MRI and pathology of REM sleep behavior disorder in dementia with Lewy bodies

作者：Murray Melissa E; Ferman Tanis J; Boeve Bradley F; Przybelski Scott A; Lesnick Timothy G; Liesinger Amanda M; Senjem Matthew L; Gunter Jeffrey L; Preboske Gregory M; Lowe Val J; Vemuri Prashanthi; Dugger Brittany N; Knopman David S; Smith Glenn E; Parisi Joseph E; Silber Michael H; Graff Radford Neill R; Petersen Ronald C; Jack Clifford R Jr; Dickson Dennis W; Kantarci Kejal^*

来源：Neurology, 2013, 81(19): 1681-1689.

Objective: To determine structural MRI and digital microscopic characteristics of REM sleep behavior disorder in individuals with low-, intermediate-, and high-likelihood dementia with Lewy bodies (DLB) at autopsy.
Methods: Patients with autopsy-confirmed low-, intermediate-, and high-likelihood DLB, according to the probability statement recommended by the third report of the DLB Consortium, and antemortem MRI, were identified (n = 75). The clinical history was assessed for presence (n = 35) and absence (n = 40) of probable REM sleep behavior disorder (pRBD), and patients' antemortem MRIs were compared using voxel-based morphometry. Pathologic burdens of phospho-tau, beta-amyloid, and a-synuclein were measured in regions associated with early neuropathologic involvement, the hippocampus and amygdala.
Results: pRBD was present in 21 patients (60%) with high-likelihood, 12 patients (34%) with intermediate-likelihood, and 2 patients (6%) with low-likelihood DLB. Patients with pRBD were younger, more likely to be male (p <= 0.001), and had a more frequent neuropathologic diagnosis of diffuse (neocortical) Lewy body disease. In the hippocampus and amygdala, phospho-tau and b-amyloid burden were lower in patients with pRBD compared with those without pRBD (p < 0.01). a-Synuclein burden did not differ in the hippocampus, but trended in the amygdala. Patients without pRBD had greater atrophy of temporoparietal cortices, hippocampus, and amygdala (p < 0.001) than those with pRBD; atrophy of the hippocampus (p = 0.005) and amygdala (p = 0.02) were associated with greater phospho-tau burdens in these regions.
Conclusion: Presence of pRBD is associated with a higher likelihood of DLB and less severe Alzheimer-related pathology in the medial temporal lobes, whereas absence of pRBD is characterized by Alzheimer-like atrophy patterns on MRI and increased phospho-tau burden.

• 出版日期2013-11-5