Predictive markers for early conversion of iRBD to neurodegenerative synucleinopathy diseases.

Abstract

To determine the predictive value of clinical assessment and dopamine transporter (DAT) uptake for the early development of neurodegenerative synucleinopathy diseases from idiopathic REM sleep behavior disorder (iRBD) over 5 years in a Chinese population. Forty-three patients with iRBD were administered clinical assessment tests, and 35 were examined by DAT-SPECT imaging during 2011. Cox proportional hazard and Kaplan-Meier analyses were used to evaluate the predictive value of the markers in a follow-up study over 5 years. Eighteen patients (41.9%) developed neurodegenerative synucleinopathy diseases after a median of 4.1 years of prospective follow-up (median interval of 10.5 years from the estimated onset of iRBD symptoms). Patients with higher scores on the Nonmotor Symptom Questionnaire (hazard ratio [HR] 3.11, 95% confidence interval [CI] 1.15-8.40, <i>p</i> = 0.026) and Scale for Outcomes in Parkinson Disease-Autonomic questionnaire (HR 4.46, 95% CI 1.64-12.10, <i>p</i> = 0.003) were more likely to develop neurodegenerative synucleinopathy diseases. Furthermore, the population with decreased ^99mTc-TRODAT-1 binding in the left striatum (HR 2.7, 95% CI 1.02-7.14, <i>p</i> = 0.046) and putamen (HR 3.23, 95% CI 1.16-8.33, <i>p</i> = 0.024) had a relatively higher risk of developing neurodegenerative synucleinopathy diseases. Our findings elucidate the predictive value of autonomic dysfunction and DAT uptake in identifying patients with iRBD at a high risk of progressing into neurodegenerative synucleinopathy diseases and could form a basis for future disease-prevention trials.