Study on the Clinical Features of Parkinson's Disease With Probable Rapid Eye Movement Sleep Behavior Disorder
Kexin Long, Chang-min Wan, Yaqin Xiang, Jiabin Liu, Qian Xu, Qiying Sun, Zhiqin Wang, Yun Tian, Liangjuan Fang, Yang Yang, Xinxiang Yan, Beisha Tang, Jifeng Guo
Abstract
To investigate the clinical features and associated factors of Parkinson's disease (PD) patients with probable rapid eye movement sleep behavior disorder (PD-pRBD).A total of 2440 patients with clinically established or clinically probable PD were divided into two groups: PD-pRBD and PD without pRBD group (PD-NRBD) according to the RBD questionnaire-Hong Kong (RBDQ-HK). Data collection included demographic data, basic clinical history and the assessment of motor and non-motor symptoms. Based on the onset time of pRBD and the motor symptoms in PD, PD-pRBD patients were further divided into pRBD prior to PD (PD-prRBD) group and pRBD posterior to PD (PD-poRBD) group. Clinical features were compared between PD-pRBD group and PD-NRBD group, as well as PD-prRBD group and PD-poRBD group. And the associated factors of pRBD were also explored. The prevalence of pRBD was 41.4% in our PD cohort. Compared with the PD-NRBD group, the PD-pRBD group had longer disease duration and more severe motor symptoms especially rigidity, bradykinesia, posture gait, frozen gait. And the PD-pRBD group had significantly higher levodopa equivalent dose daily (LEDD) and higher ratio of dyskinesia, wearing-off and late stage of H-Y stage. The score of non-motor symptom rating scale (NMSS), cognitive impairment, Parkinson disease sleep scale (PDSS), excessive daytime sleepiness (EDS),constipation, hyposmia, depression and the 39-item Parkinson's disease questionnaire (PDQ-39 ) also appeared worse in the PD-pRBD group. Significant differences widely existed between PD-prRBD group and PD-poRBD group, including educational level, motor subtype, disease duration, disease’s progression, UPDRS-II, UPDRS-III, tremor, rigidity, bradykinesia, posture gait, frozen gait, LEDD, dyskinesia, wearing-off, H-Y stage, NMSS-6 , PDSS and social support. Late-onset PD (LOPD), long course of disease, high UPDRS-I score, high NMSS-4 score, low PDSS score, constipation and hyposmia were all identified as the risk factors for PD-pRBD. Comparing with PD-NRBD group, PD-pRBD group may have more severe motor symptoms, motor complications and non-motor symptoms, as well as poorer quality of life; LOPD, long disease duration, high UPDRS-I score, high NMSS-4 score, low PDSS score, constipation and hyposmia can be risk factors for RBD in PD; Differences also occur between PD-prRBD group and PD-poRBD group.