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Evolution of prodromal Parkinson's disease and dementia with Lewy bodies: a prospective study.
Fereshtehnejad, Seyed-Mohammad; Yao, Chun; Pelletier, Amelie; Montplaisir, Jacques Y; Gagnon, Jean-François; Postuma, Ronald B.
Afiliación
  • Fereshtehnejad SM; Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
  • Yao C; Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
  • Pelletier A; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
  • Montplaisir JY; Integrated Program in Neuroscience, McGill University, QC, Canada.
  • Gagnon JF; Research Institute of the McGill University Health Centre, Montreal General Hospital, Department of Neurology, Montreal, QC, Canada.
  • Postuma RB; Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada.
Brain ; 142(7): 2051-2067, 2019 07 01.
Article en En | MEDLINE | ID: mdl-31111143
Parkinson's disease has a long prodromal stage with various subclinical motor and non-motor manifestations; however, their evolution in the years before Parkinson's disease is diagnosed is unclear. We traced the evolution of early motor and non-motor manifestations of synucleinopathy from the stage of idiopathic rapid eye movement (REM) sleep behaviour disorder until defined neurodegenerative disease. During 2004-16, we recruited and then annually followed 154 polysomnography-proven patients with idiopathic REM sleep behaviour disorder, of whom 55 phenoconverted to defined parkinsonism or dementia. Longitudinal data on multiple prodromal features, including the Unified Parkinson's Disease Rating Scale parts I-III, quantitative motor tests, olfaction, colour vision, cognition, and autonomic functions were gathered annually (average = five follow-up visits, range: 2-12 years). The same measures were also assessed in 102 age- and sex-matched healthy control subjects. By looking backward from the time of dementia or parkinsonism diagnosis, we examined trajectories of each prodromal feature using mixed effect models. Based on analysis, olfactory loss was first to develop, with predicted onset >20 years before phenoconversion. This was followed by impaired colour vision, constipation, and erectile dysfunction, starting 10-16 years prior to phenoconversion. At 7-9 years before phenoconversion, slight urinary dysfunction and subtle cognitive decline could be detected. Among motor symptoms altered handwriting, turning in bed, walking, salivation, speech, and facial expression began to be disrupted starting 7-11 years prior to parkinsonism diagnosis, but remained mild until soon before phenoconversion. Motor examination abnormalities began 5-7 years before phenoconversion, with the alternate tap test having the longest interval (8 years before phenoconversion). Among cardinal motor phenotypes, bradykinesia appeared first, ∼5-6 years prior to phenoconversion, followed by rigidity (Year -3) and tremor (Year -2). With direct prospective evaluation of an idiopathic REM sleep behaviour disorder cohort during phenoconversion, we documented an evolution of prodromal manifestations similar to that predicted by pathological staging models, with predicted prodromal intervals as long as 20 years.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Enfermedad de Parkinson / Enfermedad por Cuerpos de Lewy / Trastorno de la Conducta del Sueño REM / Síntomas Prodrómicos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Brain Año: 2019 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Enfermedad de Parkinson / Enfermedad por Cuerpos de Lewy / Trastorno de la Conducta del Sueño REM / Síntomas Prodrómicos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Brain Año: 2019 Tipo del documento: Article País de afiliación: Canadá