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KMID : 1197720190120020103
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대한파킨슨병 및 이상운동질환 학회지
2019 Volume.12 No. 2 p.103 ~ p.112
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Nonmotor and Dopamine Transporter Change in REM Sleep Behavior Disorder by Olfactory Impairment
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Lee Jee-Young
Yoon Eun-Jin
Kim Yu-Kyeong
Shin Chae-Won
Nam Hyun-Woo
Jeong Jae-Min
Kim Han-Joon
Jeon Beom-Seok
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Abstract
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Objective: It is unclear whether the decline in dopamine transporters (DAT) differs among idiopathic rapid eye movement sleep behavior disorder (iRBD) patients with different levels of olfactory impairment. This study aimed to characterize DAT changes in relation to nonmotor features in iRBD patients by olfactory loss.
Methods: This prospective cohort study consisted of three age-matched groups: 30 polysomnography-confirmed iRBD patients, 30 drug-naive Parkinson’s disease patients, and 19 healthy controls without olfactory impairment. The iRBD group was divided into two groups based on olfactory testing results. Participants were evaluated for reported prodromal markers and then underwent 18F-FP-CIT positron emission tomography and 3T MRI. Tracer uptakes were analyzed in the caudate, anterior and posterior putamen, substantia nigra, and raphe nuclei.
Results: Olfactory impairment was defined in 38.5% of iRBD patients. Mild parkinsonian signs and cognitive functions were not different between the two iRBD subgroups; however, additional prodromal features, constipation, and urinary and sexual dysfunctions were found in iRBD patients with olfactory impairment but not in those without. Tracer uptake showed significant group differences in all brain regions, except the raphe nuclei. The iRBD patients with olfactory impairment had uptake reductions in the anterior and posterior putamen, caudate, and substantia nigra (p < 0.016 in all, adjusted for age), which ranged from 0.6 to 0.8 of age-normative values. In contrast, those without olfactory impairment had insignificant changes in all regions ranging above 0.8.
Conclusion: There was a clear distinction in DAT loss and nonmotor profiles by olfactory status in iRBD.
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KEYWORD
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Idiopathic REM sleep behavior disorder, Olfaction, Parkinson’s disease, Dopamine transporters, Positron emission tomography
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