REM sleep behavior disorder and neuropathology in Parkinson's disease.
BACKGROUND
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.
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.
Ronald B
RB
Postuma
Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ.
Charles H
CH
Adler
Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ.
Brittany N
BN
Dugger
Department of Biostatistics, Mayo Clinic, Scottsdale, AZ.
Joseph G
JG
Hentz
Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ.|University of Arizona College of Medicine, Phoenix, AZ.
Holly A
HA
Shill
Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ.
Erika
E
Driver-Dunckley
Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ.
Marwan N
MN
Sabbagh
Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ.
Sandra A
SA
Jacobson
Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ.
Christine M
CM
Belden
Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ.
Lucia I
LI
Sue
Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ.
Geidy
G
Serrano
Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ.
Thomas G
TG
Beach
D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D020187:REM Sleep Behavior Disorder / Q000209:etiology / Q000378:metabolism* / Q000473:pathology; D051844:alpha-Synuclein / Q000378:metabolism*
D051844:alpha-Synuclein
Parkinson's disease; REM sleep behavior disorder; diagnosis; pathology