How Do Prodromal Parkinson Disease and Dementia with Lewy Bodies Progress?

A prospective study of patients with REM sleep behavior disorder at baseline yields much information about the timing of prodromal symptoms before diagnosis.

Parkinson disease (PD) has a prolonged prodromal stage during which many signs and symptoms occur before diagnosis. To trace the evolution of the early manifestations, investigators used the onset of idiopathic rapid eye movement (REM) sleep behavior disorder as the baseline and the diagnosis of PD as the endpoint.

Of 154 polysomnography-proven patients with idiopathic REM sleep behavior disorder, 138 remained at the end of follow-up; 55 converted to parkinsonism or to dementia. Patients had a mean of five visits during 2 to 12 years of follow-up. There were 102 age- and gender-matched controls. In mixed-effect models, the following signs and symptoms occurred the specified time before phenoconversion:

Olfactory loss: more than 20 years
Color …

Reviewing Author

Michael S. Okun, MD

Disclosures

Consultant/Advisory BoardParkinson’s Foundation; Tourette Association of America

Speaker’s BureauMedscape/WebMD CME, Movement Disorders Society CME, American Academy of Neurology CME

RoyaltiesBooks4Patients; Demos; Cambridge; Taylor and Francis; Robert Rose; Public Affairs

Grant/Research SupportNational Institutes of Health; Parkinson’s Foundation; Tourette Association of America; University of Florida Foundation

Editorial BoardsTremor and Other Hyperkinetic Movements; JAMA Neurology

Leadership Positions in Professional SocietiesParkinson’s Foundation (Medical Advisor)