4.7 Article

Autonomic symptoms in idiopathic REM behavior disorder: a multicentre case-control study

Journal

JOURNAL OF NEUROLOGY
Volume 261, Issue 6, Pages 1112-1118

Publisher

SPRINGER HEIDELBERG
DOI: 10.1007/s00415-014-7317-8

Keywords

REM sleep behavior disorder; Autonomic function; Parasomnia

Funding

  1. Teva
  2. Novartis
  3. GlaxoSmithKline
  4. Boehringer Ingelheim
  5. Orion Pharma
  6. Merck Serono
  7. UCB
  8. Cephalon
  9. Jazz
  10. Bioprojet
  11. Canadian Institute of Health Research
  12. Fonds de la Recherche en Sante Quebec
  13. Webster Foundation
  14. Drummond Foundation
  15. Novartis Canada
  16. Teva Neurosciences
  17. Ipsen
  18. Pfizer
  19. UCB Pharma
  20. Charles University in Prague [PRVOUK P26/LF1/4]
  21. Austrian Science Fund [KLI 236]
  22. Nationalbank of Austria [15127]
  23. Micheal J. Fox Foundation for Parkinson's Research
  24. International Parkinson Fonds Germany
  25. Merck

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Patients with idiopathic REM sleep behavior disorder (iRBD) are at very high risk of developing neurodegenerative synucleinopathies, which are disorders with prominent autonomic dysfunction. Several studies have documented autonomic dysfunction in iRBD, but large-scale assessment of autonomic symptoms has never been systematically performed. Patients with polysomnography-confirmed iRBD (318 cases) and controls (137 healthy volunteers and 181 sleep center controls with sleep diagnoses other than RBD) were recruited from 13 neurological centers in 10 countries from 2008 to 2011. A validated scale to study the disorders of the autonomic nervous system in Parkinson's disease (PD) patients, the SCOPA-AUT, was administered to all the patients and controls. The SCOPA-AUT consists of 25 items assessing the following domains: gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, and sexual dysfunction. Our results show that compared to control subjects with a similar overall age and sex distribution, patients with iRBD experience significantly more problems with gastrointestinal, urinary, and cardiovascular functioning. The most prominent differences in severity of autonomic symptoms between our iRBD patients and controls emerged in the gastrointestinal domain. Interestingly, it has been reported that an altered gastrointestinal motility can predate the motor phase of PD. The cardiovascular domain SCOPA-AUT score in our study in iRBD patients was intermediate with respect to the scores reported in PD patients by other authors. Our findings underline the importance of collecting data on autonomic symptoms in iRBD. These data may be used in prospective studies for evaluating the risk of developing neurodegenerative disorders.

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