort compared to matched controls is planned. Support (If Any) Mayo Clinic CCaTS.
ISSN:	0161-8105 1550-9109
DOI:	10.1093/sleep/zsy061.1020