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Influence of RBD onset on the clinical characteristics of Parkinson’s disease patients: a retrospective study

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Abstract

Introduction

In Parkinson’s disease (PD), rapid eye movement (REM) sleep behavior disorder (RBD) might either precede the appearance of motor symptoms, or develop during the disease course. PD patients with RBD are characterized by a higher burden of cognitive impairment and hallucinations. However, few studies have analyzed the clinical characteristics of PD patients according to the timeline of RBD onset.

Methods

PD patients have been retrospectively enrolled. Presence and onset of probable RBD (pRBD) has been evaluated using RBD Screening Questionnaire (score ≥ 6). Presence of Mild Cognitive Impairment (MCI) at baseline has been evaluated using the MDS criteria level II. Presence of motor complications and hallucinations has been evaluated at a 5-year follow-up.

Results

A total of 115 PD patients (65 men, 56.5%; mean age 62.5 ± 9.7 years; mean disease duration 3.7 ± 3.9 years) have been enrolled. Out of these, 63 fulfilled the diagnosis of pRBD (54.8%) with 21 (33.3%) reporting the RBD onset before the onset of the motor symptoms (PD-RBDpre), and 42 (66.7%) after the motor symptoms (PD-RBDpost). At enrolment presence of MCI was associated with PD-RBDpre patients (OR 5.04; 95% CI 1.33–19.05; p value 0.02). At follow-up, a higher risk of developing hallucinations was also associated with PD-RBDpre (OR 4.68; 95% CI 1.24–17.63; p = 0.022).

Conclusions

PD patients with RBD occurring before the onset of motor symptoms represent a subgroup of patients with a more severe cognitive phenotype and with a higher risk of developing hallucinations along the disease course, with significant implications in terms of prognostic stratification and therapeutic approach.

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Data availability statement

The data supporting the findings of this study are available on request from the corresponding author.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy

    Calogero Edoardo Cicero, Antonina Luca, Giovanni Mostile, Giulia Donzuso, Loretta Giuliano, Mario Zappia & Alessandra Nicoletti

  2. Oasi Research Institute-IRCCS, Troina, Italy

    Giovanni Mostile

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  1. Calogero Edoardo Cicero
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  2. Antonina Luca
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  3. Giovanni Mostile
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  7. Alessandra Nicoletti
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Contributions

CEC: conception and design of the study, acquisition of data, analysis and interpretation of data, drafting of the article; AL: acquisition of data, analysis and interpretation of data, critical review of the article; GM: acquisition of data, analysis and interpretation of data, critical review of the article; GD: acquisition of data, analysis and interpretation of data, critical review of the article; LG: acquisition of data, analysis and interpretation of data, critical review of the article; MZ: analysis and interpretation of data, critical review of the article; AN: conception and design of the study, analysis and interpretation of data, critical review of the article.

Corresponding author

Correspondence to Alessandra Nicoletti.

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The authors declare that they have no conflict of interest.

Ethical standards

All the patients provided written informed consent to participate in the study. The study has been approved by the Ethical Committee of the AOU Policlinico G. Rodolico-San Marco (111/2019/PO) and has been conducted in accordance to the Declaration of Helsinki.

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Cicero, C.E., Luca, A., Mostile, G. et al. Influence of RBD onset on the clinical characteristics of Parkinson’s disease patients: a retrospective study. J Neurol 270, 3171–3178 (2023). https://doi.org/10.1007/s00415-023-11659-5

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  • DOI: https://doi.org/10.1007/s00415-023-11659-5

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