Journal Article

0725 TIME COURSE FOR PHENOCONVERSION TO A DEFINED NEURODEGENERATIVE DISEASE IN WOMEN WITH IDIOPATHIC REM SLEEP BEHAVIOR DISORDER WITH AND WITHOUT ANTIDEPRESSANT USE

Commers, N, St. Louis, EK, Boeve, BF, McCord, SV, Lipford, MC, Tabatabai, GM, Boeve, AR, Junna, MR, Sandness, DJ, Timm, PC, McCarter, SJ, Maja, T, Silber, MH

2017

Overview

Abstract Introduction: Idiopathic REM sleep behavior disorder (iRBD) is highly associated with neurodegenerative diseases, especially the synucleinopathies, in adults over age 50 years. Several previous studies have examined the strong association between RBD and synucleinopathies in predominantly male patient populations, but relatively little is known about the clinical course of RBD in women, and the longitudinal influence of antidepressant use on development of a defined neurodegenenerative disease. We aimed to analyze the rate of phenoconversion from iRBD to a defined neurodegenerative disorder, including Parkinson disease, mild cognitive impairment, dementia with Lewy bodies, and multiple system atrophy in women with and without antidepressant use. Methods: We retrospectively reviewed 77 women with iRBD seen at Mayo Clinic between 1990 and 2016. The Kaplan-Meier method was used to estimate the time of disease-free survival between iRBD symptom onset and phenoconversion to a defined neurodegenerative disease, and to assess associated clinical factors for disease progression. Results: Phenoconversion to a defined neurodegenerative disease was 22.5% at 5 years, 43.2% at 10 years, 66.6% at 15 years, and 91.5% at 21.7 years. Median follow-up duration after symptom onset was 11.7 years (95%ile range 8–17.7 years), median age of RBD onset was 54.5 years, and median age of neurodegenerative disease development was 64 years. 23% of women had a non-REM overlap parasomnia, and 70.5% were taking antidepressants. Antidepressant users had a median disease-free survival of 16.5 years, compared to 8.9 years for antidepressant non-users (p=0.06). Conclusion: The risk of phenoconversion to a defined neurodegenerative disorder in women with iRBD is comparably high to previous male predominant cohorts over longitudinal followup from RBD symptom onset, yet appears to be slower than in some prior studies, possibly associated with frequent antidepressant use in our cohort. Further comparative analysis of men with iRBD including both antidepressant users and non-users will be necessary to clarify the impact of gender and antidepressant use on disease-free survival in iRBD. Support (If Any): Mayo Clinic CCaTS.

• Publisher: Oxford University Press
• Subject: Antidepressants / Behavior disorders / Disease / Neurodegeneration / Parkinson's disease / REM sleep / Sleep disorders / Womens health