Screening for prodromal Parkinson's disease in the general community: a sleep-based approach |
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| Institution: | 1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada;2. Centre d''Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada;3. Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany;4. Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada;5. Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada;1. Baptist Health Neurology, 789 Eastern Bypass Suite 16, Richmond, KY 40475, USA;2. Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA;3. Sleep Research Institute, Alberto Alcocer 19, 28036 Madrid, Spain;4. UCLA Sleep Disorders Center, Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, Los Angeles, CA 90095, USA;5. Cleveland Sleep Research Center, 17900 Jefferson Park Road, Suite 102, Middleburg Heights, OH 44130, USA;6. University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8508, USA;7. University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1010, Houston, TX 77030, USA;8. Summit Analytical, LLC, 2422 Stout Street, Denver, CO 80205, USA;9. XenoPort, Inc., 3410 Central Expressway, Santa Clara, CA 95051, USA;1. Institute of Mental Health/National Clinical Research Center for Mental Disorder/Peking University Sixth Hospital, Peking University, Beijing, China;2. Institute of Mental Health, Hebei Medical University, Shijiazhuang, China;3. Department of Psychiatry, First Hospital of Hebei Medical University, Shijiazhuang, China;1. Department of Medical Sciences, Respiratory, Allergy, and Sleep Research, Uppsala University, Uppsala, Sweden;2. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;3. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden;4. Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden;1. Sleep and Circadian Research Laboratory, Departments of Psychiatry and Neurology, University of Michigan Medical School, Ann Arbor, MI 48109, USA;2. Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI 48202, USA |
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| Abstract: | Objective/BackgroundNeuroprotective therapy for Parkinson's disease (PD) is most likely to be effective if provided in its prodromal stages. However, identifying prodromal PD is difficult because PD is relatively uncommon, and most markers are nonspecific. Rapid eye movement (REM) sleep behavior disorder (RBD) is by far the strongest clinical marker of prodromal PD, but most patients do not seek out medical attention. Developing an efficient way of diagnosing RBD from the general community may be the most practical method to detect prodromal PD.MethodsWe developed a screening strategy that began with a newspaper advertisement containing a single-question screen for RBD. All screen-positive subjects underwent an interview based on the Innsbruck RBD inventory aimed to optimize the positive predictive value. Those who passed both screens underwent confirmatory polysomnography. The proportion of screened RBD patients who met the International Parkinson and Movement Disorder Society (MDS) criteria for prodromal PD was assessed. A broad array of clinical markers of neurodegeneration was compared between newspaper-screened RBD patients and 130 RBD patients clinically referred to the sleep center.ResultsOf 111 RBD-screen-positive participants, 40 (36%) passed the secondary screen, and 29 underwent full polysomnography. Of these 29 patients, 19 were ultimately proven to have RBD (PPV = 66%), 12 (63%) of whom met the criteria for prodromal PD. Compared to patients referred to the sleep center, newspaper-screened patients had similar age, sex, olfaction, autonomic function, and color vision. However, motor and cognitive assessments were slightly better in newspaper-screened patients.ConclusionsA multistep screening approach using RBD screening questionnaires and telephone follow-up can efficiently identify prodromal PD in the general community. |
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