Prevalence and Clinical Characteristics of Probable REM Behavior Disorder in Thai Parkinson's Disease Patients

Abstract

Background. Previous studies have shown that Parkinson's disease (PD) patients who have REM behavior disorder (PD with RBD) might be a PD subtype since they have different symptom clusters and disease trajectories from PD without RBD. Objective. To study the prevalence of PD with pRBD and to compare the clinical characteristics with PD without pRBD. The feasibility of clinical interview of items adopted from the Mayo Sleep Questionnaire was also to be determined. Methods. A total of 140 Parkinson's patients visiting neurological clinics during January to December 2016 were enrolled in this study. "Probable RBD (pRBD)" was defined as present when the patient answered "yes" to a question adapted from the first Mayo Sleep Questionnaire (MSQ). The demographic data, motor symptoms, and nonmotor symptoms were obtained. Results. The prevalence of pRBD among this study's PD patients was 48.5% (68 out of the total of 140). The median onset of RBD before PD diagnosis was 5 years (range: 0-11 years). By comparison of PD with pRBD and PD without pRBD, this study showed significant difference in the levodopa equivalent dose (742 mg/day versus 566 mg/day; p<0.01), prevalence of symptomatic orthostatic hypotension (35.3% versus 8.3%; p<0.01). The multivariable analysis found that pRBD is independently associated with orthostatic hypotension (OR = 5.02, p<0.01). Conclusion. The findings regarding prevalence and main clinical features of PD with pRBD in this study were similar to those of a previous study of PD with polysomnogram- (PSG-) proven RBD. This study hypothesized that interviewing by adopted MSQ may be a cost-effective tool for screening RBD. Further studies with direct comparison are needed.