Risk factors for neurodegeneration in idiopathic rapid eye movement sleep behavior disorder: A multicenter study

• Published in: Annals of neurology Vol. 77; no. 5; pp. 830 - 839
• Main Authors: Postuma, Ronald B., Iranzo, Alex, Hogl, Birgit, Arnulf, Isabelle, Ferini-Strambi, Luigi, Manni, Raffaele, Miyamoto, Tomoyuki, Oertel, Wolfgang, Dauvilliers, Yves, Ju, Yo-El, Puligheddu, Monica, Sonka, Karel, Pelletier, Amelie, Santamaria, Juan, Frauscher, Birgit, Leu-Semenescu, Smaranda, Zucconi, Marco, Terzaghi, Michele, Miyamoto, Masayuki, Unger, Marcus M., Carlander, Bertrand, Fantini, Maria-Livia, Montplaisir, Jacques Y.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.05.2015; Wiley Subscription Services, Inc; Wiley
• Subjects: Aged; Behavior disorders; Disease Progression; Family medical history; Female; Follow-Up Studies; Health risk assessment; Human health and pathology; Humans; Life Sciences; Life Style; Male; Middle Aged; Neurodegeneration; Neurodegenerative Diseases - diagnosis; Neurodegenerative Diseases - epidemiology; Neurons and Cognition; Parkinson's disease; REM Sleep Behavior Disorder - diagnosis; REM Sleep Behavior Disorder - epidemiology; Risk Factors; Surveys and Questionnaires
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.24385

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. Ann Neurol 2015;77:830–839