TY - JOUR
T1 - Risk factors for neurodegeneration in idiopathic rapid eye movement sleep behavior disorder
T2 - A multicenter study
AU - Postuma, Ronald B.
AU - Iranzo, Alex
AU - Hogl, Birgit
AU - Arnulf, Isabelle
AU - Ferini-Strambi, Luigi
AU - Manni, Raffaele
AU - Miyamoto, Tomoyuki
AU - Oertel, Wolfgang
AU - Dauvilliers, Yves
AU - Ju, Yo El
AU - Puligheddu, Monica
AU - Sonka, Karel
AU - Pelletier, Amelie
AU - Santamaria, Juan
AU - Frauscher, Birgit
AU - Leu-Semenescu, Smaranda
AU - Zucconi, Marco
AU - Terzaghi, Michele
AU - Miyamoto, Masayuki
AU - Unger, Marcus M.
AU - Carlander, Bertrand
AU - Fantini, Maria Livia
AU - Montplaisir, Jacques Y.
N1 - Publisher Copyright:
© 2015 American Neurological Association.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Objective To assess whether risk factors for Parkinson disease and dementia with Lewy bodies increase rate of defined neurodegenerative disease in idiopathic rapid eye movement (REM) sleep behavior disorder (RBD). Methods Twelve centers administered a detailed questionnaire assessing risk factors for neurodegenerative synucleinopathy to patients with idiopathic RBD. Variables included demographics, lifestyle factors, pesticide exposures, occupation, comorbid conditions, medication use, family history, and autonomic/motor symptoms. After 4 years of follow-up, patients were assessed for dementia or parkinsonism. Disease risk was assessed with Kaplan-Meier analysis, and epidemiologic variables were compared between convertors and those still idiopathic using logistic regression. Results Of 305 patients, follow-up information was available for 279, of whom 93 (33.3%) developed defined neurodegenerative disease. Disease risk was 25% at 3 years and 41% after 5 years. Patients who converted were older (difference = 4.5 years, p < 0.001), with similar sex distribution. Neither caffeine, smoking, nor alcohol exposure predicted conversion. Although occupation was similar between groups, those who converted had a lower likelihood of pesticide exposure (occupational insecticide = 2.3% vs 9.0%). Convertors were more likely to report family history of dementia (odds ratio [OR] = 2.09), without significant differences in Parkinson disease or sleep disorders. Medication exposures and medical history were similar between groups. Autonomic and motor symptoms were more common among those who converted. Risk factors for primary dementia and parkinsonism were generally similar, except for a notably higher clonazepam use in dementia convertors (OR = 2.6). Interpretation Patients with idiopathic RBD are at very high risk of neurodegenerative synucleinopathy. Risk factor profiles between convertors and nonconvertors have both important commonalities and differences.
AB - Objective To assess whether risk factors for Parkinson disease and dementia with Lewy bodies increase rate of defined neurodegenerative disease in idiopathic rapid eye movement (REM) sleep behavior disorder (RBD). Methods Twelve centers administered a detailed questionnaire assessing risk factors for neurodegenerative synucleinopathy to patients with idiopathic RBD. Variables included demographics, lifestyle factors, pesticide exposures, occupation, comorbid conditions, medication use, family history, and autonomic/motor symptoms. After 4 years of follow-up, patients were assessed for dementia or parkinsonism. Disease risk was assessed with Kaplan-Meier analysis, and epidemiologic variables were compared between convertors and those still idiopathic using logistic regression. Results Of 305 patients, follow-up information was available for 279, of whom 93 (33.3%) developed defined neurodegenerative disease. Disease risk was 25% at 3 years and 41% after 5 years. Patients who converted were older (difference = 4.5 years, p < 0.001), with similar sex distribution. Neither caffeine, smoking, nor alcohol exposure predicted conversion. Although occupation was similar between groups, those who converted had a lower likelihood of pesticide exposure (occupational insecticide = 2.3% vs 9.0%). Convertors were more likely to report family history of dementia (odds ratio [OR] = 2.09), without significant differences in Parkinson disease or sleep disorders. Medication exposures and medical history were similar between groups. Autonomic and motor symptoms were more common among those who converted. Risk factors for primary dementia and parkinsonism were generally similar, except for a notably higher clonazepam use in dementia convertors (OR = 2.6). Interpretation Patients with idiopathic RBD are at very high risk of neurodegenerative synucleinopathy. Risk factor profiles between convertors and nonconvertors have both important commonalities and differences.
UR - http://www.scopus.com/inward/record.url?scp=84928215818&partnerID=8YFLogxK
U2 - 10.1002/ana.24385
DO - 10.1002/ana.24385
M3 - Article
C2 - 25767079
AN - SCOPUS:84928215818
SN - 0364-5134
VL - 77
SP - 830
EP - 839
JO - Annals of neurology
JF - Annals of neurology
IS - 5
ER -