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. 2020 Nov 21;12(1):157.
doi: 10.1186/s13195-020-00725-z.

Smaller pineal gland is associated with rapid eye movement sleep behavior disorder in Alzheimer's disease

Jeongbin Park  1 , Seung Wan Suh  2 , Grace Eun Kim  1 , Subin Lee  1 , Jun Sung Kim  1 , Hye Sung Kim  3 , Seonjeong Byun  3 , Jong Bin Bae  3 , Jae Hyoung Kim  4   5 , Sang Eun Kim  6   7 , Ji Won Han  3 , Ki Woong Kim  8   9   10
Affiliations

Smaller pineal gland is associated with rapid eye movement sleep behavior disorder in Alzheimer's disease

Jeongbin Park et al. Alzheimers Res Ther. .

Abstract

Background: To investigate the association between pineal gland volume and symptoms of rapid eye movement (REM) sleep behavior disorder (RBD) in Alzheimer's disease (AD) patients without any feature of dementia with Lewy bodies.

Methods: We enrolled 296 community-dwelling probable AD patients who did not meet the diagnostic criteria for possible or probable dementia with Lewy bodies. Among them, 93 were amyloid beta (Aβ) positive on 18F-florbetaben amyloid brain positron emission tomography. We measured RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as the RBDSQ of 5 or higher. We manually segmented pineal gland on 3T structural T1-weighted brain magnetic resonance imaging.

Results: The participants with pRBD had smaller pineal parenchyma volume (VPP) than those without pRBD (p < 0.001). The smaller the VPP, the more severe the RBD symptoms (p < 0.001). VPP was inversely associated with risk of prevalent pRBD (odds ratio = 0.909, 95% confidence interval [CI] = 0.878-0.942, p < 0.001). Area under the receiver operator characteristic curve for pRBD of VPP was 0.80 (95% CI = 0.750-0.844, p < 0.0001). These results were not changed when we analyzed the 93 participants with Aβ-positive AD separately.

Conclusions: In AD patients, reduced pineal gland volume may be associated with RBD.

Keywords: Alzheimer’s disease; Amyloid positron emission tomography; Magnetic resonance imaging; Pineal gland; Rapid eye movement sleep behavior disorder.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Assessment of pineal gland volume on 3D T1-weighted brain magnetic resonance images at 1.0 × 1.0 × 1.0 mm3. The pineal gland was manually segmented from surrounding cerebrospinal fluid space
Fig. 2
Fig. 2
Diagnostic accuracy for the prevalent probable rapid eye movement sleep behavior disorder of the pineal parenchyma volume in a all participants and b participants with Aβ-positive Alzheimer’s disease. Aβ, amyloid beta; VPP, pineal parenchyma volume (mm3); AUC, area under the curve; CI, confidence interval
Fig. 3
Fig. 3
Association between REM Sleep Behavior Disorder Screening Questionnaire total score and pineal parenchyma volume (mm3) in a all participants and b participants with Aβ-positive Alzheimer’s disease. Multiple linear regression model adjusted for age, sex, years of education, intracranial volume, head injury, amount of smoking, amount of alcohol drinking, and use of drugs influencing sleep or motor activity
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