Alterations in time estimation in multiple system atrophy

Precise spatiotemporal performance is required by many common tasks and represents a basic aspect of cognition. Time estimation in the second-to-minutes range – known as interval timing – involves the interaction of the basal ganglia and the prefrontal cortex via dopaminergic–glutamatergic pathways. Neurodegenerative disorders such as Parkinson's disease (PD) and multiple system atrophy (MSA) are characterized by basal ganglia dysfunction due to dopamine loss. Although interval timing in PD has been studied, little is known about temporal processing in MSA. In the present work, control, PD and MSA subjects (n = 8 for each group) were tested for interval timing in short (15 s) duration stimuli. MSA differed significantly from controls and PD patients in terms of decreased accuracy in the timing task. Differences between PD and MSA patients (as well as between MSA and controls) were lost after levodopa treatment. We show that time estimation for time bins between 5 and 20 s is affected in subjects with MSA, who had a significant tendency to underestimate time intervals as compared to controls or PD patients. Recordings of cognitive performance related to timing could be considered useful measurements of the progression of movement disorder-related pathologiesFil: Hogl, Birgit. Universidad de Innsbruck; AustriaFil: Agostino, Patricia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología. Laboratorio de Cronobiología; ArgentinaFil: Peralta, Maria Cecilia. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Gershanik, Oscar Samuel. Fundación Favaloro; ArgentinaFil: Golombek, Diego Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes. Departamento de Ciencia y Tecnología. Laboratorio de Cronobiología; Argentin

A single-question screen for rapid eye movement sleep behavior disorder:a multicenter validation study

BACKGROUND: Idiopathic REM sleep behavior disorder (RBD) is a parasomnia that is an important risk factor for PD and Lewy body dementia. Its prevalence is unknown. One barrier to determining prevalence is that current screening tools are too long for large-scale epidemiologic surveys. Therefore, we designed the REM Sleep Behavior Disorder Single-Question Screen (RBD1Q), a screening question for dream enactment with a simple yes/no response. METHODS: Four hundred and eighty-four sleep-clinic– based participants (242 idiopathic RBD patients and 242 controls) completed the screen during a multicenter case-control study. All participants underwent a polysomnogram to define gold-standard diagnosis according to standard criteria. RESULTS: We found a sensitivity of 93.8% and a specificity of 87.2%. Sensitivity and specificity were similar in healthy volunteers, compared to controls or patients, with other sleep diagnoses. CONCLUSIONS: A single-question screen for RBD may reliably detect disease, with psychometric properties favorably comparable to those reported for longer questionnaires

Family history of idiopathic REM behavior disorder: a multicenter case-control study

OBJECTIVE: To compare the frequency of proxy-reported REM sleep behavior disorder (RBD) among relatives of patients with polysomnogram-diagnosed idiopathic RBD (iRBD) in comparison to controls using a large multicenter clinic-based cohort. METHODS: A total of 316 patients with polysomnography-confirmed iRBD were recruited from 12 RBD study group centers, along with 316 controls matched on sex and age group. All subjects completed a self-administered questionnaire that collected proxy-reported information on family history of tremor, gait trouble, balance trouble, Parkinson disease, memory loss, and Alzheimer disease. The questionnaire also included a single question that asked about possible symptoms of RBD among first-degree relatives (siblings, parents, and children). RESULTS: A positive family history of dream enactment was reported in 13.8% of iRBD cases compared to 4.8% of controls (odds ratio [OR] = 3.9, 95% confidence interval [CI] 2.0-7.7). ORs were increased for both siblings (OR = 6.1, 95% CI 2.1-18.1) and parents (OR = 3.2, 95% CI 1.4-7.8). We found no significant difference in sex, current age (65.3 10.2 vs 66.9 10.2 years), or age at self-reported RBD onset (55.2 11.7 vs 56.6 15.1 years) in possible familial vs sporadic iRBD. No differences were found in family history of tremor, walking and balance troubles, Parkinson disease, memory loss, or Alzheimer disease. CONCLUSION: We found increased odds of proxy-reported family history of presumed RBD among individuals with confirmed iRBD. This suggests the possibility of a genetic contribution to RBD

A single-question screen for rapid eye movement sleep behavior disorder: a multicenter validation study

BACKGROUND: Idiopathic rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia that is an important risk factor for Parkinson's disease (PD) and Lewy body dementia. Its prevalence is unknown. One barrier to determining prevalence is that current screening tools are too long for large-scale epidemiologic surveys. Therefore, we designed the REM Sleep Behavior Disorder Single-Question Screen (RBD1Q), a screening question for dream enactment with a simple yes/no response. METHODS: Four hundred and eighty-four sleep-clinic-based participants (242 idiopathic RBD patients and 242 controls) completed the screen during a multicenter case-control study. All participants underwent a polysomnogram to define gold-standard diagnosis according to standard criteria. RESULTS: We found a sensitivity of 93.8% and a specificity of 87.2%. Sensitivity and specificity were similar in healthy volunteers, compared to controls or patients with other sleep diagnoses. CONCLUSIONS: A single-question screen for RBD may reliably detect disease, with psychometric properties favorably comparable to those reported for longer questionnaires

Comorbidity and medication in REM sleep behavior disorder: A multicenter case-control study

none29Objective: This controlled study investigated associations between comorbidity and medication in patients with polysomnographically confirmed idiopathic REM sleep behavior disorder (iRBD), using a large multicenter clinic-based cohort. Methods: Data of a self-administered questionnaire on comorbidity and medication use of 318 patients with iRBD and 318 matched controls were analyzed. Comparisons between cases and controls were made using logistic regression analysis. Results: Patients with iRBD were more likely to report depression (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.3-2.9) and concomitant antidepressant use (OR 2.2, 95% CI 1.4-3.6). Subanalysis of antidepressant agents revealed that the increased use of antidepressants in iRBD was due to selective serotoninergic reuptake inhibitors (OR 3.6, 95% CI 1.8-7.0) and not due to other antidepressant classes. Patients with iRBD reported more lifetime antidepressant use than comorbid depression (antidepressant use: OR 1.9, 95%CI 1.1-3.3; depression: OR 1.6, 95%CI 1.0-2.5). Patients with iRBD reported more ischemic heart disease (OR 1.9, 95% CI 1.1-3.1). This association did not change substantially when adjusting for cardiovascular risk factors (OR 2.3, 95% CI 1.3-3.9). The use of inhaled glucocorticoids was higher in patients with iRBD compared to controls (OR 5.3, 95% CI 1.8-15.8), likely reflecting the higher smoking rate in iRBD (smoking: OR 15.3, 95%CI 2.0-118.8; nonsmoking: OR 2.4, 95%CI 0.4-13.2) and consequent pulmonary disease. Conclusions: This large study confirms the association between comorbid depression and antidepressant use in iRBD. In addition, there was an unexpected association of iRBD with ischemic heart disease that was not explained by cardiovascular risk factors. © 2014 American Academy of Neurology.noneFrauscher B.; Jennum P.; Ju Y.-E.S.; Postuma R.B.; Arnulf I.; De Cock V.C.; Dauvilliers Y.; Fantini M.L.; Ferini-Strambi L.; Gabelia D.; Iranzo A.; Leu-Semenescu S.; Mitterling T.; Miyamoto M.; Miyamoto T.; Montplaisir J.Y.; Oertel W.; Pelletier A.; Prunetti P.; Puligheddu M.; Santamaria J.; Sonka K.; Unger M.; Wolfson C.; Zucconi M.; Terzaghi M.; Hogl B.; Mayer G.; Manni R.Frauscher, B.; Jennum, P.; Ju, Y. -E. S.; Postuma, R. B.; Arnulf, I.; De Cock, V. C.; Dauvilliers, Y.; Fantini, M. L.; Ferini-Strambi, L.; Gabelia, D.; Iranzo, A.; Leu-Semenescu, S.; Mitterling, T.; Miyamoto, M.; Miyamoto, T.; Montplaisir, J. Y.; Oertel, W.; Pelletier, A.; Prunetti, P.; Puligheddu, M.; Santamaria, J.; Sonka, K.; Unger, M.; Wolfson, C.; Zucconi, M.; Terzaghi, M.; Hogl, B.; Mayer, G.; Manni, R

Comorbidity and medication in REM sleep behavior disorder: A multicenter case-control study

Objective: This controlled study investigated associations between comorbidity and medication in patients with polysomnographically confirmed idiopathic REM sleep behavior disorder (iRBD), using a large multicenter clinic-based cohort. Methods: Data of a self-administered questionnaire on comorbidity and medication use of 318 patients with iRBD and 318 matched controls were analyzed. Comparisons between cases and controls were made using logistic regression analysis. Results: Patients with iRBD were more likely to report depression (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.3-2.9) and concomitant antidepressant use (OR 2.2, 95% CI 1.4-3.6). Subanalysis of antidepressant agents revealed that the increased use of antidepressants in iRBD was due to selective serotoninergic reuptake inhibitors (OR 3.6, 95% CI 1.8-7.0) and not due to other antidepressant classes. Patients with iRBD reported more lifetime antidepressant use than comorbid depression (antidepressant use: OR 1.9, 95%CI 1.1-3.3; depression: OR 1.6, 95%CI 1.0-2.5). Patients with iRBD reported more ischemic heart disease (OR 1.9, 95% CI 1.1-3.1). This association did not change substantially when adjusting for cardiovascular risk factors (OR 2.3, 95% CI 1.3-3.9). The use of inhaled glucocorticoids was higher in patients with iRBD compared to controls (OR 5.3, 95% CI 1.8-15.8), likely reflecting the higher smoking rate in iRBD (smoking: OR 15.3, 95%CI 2.0-118.8; nonsmoking: OR 2.4, 95%CI 0.4-13.2) and consequent pulmonary disease. Conclusions: This large study confirms the association between comorbid depression and antidepressant use in iRBD. In addition, there was an unexpected association of iRBD with ischemic heart disease that was not explained by cardiovascular risk factors

Neural network analysis of sleep stages enables efficient diagnosis of narcolepsy

Analysis of sleep for the diagnosis of sleep disorders such as Type-1 Narcolepsy (T1N) currently requires visual inspection of polysomnography records by trained scoring technicians. Here, we used neural networks in approximately 3,000 normal and abnormal sleep recordings to automate sleep stage scoring, producing a hypnodensity graph\u2014a probability distribution conveying more information than classical hypnograms. Accuracy of sleep stage scoring was validated in 70 subjects assessed by six scorers. The best model performed better than any individual scorer (87% versus consensus). It also reliably scores sleep down to 5 s instead of 30 s scoring epochs. A T1N marker based on unusual sleep stage overlaps achieved a specificity of 96% and a sensitivity of 91%, validated in independent datasets. Addition of HLA-DQB1*06:02 typing increased specificity to 99%. Our method can reduce time spent in sleep clinics and automates T1N diagnosis. It also opens the possibility of diagnosing T1N using home sleep studies