Predicting Post-Mortem α-Synuclein Pathology by the Combined Presence of Probable REM sleep behavior disorder and Hyposmia.

Autor: Tremblay C; Departement of neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA., Adler CH; Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA., Shill HA; Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA., Driver-Dunckley E; Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA., Mehta S; Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA., Choudhury P; Departement of neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA., Belden C; Departement of neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA., Shprecher DR; Departement of neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA., Lee-Iannotti JK; Department of Neurology, Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA., Atri A; Departement of neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA., Serrano GE; Departement of neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA., Beach TG; Departement of neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA.
Jazyk: angličtina
Zdroj: Movement disorders clinical practice [Mov Disord Clin Pract] 2024 Nov 05. Date of Electronic Publication: 2024 Nov 05.
DOI: 10.1002/mdc3.14244
Abstrakt: Background: Idiopathic rapid eye movement sleep behavior disorder (RBD) is a strong known predictor of a final clinicopathological diagnosis of a Lewy type α-synucleinopathy (LTS). Olfactory dysfunction is an early symptom of synucleinopathies and has been repeatedly associated with the presence of post-mortem LTS.
Objective: To assess the combined value of a clinician diagnosis of probable RBD (PRBD) and hyposmia in predicting the post-mortem presence of LTS in a broader, less-selected, volunteer elderly population.
Methods: We studied 652 autopsied subjects from the Arizona Study of Aging and Neurodegenerative Disorders, which were evaluated for PRBD, had completed annual movement and cognitive assessments, and had at least one the University of Pennsylvania Smell Identification Test (UPSIT) olfactory test.
Results: Histological evidence of LTS was significantly more frequent in those who had PRBD (112/152: 73.7%) than those without (177/494: 35.8%) (P < 0.001). LTS was more frequent in cases with PRBD and a low UPSIT score (90.8%) compared to cases with PRBD only (73.7%) (P < 0.001) or cases with a low UPSIT score only (69.4%) (P < 0.001). Sensitivity of PRBD diagnosis for predicting LTS was 38.8% and specificity 88.8%, whereas sensitivity of a low UPSIT score was 74.4% and specificity 73.4% (Youden's index = 0.276 for PRBD, 0.478 for UPSIT). When combining both measures, sensitivity was 34.3% and specificity increased to 97.2%.
Conclusion: PRBD, diagnosed without sleep study confirmation, combined with a reduced olfactory performance is highly specific for predicting post-mortem presence of LTS. The combination of both measures may provide a cost-effective means of predicting LTS in a broader community.
(© 2024 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)
Databáze: MEDLINE
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