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Observational Study
. 2024 Jun;31(6):e16260.
doi: 10.1111/ene.16260. Epub 2024 Feb 26.

Biomarkers of neurodegeneration in isolated and antidepressant-related rapid eye movement sleep behavior disorder

Francesco Biscarini  1 , Fabio Pizza  1   2 , Stefano Vandi  1   2 , Alex Incensi  2 , Elena Antelmi  2   3 , Vincenzo Donadio  2 , Raffaele Ferri  4 , Rocco Liguori  1   2 , Giuseppe Plazzi  2   5
Affiliations
Observational Study

Biomarkers of neurodegeneration in isolated and antidepressant-related rapid eye movement sleep behavior disorder

Francesco Biscarini et al. Eur J Neurol. 2024 Jun.

Abstract

Background and purpose: This study compared the features of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and antidepressant-related REM sleep behaviour disorder (RBD) with the aim of highlighting markers that might distinguish the two entities.

Methods: The observational cohort study included RBD patients with and without antidepressant use (antiD+ and antiD- patients, respectively), without cognitive impairment and parkinsonism. Clinical features of RBD, subtle motor and non-motor symptoms of parkinsonism, sleep architecture, REM atonia index, dopamine transporter-single photon emission computed tomography (DAT-SPECT) and skin biopsies for the intraneuronal alpha-synuclein (α-syn), were evaluated in the baseline work-up.

Results: Thirty-nine patients, 10 antiD+ and 29 antiD-, were included. AntiD+ patients (more frequently female) reported more psychiatric symptoms, less violent dream enactment, and less frequent hyposmia. Dermal α-syn was detected in 93.1% of antiD- versus 30% of antiD+ patients (p = 0.00024). No differences appeared in other motor and non-motor symptoms, Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III score, DAT-SPECT, or polysomnographic features.

Conclusions: Patients with antidepressant-related RBD have clinical and neuropathological features suggesting a lower risk of evolution than those with iRBD.

Keywords: alpha‐synuclein; antidepressant‐related REM sleep behavior disorder; skin biopsy.

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Conflict of interest statement

The authors declare that there are no conflicts of interest relevant to this work.

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