Cross‐sectional and longitudinal associations between probable rapid eye movement sleep behavior disorder and impulse control disorders in Parkinson’s disease

Abstract

Background and purpose: The aim was to investigate whether probable rapid eye movement sleep behavior disorder (pRBD) is associated with impulse control disorders (ICDs) in drug-na€ ıve patients with Parkinson's disease (PD) and whether baseline pRBD is associated with a higher incidence of ICDs during follow-up. Methods: The Parkinson's Progression Markers Initiative is an international, multicenter, prospective cohort study to identify biomarkers of PD progression. In all, 423 drug-na€ ıve patients with early-stage PD were included in the cross-sectional analysis, and 320 patients who screened negative for any ICDs or related behaviors at baseline were included in the longitudinal analysis. Results: In the cross-sectional analysis, a significant correlation was found between pRBD and ICDs in drug-na€ ıve patients whilst controlling for potential confounders [odds ratio 2.56, 95% confidence interval (CI) 1.38-4.76, P = 0.003]. In the longitudinal analysis, baseline pRBD was an independent predictor of ICD development over time [hazard ratio (HR) 1.648, 95% CI 1.054-2.576; P = 0.028]. Other significant predictors of ICDs included younger age of onset (HR = 0.973, 95% CI = 0.950-0.997; P = 0.026) and greater State-Trait Anxiety Inventory score (HR = 1.040, 95% CI = 1.020-1.061; P < 0.001). Conclusion: Our data suggest that identifying baseline pRBD in early-stage PD may help clinicians to choose a better therapeutic strategy so as to prevent or limit neuropsychiatric complications.

Is Rapid Eye Movement Sleep Behavior Disorder a Risk Factor for Impulse Control Disorder in Parkinson Disease?

“…Recently, a meta‐analysis including 10 observational cross‐sectional studies and involving data from 2,781 PD patients found that RBD was associated with a >2‐fold increased risk of developing ICBs, even after stratifying subgroups based on methods for diagnosing RBD and ICBs 18 . Finally, another longitudinal analysis was recently performed using the PPMI cohort data, finding that pRBD at BL was an independent predictor of ICD development over time 19 . However, a cutoff of ≥5 on the RBDSQ was used to define pRBD, as in the general population, whereas a cutoff of ≥6 has been shown to be the best value for detecting RBD in PD 26 .…”

“…Although one study assessed longitudinal severity of ICBs and its predictors in PD using multiple imputation analysis, 17 to date only one longitudinal study has assessed whether RBD is a possible risk factor for the development of incident ICBs 19 . This study, using Parkinson's Progression Markers Initiative (PPMI) cohort data, found that pRBD at baseline (BL), defined by a score ≥ 5 on the RBD Screening Questionnaire (RBDSQ), was an independent predictor of ICD development over time, after adjusting for some covariates (sex, age of disease onset, disease severity and duration, cognitive abilities, anxiety, and depression).…”

Impulse control disorders and related behaviors in Parkinson's disease: risk factors, clinical and genetic aspects, and management

“…PD patients with ICDs show a higher level of neuroticism and lower levels of agreeableness and conscientiousness [58], particularly among PD patients with pathological gambling [66] or hypersexuality [10]. Such patients are also reported to have ineffective coping skills [67], premorbid personality (novelty seeking and harm avoidance) [60], and anxiety [68].…”

“…They may show different neuropsychological profiles depending on ICD subtype, with distinct dysexecutive or memory impairments [13,76]. But these alterations may be reversible [68,82,[84][85][86][87][88], although some recent findings did not reproduce this association [88,89].…”

“…PD patients with RLS develop more ICD, especially compulsive eating disorders, and show a different psycho-behavioral profile with more hyperdopaminergic behaviors on the ASBPD scale [82]. A strong association has been reported between ICDs, especially pathological gambling, and rapid eye movement sleep behavior disorder (RBD) both in early PD and longitudinally [68,82,[84][85][86][87]88 & ], although some recent findings did not reproduce this association [88…”