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Neurodegenerative disorder risk in idiopathic REM sleep behavior disorder: study in 174 patients.

Iranzo A, Fernández-Arcos A, Tolosa E, Serradell M, Molinuevo JL, Valldeoriola F, Gelpi E, Vilaseca I, Sánchez-Valle R, Lladó A, Gaig C, Santamaría J - PLoS ONE (2014)

Bottom Line: In a large IRBD cohort diagnosed in a tertiary referal sleep center, prolonged follow-up indicated that the majority of patients are eventually diagnosed with the synucleinopathies PD, DLB and less frequently MSA.IRBD represented the prodromal period of these conditions.Our findings in IRBD have important implications in clinical practice, in the investigation of the early pathological events occurring in the synucleinopathies, and for the design of interventions with potential disease-modifying agents.

View Article: PubMed Central - PubMed

Affiliation: Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain ; CIBERNED, Barcelona, Spain.

ABSTRACT

Objective: To estimate the risk for developing a defined neurodegenerative syndrome in a large cohort of idiopathic REM sleep behavior disorder (IRBD) patients with long follow-up.

Methods: Using the Kaplan-Meier method, we estimated the disease-free survival rate from defined neurodegenerative syndromes in all the consecutive IRBD patients diagnosed and followed-up in our tertiary referal sleep center between November 1991 and July 2013.

Results: The cohort comprises 174 patients with a median age at diagnosis of IRBD of 69 years and a median follow-up of four years. The risk of a defined neurodegenerative syndrome from the time of IRBD diagnosis was 33.1% at five years, 75.7% at ten years, and 90.9% at 14 years. The median conversion time was 7.5 years. Emerging diagnoses (37.4%) were dementia with Lewy bodies (DLB) in 29 subjects, Parkinson disease (PD) in 22, multiple system atrophy (MSA) in two, and mild cognitive impairment (MCI) in 12. In six cases, in whom postmortem was performed, neuropathological examination disclosed neuronal loss and widespread Lewy-type pathology in the brain in each case.

Conclusions: In a large IRBD cohort diagnosed in a tertiary referal sleep center, prolonged follow-up indicated that the majority of patients are eventually diagnosed with the synucleinopathies PD, DLB and less frequently MSA. IRBD represented the prodromal period of these conditions. Our findings in IRBD have important implications in clinical practice, in the investigation of the early pathological events occurring in the synucleinopathies, and for the design of interventions with potential disease-modifying agents.

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Related in: MedlinePlus

Rates of neurological-disease-free-survival according to the time of IRBD diagnosis in the first 44 patients from the cohort (doted line) and the remaining 130 (continuous line).
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pone-0089741-g002: Rates of neurological-disease-free-survival according to the time of IRBD diagnosis in the first 44 patients from the cohort (doted line) and the remaining 130 (continuous line).

Mentions: In the 65 subjects diagnosed with a defined neurodegenerative syndrome, the median interval between estimated RBD onset and diagnosis of a defined neurodegenerative syndrome was 11.0 (range, 2 to 24) years, and the median interval between IRBD diagnosis and diagnosis of a defined neurodegenerative syndrome was 4.0 (range, 0.5 to 13) years. The risk of a defined neurodegenerative syndrome from IRBD diagnosis was 33.1% at five years, 75.7% at ten years, and 90.9% at 14 years (Figure 1). The median conversion time in our sample was 7.5±0.5 years (95% CI 6.5 to 8.4). No difference in the risk of developing a neurodegenerative syndrome was found between the first 44 patients and the subsequent 130 patients (p = 0.319) (Figure 2).


Neurodegenerative disorder risk in idiopathic REM sleep behavior disorder: study in 174 patients.

Iranzo A, Fernández-Arcos A, Tolosa E, Serradell M, Molinuevo JL, Valldeoriola F, Gelpi E, Vilaseca I, Sánchez-Valle R, Lladó A, Gaig C, Santamaría J - PLoS ONE (2014)

Rates of neurological-disease-free-survival according to the time of IRBD diagnosis in the first 44 patients from the cohort (doted line) and the remaining 130 (continuous line).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3935943&req=5

pone-0089741-g002: Rates of neurological-disease-free-survival according to the time of IRBD diagnosis in the first 44 patients from the cohort (doted line) and the remaining 130 (continuous line).
Mentions: In the 65 subjects diagnosed with a defined neurodegenerative syndrome, the median interval between estimated RBD onset and diagnosis of a defined neurodegenerative syndrome was 11.0 (range, 2 to 24) years, and the median interval between IRBD diagnosis and diagnosis of a defined neurodegenerative syndrome was 4.0 (range, 0.5 to 13) years. The risk of a defined neurodegenerative syndrome from IRBD diagnosis was 33.1% at five years, 75.7% at ten years, and 90.9% at 14 years (Figure 1). The median conversion time in our sample was 7.5±0.5 years (95% CI 6.5 to 8.4). No difference in the risk of developing a neurodegenerative syndrome was found between the first 44 patients and the subsequent 130 patients (p = 0.319) (Figure 2).

Bottom Line: In a large IRBD cohort diagnosed in a tertiary referal sleep center, prolonged follow-up indicated that the majority of patients are eventually diagnosed with the synucleinopathies PD, DLB and less frequently MSA.IRBD represented the prodromal period of these conditions.Our findings in IRBD have important implications in clinical practice, in the investigation of the early pathological events occurring in the synucleinopathies, and for the design of interventions with potential disease-modifying agents.

View Article: PubMed Central - PubMed

Affiliation: Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain ; CIBERNED, Barcelona, Spain.

ABSTRACT

Objective: To estimate the risk for developing a defined neurodegenerative syndrome in a large cohort of idiopathic REM sleep behavior disorder (IRBD) patients with long follow-up.

Methods: Using the Kaplan-Meier method, we estimated the disease-free survival rate from defined neurodegenerative syndromes in all the consecutive IRBD patients diagnosed and followed-up in our tertiary referal sleep center between November 1991 and July 2013.

Results: The cohort comprises 174 patients with a median age at diagnosis of IRBD of 69 years and a median follow-up of four years. The risk of a defined neurodegenerative syndrome from the time of IRBD diagnosis was 33.1% at five years, 75.7% at ten years, and 90.9% at 14 years. The median conversion time was 7.5 years. Emerging diagnoses (37.4%) were dementia with Lewy bodies (DLB) in 29 subjects, Parkinson disease (PD) in 22, multiple system atrophy (MSA) in two, and mild cognitive impairment (MCI) in 12. In six cases, in whom postmortem was performed, neuropathological examination disclosed neuronal loss and widespread Lewy-type pathology in the brain in each case.

Conclusions: In a large IRBD cohort diagnosed in a tertiary referal sleep center, prolonged follow-up indicated that the majority of patients are eventually diagnosed with the synucleinopathies PD, DLB and less frequently MSA. IRBD represented the prodromal period of these conditions. Our findings in IRBD have important implications in clinical practice, in the investigation of the early pathological events occurring in the synucleinopathies, and for the design of interventions with potential disease-modifying agents.

Show MeSH
Related in: MedlinePlus