In-vivo staging of pathology in REM sleep behaviour disorder: a multimodality imaging case-control study

Publication date: July 2018Source: The Lancet Neurology, Volume 17, Issue 7Author(s): Karoline Knudsen, Tatyana D Fedorova, Allan K Hansen, Michael Sommerauer, Marit Otto, Kristina B Svendsen, Adjmal Nahimi, Morten G Stokholm, Nicola Pavese, Christoph P Beier, David J Brooks, Per BorghammerSummaryBackgroundAccumulating evidence suggests that α-synuclein aggregates—a defining pathology of Parkinson's disease—display cell-to-cell transmission. α-synuclein aggregation is hypothesised to start in autonomic nerve terminals years before the appearance of motor symptoms, and subsequently spread via autonomic nerves to the spinal cord and brainstem. To assess this hypothesis, we investigated sympathetic, parasympathetic, noradrenergic, and dopaminergic innervation in patients with idiopathic rapid eye movement (REM) sleep behaviour disorder, a prodromal phenotype of Parkinson's disease.MethodsIn this prospective, case-control study, we recruited patients with idiopathic REM sleep behaviour disorder, confirmed by polysomnography, without clinical signs of parkinsonism or dementia, via advertisement and through sleep clinics in Denmark. We used 11C-donepezil PET and CT to assess cholinergic (parasympathetic) gut innervation, 123I-metaiodobenzylguanidine (MIBG) scintigraphy to measure cardiac sympathetic innervation, neuromelanin-sensitive MRI to measure integrity of pigmented neurons of the locus coeruleus, 11C-methylreboxetine (MeNER) PET to assess noradrenergic nerve terminals ...
Source: The Lancet Neurology - Category: Neurology Source Type: research