Risk Factors for Phenoconversion in Rapid Eye Movement Sleep Behavior Disorder

Abstract

Objective This study was undertaken to follow up predictive factors for α‐synuclein–related neurodegenerative diseases in a multicenter cohort of idiopathic/isolated rapid eye movement sleep behavior disorder (iRBD). Methods Patients with iRBD from 12 centers underwent a detailed assessment for potential environmental and lifestyle risk factors via a standardized questionnaire at baseline. Patients were then prospectively followed and received assessments for parkinsonism or dementia during follow‐up. The cumulative incidence of parkinsonism or dementia was estimated with competing risk analysis. Cox regression analyses were used to evaluate the predictive value of environmental/lifestyle factors over a follow‐up period of 11 years, adjusting for age, sex, and center. Results Of 319 patients who were free of parkinsonism or dementia, 281 provided follow‐up information. After a mean follow‐up of 5.8 years, 130 (46.3%) patients developed neurodegenerative disease. The overall phenoconversion rate was 24.2% after 3 years, 44.8% after 6 years, and 67.5% after 10 years. Patients with older age (adjusted hazard ratio [aHR] = 1.05) and nitrate derivative use (aHR = 2.18) were more likely to phenoconvert, whereas prior pesticide exposure (aHR = 0.21–0.64), rural living (aHR = 0.53), lipid‐lowering medication use (aHR = 0.59), and respiratory medication use (aHR = 0.36) were associated with lower phenoconversion risk. Risk factors for those converting to primary dementia and parkinsonism were generally similar, with dementia‐first converters having lower coffee intake and beta‐blocker intake, and higher occurrence of family history of dementia. Interpretation Our findings elucidate the predictive values of environmental factors and comorbid conditions in identifying RBD patients at higher risk of phenoconversion. ANN NEUROL 2022;91:404–416

Dream‐enactment behaviours during the COVID‐19 pandemic: an international COVID‐19 sleep study

“…A rather unexpected finding of the association of DEB with younger age is in contrast to the finding that increasing age is a risk factor for RBD (Zhang et al, 2022 ). In other words, there will be a distinct possibility that this young age group may suffer from DEB‐like episodes related to non‐REM (NREM) parasomnia during the COVID‐19 pandemic.…”

Predictive risk factors of phenoconversion in idiopathic REM sleep behavior disorder: the Italian study “FARPRESTO”

“…The so-called symptomatic RBD, on the other hand, occurs in association with neurodegenerative diseases belonging to the α-synucleinopathies, narcolepsy, and subacute-or acute-onset conditions involving the central nervous system (structural brain lesions, CNS diseases, drug consumption or alcohol withdrawal, and post-traumatic stress disorder) [1]. In recent years, follow-up studies have shown that most iRBD patients will develop an overt alphasynucleinopathy over time, with a rate of phenoconversion of 73.5% after 12 years from diagnosis [10][11][12][13]. RBD thus represents an early marker of neurodegeneration, a unique open window on the initial phase of alpha-synucleinopathies, encouraging research on neuroprotective therapies [14].…”

Personality profile and its association with conversion to neurodegenerative disorders in idiopathic REM sleep behavior disorder

“…The explanation for this result may be that openness trait might be affected by other variables in iRBD. Previous studies suggested that older age and poor cognition could predict future phenoconversion in iRBD patients, which are also tightly related to open personality trait [15][16][17][18] . Thus, age and cognition might modulate the effect of openness on future phenoconversion.…”