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. 2025 Dec;47(6):6711-6730.
doi: 10.1007/s11357-025-01757-9. Epub 2025 Jul 1.

Self-testing for symptoms and signs of prodromal alpha-synucleinopathies: results from the Tasmanian ISLAND Sleep Study

Samantha Bramich  1 , Alastair J Noyce  2   3 , Anna E King  2 , Eddy Roccati  2 , Sharon L Naismith  4 , James C Vickers  2 , Jane Alty  2   5   6
Affiliations

Self-testing for symptoms and signs of prodromal alpha-synucleinopathies: results from the Tasmanian ISLAND Sleep Study

Samantha Bramich et al. Geroscience. 2025 Dec.

Abstract

Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) may occur at least 10 years before a clinical diagnosis of an α-synucleinopathy, such as dementia with Lewy bodies (DLB), Parkinson's disease (PD) or multiple system atrophy (MSA). The extent to which people with iRBD manifest subtle features of these conditions is an area of active research and whether these changes can be measured remotely in the community is an important aim. Better characterisation may aid early detection and monitoring for people at risk of neurodegeneration. The aim of this study was to investigate remote tests of subjective and objective features of α-synuclein-related conditions in probable iRBD (pRBD). We hypothesised that α-synuclein-related symptoms and signs would be more frequent in pRBD than healthy controls. 2,891 participants aged 50 + from the Tasmanian ISLAND Sleep Study completed the REM Sleep Behavior Disorder Single-Question Screen (RBD1Q), and several online questionnaires and unsupervised objective assessments of motor, cognitive and olfactory function. People with pRBD (n = 267; mean (SD) age 63 (7.6) years; 53% female) reported more α-synuclein-related features than controls (n = 2,624; mean (SD) age 64 (7.7) years; 75% female), especially orthostatic intolerance, neuropathic pain, falls, olfactory impairment and hand motor dysfunction. These results show that people with pRBD exhibit a range of symptoms and signs of α-synuclein-related conditions that can be measured using remote (online and postal) assessment tools. Remote monitoring in the community may aid early detection of progression to DLB, PD and MSA and facilitate enrolment into clinical trials.

Keywords: Dementia; Neurodegeneration; Parkinson’s disease; REM sleep behaviour disorder; Sleep disorders; TAS Test.

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Conflict of interest statement

Declarations. Ethical statement: All participants gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of participants were removed before data analysis. This study was approved by the Human Research Ethics committee of the University of Tasmania (Ethics approval numbers: 26435, 29005 and 18264). Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Adapted version of the Baylor Functional Assessment Scale
Fig. 2
Fig. 2
Boxplot of total reported motor symptoms between pRBD and control groups
Fig. 3
Fig. 3
Number of falls reported by those with pRBD and controls within the past three months
Fig. 4
Fig. 4
Boxplot of total COMPASS-31 (autonomic) scores between pRBD and control groups
Fig. 5
Fig. 5
Column chart of COMPASS-31 (autonomic) domain scores between pRBD and control groups
Fig. 6
Fig. 6
Column chart of pain category scores between pRBD and control groups
Fig. 7
Fig. 7
pRBD and control groups stratified by olfactory score range.
See this image and copyright information in PMC

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