Pareidolias in REM Sleep Behavior Disorder: A Possible Predictive Marker of Lewy Body Diseases?

Study Objectives: To investigate conditions and clinical significance of pareidolias in patients with idiopathic rapid eyemovent (REM) sleep behavior disorder (iRBD). Methods: This cross-sectional study examined 202 patients with iRBD (66.8 +/- 8.0 yr, 58 female) and 46 healthy control subjects (64.7 +/- 5.8 years, 14 females). They underwent the Pareidolia test, a newly developed instrument for evoking pareidolias, video polysomnography, olfactory tests, and Addenbrooke's cognitive examination-revised. Results: Results show that 53.5% of iRBD patients exhibited one or more pareidolic responses: The rate was higher than control subjects showed (21.7%). The pictures evoking pareidolic responses were more numerous for iRBD patients than for control subjects (1.2 +/- 1.8 vs. 0.4 +/- 0.8, p<.001). Subgroup analyses revealed that iRBD patients with pareidolic responses had higher amounts of REM sleep without atonia (RWA), with lower sleep efficiency, lower cognitive function, and older age than subjects without pareidolic responses. Results of multivariate analyses show the number of pareidolic responses as a factor associated with decreased cognitive function in iRBD patients with better predictive accuracy. Morbidity length and severity of iRBD, olfactory function, and the amount of RWA were not factors associated with better predictive accuracy. Conclusions: Half or more of the iRBD patients showed pareidolic responses. The responses were proven to be associated more intimately with their cognitive decline than clinical or physiological variables related to RBD. Pareidolias in iRBD are useful as a predictive marker of future development of Lewy body diseases.