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Kim H, Seo P, Kim MJ, Huh JI, Sunwoo JS, Cha KS, Jeong E, Kim HJ, Jung KY, Kim KH. Characterization of attentional event-related potential from REM sleep behavior disorder patients based on explainable machine learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 234:107496. [PMID: 36972628 DOI: 10.1016/j.cmpb.2023.107496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 02/20/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of neurodegeneration and is associated with cortical dysfunction. The purpose of this study was to investigate the spatiotemporal characteristics of cortical activities underlying impaired visuospatial attention in iRBD patients using an explainable machine-learning approach. METHODS An algorithm based on a convolutional neural network (CNN) was devised to discriminate cortical current source activities of iRBD patients due to single-trial event-related potentials (ERPs), from those of normal controls. The ERPs from 16 iRBD patients and 19 age- and sex-matched normal controls were recorded while the subjects were performing visuospatial attentional task, and converted to two-dimensional images representing current source densities on flattened cortical surface. The CNN classifier was trained based on overall data, and then, a transfer learning approach was applied for the fine-tuning to each patient. RESULTS The trained classifier yielded high classification accuracy. The critical features for the classification were determined by layer-wise relevance propagation, so that the spatiotemporal characteristics of cortical activities that were most relevant to cognitive impairment in iRBD were revealed. CONCLUSIONS These results suggest that the recognized dysfunction in visuospatial attention of iRBD patients originates from neural activity impairment in relevant cortical regions and may contribute to the development of useful iRBD biomarkers based on neural activity.
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Affiliation(s)
- Hyun Kim
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Pukyeong Seo
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Min Ju Kim
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Jun Il Huh
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Kwang Su Cha
- Department of Neurology Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - El Jeong
- Interdisciplinary Program in Bioengineering College of Engineering, Seoul National University, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Ki-Young Jung
- Department of Neurology Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
| | - Kyung Hwan Kim
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea.
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Chen J, Zhou L, Jiang C, Chen Z, Zhang L, Zhou H, Kang W, Jiang X, Li Y, Luo N, Yao M, Niu M, Chen S, Zuo XN, Li L, Liu J. Impaired Ocular Tracking and Cortical Atrophy in Idiopathic Rapid Eye Movement Sleep Behavior Disorder. Mov Disord 2022; 37:972-982. [PMID: 35107831 DOI: 10.1002/mds.28931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Idiopathic rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of synucleinopathies. Patients with synucleinopathies frequently display eye movement abnormalities. However, whether patients with iRBD have eye movement abnormalities remains unknown. OBJECTIVE The aim of this study was to assess eye movement abnormalities and related gray matter alterations and explore whether such abnormalities can serve as biomarkers to indicate phenoconversion to synucleinopathies in iRBD. METHODS Forty patients with iRBD with early disease progression and 35 healthy control subjects participated in a 15-minute ocular-tracking task that evaluated their control of eye movement abilities. They also underwent clinical assessments for olfactory function, nonmotor symptoms, and autonomic symptoms, all of which are biomarkers to predict phenoconversion to synucleinopathies in iRBD. A subgroup of the participants (20 patients with iRBD and 20 healthy control subjects) also participated in structural magnetic resonance imaging. RESULTS The ocular-tracking ability in patients with iRBD was inferior to that of healthy control subjects in two aspects: pursuit initiation and steady-state tracking. Cortical thinning in the right visual area V4 in patients with iRBD is coupled with impaired pursuit initiation. Furthermore, prolonged pursuit initiation in patients with iRBD exhibits a trend of correlation with olfactory loss, the earliest biomarker that develops prior to other prodromal biomarkers. CONCLUSIONS We found ocular-tracking abnormalities in patients with iRBD even early in their disease progression that have not been reported before. These abnormalities are coupled with atrophy of brain areas involved in the perception of object motion and might indicate phenoconversion to synucleinopathies in iRBD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jing Chen
- Faculty of Arts and Science, New York University Shanghai, Shanghai, China
- NYU-ECNU Institute of Brain and Cognitive Science at New York University Shanghai, Shanghai, China
- Key Laboratory of Brain Functional Genomics, East China Normal University, Shanghai, China
| | - Liche Zhou
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jiang
- Developmental Population Neuroscience Research Center, IDG/McGovern Institute for Brain Research, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Zhichun Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Zhang
- Department of Biostatistics, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Zhou
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyan Kang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xufeng Jiang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningdi Luo
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengsha Yao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengyue Niu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi-Nian Zuo
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Li
- Faculty of Arts and Science, New York University Shanghai, Shanghai, China
- NYU-ECNU Institute of Brain and Cognitive Science at New York University Shanghai, Shanghai, China
- Key Laboratory of Brain Functional Genomics, East China Normal University, Shanghai, China
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Choi GS, Yun JY, Hwang S, Kim SE, Kim JY, Im CH, Lee HW. Can Corticomuscular Coherence Differentiate between REM Sleep Behavior Disorder with or without Parkinsonism? J Clin Med 2021; 10:jcm10235585. [PMID: 34884285 PMCID: PMC8658120 DOI: 10.3390/jcm10235585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
REM sleep behavior disorder (RBD) could be a predictor of Parkinsonism even before development of typical motor symptoms. This study aims to characterize clinical features and corticomuscular and corticocortical coherence (CMC and CCC, respectively) during sleep in RBD patients with or without Parkinsonism. We enrolled a total of 105 subjects, including 20 controls, 54 iRBD, and 31 RBD+P patients, patients who were diagnosed as idiopathic RBD (iRBD) and RBD with Parkinsonism (RBD+P) in our neurology department. We analyzed muscle atonia index (MAI) and CMC between EEG and chin/limb muscle electromyography (EMG) and CCC during different sleep stages. Although differences in the CMC of iRBD group were observed only during REM sleep, MAI differences between groups were noted during both REM and NREM N2 stage sleep. During REM sleep, CMC was higher and MAI was reduced in iRBD patients compared to controls (p = 0.001, p < 0.001, respectively). Interestingly, MAI was more reduced in RBD+P compared to iRBD patients. In comparison, CCC was higher in iRBD patients compared to controls whereas CCC was lower in RBD+P groups compared to control and iRBD groups in various frequency bands during both NREM N2 and REM sleep stages. Among them, increased CMC during REM sleep revealed correlation between clinical severities of RBD symptoms. Our findings indicate that MAI, CMC, and CCC showed distinctive features in iRBD and RBD+P patients compared to controls, suggesting potential usefulness to understand possible links between these diseases.
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Affiliation(s)
- Gyeong Seon Choi
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
- Department of Neurology, Bundang Jesaeng General Hospital, Seongnam 13590, Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
- Department of Medical Science, Ewha Womans University School of Medicine, Seoul 07804, Korea;
| | - Sungeun Hwang
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
| | - Song E. Kim
- Department of Medical Science, Ewha Womans University School of Medicine, Seoul 07804, Korea;
| | - Jeong-Yeon Kim
- Department of Biomedical Engineering, Hanyang University School of Engineering, Seoul 04763, Korea; (J.-Y.K.); (C.-H.I.)
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University School of Engineering, Seoul 04763, Korea; (J.-Y.K.); (C.-H.I.)
| | - Hyang Woon Lee
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea; (G.S.C.); (J.Y.Y.); (S.H.)
- Department of Medical Science, Ewha Womans University School of Medicine, Seoul 07804, Korea;
- Computational Medicine, Graduate Program in System Health Science & Engineering, Ewha Womans University, Seoul 03765, Korea
- Correspondence: ; Tel.: +82-2-2650-2673
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Lyu Z, Zheng S, Zhang X, Mai Y, Pan J, Hummel T, Hähner A, Zou L. Olfactory impairment as an early marker of Parkinson's disease in REM sleep behaviour disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2021; 92:271-281. [PMID: 33436502 DOI: 10.1136/jnnp-2020-325361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022]
Abstract
Olfactory impairment and rapid eye movement sleep behaviour disorder (RBD) are prodromal symptoms of Parkinson's disease (PD) that may be associated with each other. This review aims to investigate the significance of olfaction in the diagnosis and prognosis of patients with RBD and to assess moderating factors affecting olfactory performance. We searched articles on olfaction in RBD and PD in five electronic databases. We identified 32 studies for the systematic review and used 28 of those, including 2858 participants for meta-analysis. Results revealed significant deficits in odour identification (g=-1.80; 95% CI: -2.17 to -1.43), threshold (g=-1.29; 95% CI: -1.67 to -0.91), discrimination (g=-1.08; 95% CI: -1.28 to -0.87) and overall olfactory function (g=-1.64; 95% CI: -1.94 to -1.35) in patients with RBD. Except for the Unified Parkinson's Disease Rating Scale Part III scores, none of the known moderating variables (including age, sex, disease duration and years of education) accounted for the olfactory function heterogeneity in patients with RBD. We identified similar olfactory impairments in patients with RBD and patients with PD (either with or without underlying RBD). These findings suggest that olfactory impairment may be a sensitive and stable diagnostic biomarker of RBD and appears to be useful for identifying patients with idiopathic RBD at high risk for early conversion to PD.
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Affiliation(s)
- Zhihong Lyu
- Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Shuxin Zheng
- Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoyuan Zhang
- Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China .,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yiling Mai
- Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiyang Pan
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Sachsen, Germany
| | - Antje Hähner
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Sachsen, Germany
| | - Laiquan Zou
- Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China .,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Her S, Cha KS, Choi JW, Kim H, Byun JI, Sunwoo JS, Kim TJ, Lim JA, Jung KY, Kim KH. Impaired visuospatial attention revealed by theta- and beta-band cortical activities in idiopathic REM sleep behavior disorder patients. Clin Neurophysiol 2019; 130:1962-1970. [PMID: 31476702 DOI: 10.1016/j.clinph.2019.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/04/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Idiopathic REM sleep behavior disorder (iRBD) patients are susceptible to cognitive deficits, especially attention dysfunction. The objective of this study is to elucidate the neural mechanism of the dysfunction in attention known as 'inhibition of return' (IOR) in iRBD patients based on an analysis of oscillatory cortical activity during a selective attention task. METHODS Event-related potentials (ERPs) were recorded from iRBD patients and normal control subjects while performing a Posner task. The differences in N1 ERP and theta- and beta-bands event-related spectral perturbations (ERSPs) between valid and invalid stimuli were compared between groups. RESULTS The N1 amplitude was significantly higher for the invalid stimuli in controls, while the valid-invalid difference was not significant in iRBD patients. The valid-invalid differences in ERSPs were prominent in controls at ∼100-400 ms for the theta-band and ∼200-400 ms for the beta-band, and the valid-invalid differences in ERSPs were not significant in the iRBD patients. CONCLUSION The results demonstrated that valid-invalid differences in neural activity were absent in iRBD patients, and these neural findings were in accord with the behavioral results. SIGNIFICANCE Our findings imply impairment in sensory-perceptual processing mediated by attentional control and response inhibition in early-stage iRBD before clinical neurodegeneration.
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Affiliation(s)
- Seongjin Her
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Kwang Su Cha
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea; Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Woo Choi
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea; Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Hyun Kim
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Chamjoeun Hospital, Gwangju, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyung Hwan Kim
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea.
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Galbiati A, Carli G, Hensley M, Ferini-Strambi L. REM Sleep Behavior Disorder and Alzheimer's Disease: Definitely No Relationship? J Alzheimers Dis 2019; 63:1-11. [PMID: 29578489 DOI: 10.3233/jad-171164] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a REM sleep parasomnia characterized by the loss of the typical muscular atonia present during healthy REM sleep. RBD can occur in the absence of other neurological conditions or in association with a neurodegenerative disorder. It is now well established that RBD is a strong predictor of neurodegeneration, in particular synucleinopathies, such as Parkinson's disease, Lewy body dementia (LBD), or multiple system atrophy. However, some longitudinal studies report that a minority of patients develop either overlapping form of dementia or Alzheimer disease's (AD). Although AD is reported as a possible development in patients with RBD, it is in a limited number of cases and there are concerns about the accuracy of the diagnostic criteria. Neuropsychological impairments identified in cross-sectional studies of RBD patients describe a profile similar to that observed in dementia related to synucleinopathies. However, only deficits in executive function predict the development of neurodegeneration. Longitudinal studies reported the development of AD in RBD patients in about 7% of cases with variability ranging from 3% and 11%. Since the majority of longitudinal investigations do not report AD as a possible development for RBD patients the proportion may be overestimated. The study of the relationship between RBD and AD may be confounded by two factors that lead to misdiagnosis: the use of clinical criteria alone and the overlap between the clinical features and neuropathology of AD and LBD. Future studies to investigate this association must use updated diagnostic criteria incorporating ancillary investigations.
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Affiliation(s)
- Andrea Galbiati
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.,"Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
| | - Giulia Carli
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy
| | - Michael Hensley
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.,"Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
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Terzaghi M, Toscano G, Casoni F, Picascia M, Arnaldi D, Rustioni V, Versino M, Sinforiani E, Manni R. Assessment of cognitive profile as a prodromal marker of the evolution of rapid eye movement sleep behavior disorder. Sleep 2019; 42:5477298. [DOI: 10.1093/sleep/zsz103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study Objectives
To search for a specific neuropsychological profile in idiopathic REM sleep behavior disorder (iRBD), able to predict the onset of neurodegenerative disorders.
Methods
In a longitudinal follow-up study of 63 consecutive iRBD patients (follow-up duration 6.7 ± 3.8 years), the baseline cognitive profile of converters to neurodegenerative disease was compared with that of the nonconverters. Five cognitive domains were assessed: memory, attention-working memory, executive functions, visuospatial abilities, language. Mild cognitive impairment (MCI) was diagnosed according to the Movement Disorder Society’s diagnostic criteria for Parkinson’s disease.
Results
30 subjects (47.6%) developed a neurodegenerative disease (latency to conversion 60.33 ± 44.81 months). MCI was found in 50% of the converters and 12% of the nonconverters (p = .001), and its presence conferred a neurodegenerative disease risk of 10% at 3 years, 36% at 5 years, and 73% at 10 years (p = .002). Pathological equivalent scores on at least one neuropsychological test were detected in 46.7% of the converters versus 21.2% of the nonconverters in the memory domain (p = .032), in 40.0% versus 6.1% in that of executive functions (p = .002), and in 20.0% versus 3% in the visuospatial abilities domain (p = .047). On multivariate analysis, impaired executive functions significantly correlated with phenoconversion (p = .018). Lower Mini Mental State Examination (MMSE) scores (p = .004) and memory deficits (p = .031) were found in patients who developed dementia first.
Conclusions
Cognitive profile is useful for stratifying risk of phenoconversion in patients with iRBD. The presence of MCI and impaired executive functions, memory, and visuospatial abilities discriminated the converters. Lower MMSE scores and memory deficits may characterize those subjects who first develop dementia.
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Affiliation(s)
- Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gianpaolo Toscano
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Picascia
- Laboratory of Neuropsychology/Alzheimer’s Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valter Rustioni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Maurizio Versino
- DMC University of Insubria, ASST Sette laghi Ospedale di Circolo, Varese, Italy
| | - Elena Sinforiani
- Laboratory of Neuropsychology/Alzheimer’s Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
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Liguori C, Paoletti FP, Placidi F, Ruffini R, Sancesario GM, Eusebi P, Mercuri NB, Parnetti L. CSF Biomarkers for Early Diagnosis of Synucleinopathies: Focus on Idiopathic RBD. Curr Neurol Neurosci Rep 2019; 19:3. [DOI: 10.1007/s11910-019-0918-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Jin H, Zhang JR, Shen Y, Liu CF. Clinical Significance of REM Sleep Behavior Disorders and Other Non-motor Symptoms of Parkinsonism. Neurosci Bull 2017; 33:576-584. [PMID: 28770440 DOI: 10.1007/s12264-017-0164-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/14/2017] [Indexed: 12/16/2022] Open
Abstract
Rapid eye movement sleep behavior disorder (RBD) is one of the most common non-motor symptoms of parkinsonism, and it may serve as a prodromal marker of neurodegenerative disease. The mechanism underlying RBD is unclear. Several prospective studies have reported that specific non-motor symptoms predict a conversion risk of developing a neurodegenerative disease, including olfactory dysfunction, abnormal color vision, autonomic dysfunction, excessive daytime sleepiness, depression, and cognitive impairment. Parkinson's disease (PD) with RBD exhibits clinical heterogeneity with respect to motor and non-motor symptoms compared with PD without RBD. In this review, we describe the main clinical and pathogenic features of RBD, focusing on its association with other non-motor symptoms of parkinsonism.
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Affiliation(s)
- Hong Jin
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Jin-Ru Zhang
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Yun Shen
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Chun-Feng Liu
- Department of Neurology and Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China.
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Jiang H, Huang J, Shen Y, Guo S, Wang L, Han C, Liu L, Ma K, Xia Y, Li J, Xu X, Xiong N, Wang T. RBD and Neurodegenerative Diseases. Mol Neurobiol 2016; 54:2997-3006. [PMID: 27032389 DOI: 10.1007/s12035-016-9831-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/04/2016] [Indexed: 01/08/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disorder characterized by enacting one's dreams during the REM sleep, with most of the dreams being violent or aggressive, so that patients often come to see the doctor complaining hurting themselves or bed partners during sleep. Prevalence of RBD, based on population, is 0.38-2.01 %, but much higher in patients with neurodegenerative diseases, especially synucleinopathies. RBD may herald the emergence of synucleinopathies by decades, such that it may be used as an effective early marker of neurodegenerative diseases. Pharmaceutical treatment of RBD includes clonazepam, melatonin, pramipexole, and some newly reported medications. In this review, we summarized the clinical and PSG features of RBD, the pathophysiology and the therapy of it, focusing on the correlation between neurodegenerative diseases and RBD, in order to emphasize the significance of RBD as an early marker of neurodegenerative diseases.
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Affiliation(s)
- Haiyang Jiang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Yan Shen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Shiyi Guo
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Luxi Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Chao Han
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Ling Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Kai Ma
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Yun Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Jie Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Xiaoyun Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, Hubei, China.
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Ipsiroglu OS, Hung YHA, Chan F, Ross ML, Veer D, Soo S, Ho G, Berger M, McAllister G, Garn H, Kloesch G, Barbosa AV, Stockler S, McKellin W, Vatikiotis-Bateson E. "Diagnosis by behavioral observation" home-videosomnography - a rigorous ethnographic approach to sleep of children with neurodevelopmental conditions. Front Psychiatry 2015; 6:39. [PMID: 25852578 PMCID: PMC4362082 DOI: 10.3389/fpsyt.2015.00039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/25/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Advanced video technology is available for sleep-laboratories. However, low-cost equipment for screening in the home setting has not been identified and tested, nor has a methodology for analysis of video recordings been suggested. METHODS We investigated different combinations of hardware/software for home-videosomnography (HVS) and established a process for qualitative and quantitative analysis of HVS-recordings. A case vignette (HVS analysis for a 5.5-year-old girl with major insomnia and several co-morbidities) demonstrates how methodological considerations were addressed and how HVS added value to clinical assessment. RESULTS We suggest an "ideal set of hardware/software" that is reliable, affordable (∼$500) and portable (=2.8 kg) to conduct non-invasive HVS, which allows time-lapse analyses. The equipment consists of a net-book, a camera with infrared optics, and a video capture device. (1) We present an HVS-analysis protocol consisting of three steps of analysis at varying replay speeds: (a) basic overview and classification at 16× normal speed; (b) second viewing and detailed descriptions at 4-8× normal speed, and (c) viewing, listening, and in-depth descriptions at real-time speed. (2) We also present a custom software program that facilitates video analysis and note-taking (Annotator(©)), and Optical Flow software that automatically quantifies movement for internal quality control of the HVS-recording. The case vignette demonstrates how the HVS-recordings revealed the dimension of insomnia caused by restless legs syndrome, and illustrated the cascade of symptoms, challenging behaviors, and resulting medications. CONCLUSION The strategy of using HVS, although requiring validation and reliability testing, opens the floor for a new "observational sleep medicine," which has been useful in describing discomfort-related behavioral movement patterns in patients with communication difficulties presenting with challenging/disruptive sleep/wake behaviors.
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Affiliation(s)
- Osman S Ipsiroglu
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada ; Faculty of Science, Thompson Rivers University , Kamloops, BC , Canada ; Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada
| | - Yi-Hsuan Amy Hung
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Forson Chan
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Michelle L Ross
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Dorothee Veer
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Sonja Soo
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Gloria Ho
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Mai Berger
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Graham McAllister
- Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Heinrich Garn
- Austrian Institute of Technology , Vienna , Austria ; Technical University of Vienna , Vienna , Austria
| | - Gerhard Kloesch
- Department of Neurology, Medical University of Vienna , Vienna , Austria
| | | | - Sylvia Stockler
- Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada ; Division of Biochemical Diseases, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - William McKellin
- Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada ; Department of Anthropology, Faculty of Arts, University of British Columbia , Vancouver, BC , Canada
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Bertrand JA, Génier Marchand D, Postuma RB, Gagnon JF. Cognitive dysfunction in rapid eye movement sleep behavior disorder. Sleep Biol Rhythms 2013. [DOI: 10.1111/j.1479-8425.2012.00547.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Parasomnias are abnormal behaviors emanating from or associated with sleep. Sleepwalking and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, or promote sleep inertia lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after an arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications; in particular, the widely prescribed benzodiazepine receptor agonists. Recently, compelling evidence suggests that nocturnal eating may in some cases be a nonmotor manifestation of Restless Legs Syndrome (RLS). rapid eye movement (REM) Sleep Behavior Disorder (RBD) is characterized by a loss of REM paralysis leading to potentially injurious dream enactment. The loss of atonia in RBD often predates the development of Parkinson's disease and other disorders of synuclein pathology. Parasomnia behaviors are related to an activation (in NREM parasomnias) or a disinhibition (in RBD) of central pattern generators (CPGs). Initial management should focus on decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders. Clonazepam and melatonin appear to be effective therapies in RBD, whereas paroxetine has been reported effective in some cases of sleep terrors. At this point, pharmacotherapy for other parasomnias is less certain, and further investigations are necessary.
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Affiliation(s)
- Michael J Howell
- Department of Neurology, University of Minnesota Medical Center, Sleep Disorders Center, University of Minnesota, Minnesota, MN, USA.
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Gagnon JF, Bertrand JA, Génier Marchand D. Cognition in rapid eye movement sleep behavior disorder. Front Neurol 2012; 3:82. [PMID: 22629254 PMCID: PMC3354332 DOI: 10.3389/fneur.2012.00082] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 04/25/2012] [Indexed: 11/19/2022] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by excessive muscle activity and undesirable motor events during REM sleep. RBD occurs in approximately 0.5% of the general population, with a higher prevalence in older men. RBD is a frequent feature of dementia with Lewy bodies (DLB), but is only rarely reported in Alzheimer’s disease. RBD is also a risk factor for α-synuclein-related diseases, such as DLB, Parkinson’s disease (PD), and multiple system atrophy. Therefore, RBD has major implications for the diagnosis and treatment of neurodegenerative disorders and for understanding specific neurodegeneration patterns. Several markers of neurodegeneration have been identified in RBD, including cognitive impairments such as deficits in attention, executive functions, learning capacities, and visuospatial abilities. Approximately 50% of RBD patients present mild cognitive impairment. Moreover, RBD is also associated with cognitive decline in PD.
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Affiliation(s)
- Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal Montréal, QC, Canada
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