Dopaminergic damage pattern predicts phenoconversion time in isolated rapid eye movement sleep behavior disorder.

Feng, Shuang; Ge, Jingjie; Zhao, Shujun; Xu, Qian; Lin, Huamei; Li, Xiuming; Wu, Jianjun; Guan, Yihui; Zhang, Tianhao; Zhao, Shilun; Zuo, Chuantao; Shan, Baoci; Wu, Ping; Nie, Binbin; Yu, Huan; Shi, Kuangyu (2023). Dopaminergic damage pattern predicts phenoconversion time in isolated rapid eye movement sleep behavior disorder. European journal of nuclear medicine and molecular imaging, 51(1), pp. 159-167. Springer 10.1007/s00259-023-06402-1

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PURPOSE

The exact phenoconversion time from isolated rapid eye movement (REM) sleep behavior disorder (iRBD) to synucleinopathies remains unpredictable. This study investigated whole-brain dopaminergic damage pattern (DDP) with disease progression and predicted phenoconversion time in individual patients.

METHODS

Age-matched 33 iRBD patients and 20 healthy controls with 11C-CFT-PET scans were enrolled. The patients were followed up 2-10 (6.7 ± 2.0) years. The phenoconversion year was defined as the base year, and every 2 years before conversion was defined as a stage. Support vector machine with leave-one-out cross-validation strategy was used to perform prediction.

RESULTS

Dopaminergic degeneration of iRBD was found to occur about 6 years before conversion and then abnormal brain regions gradually expanded. Using DDP, area under curve (AUC) was 0.879 (90% sensitivity and 88.3% specificity) for predicting conversion in 0-2 years, 0.807 (72.7% sensitivity and 83.3% specificity) in 2-4 years, 0.940 (100% sensitivity and 84.6% specificity) in 4-6 years, and 0.879 (100% sensitivity and 80.7% specificity) over 6 years. In individual patients, predicted stages correlated with whole-brain dopaminergic levels (r =  - 0.740, p < 0.001).

CONCLUSION

Our findings suggest that DDP could accurately predict phenoconversion time of individual iRBD patients, which may help to screen patients for early intervention.

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