Parkinsonism & related disorders最新文献

{"title":"Recruitment strategies for the racial disparities in Parkinson's disease study: Partnering with patients from the Black community","authors":"Jacqueline Vanegas ,&nbsp;Rebecca Weimer ,&nbsp;Nathan Krinickas ,&nbsp;Deborah A. Hall ,&nbsp;Lisa M. Shulman","doi":"10.1016/j.parkreldis.2025.108173","DOIUrl":"10.1016/j.parkreldis.2025.108173","url":null,"abstract":"<div><h3>Introduction</h3><div>Most Parkinson's Disease (PD) studies fail to recruit diverse racial and ethnic groups in their study sample. PD research mainly contains data from White PD patients and fails to reflect the experiences of Black PD patients and other individuals from underrepresented groups/minorities. This paper aims to describe effective recruitment strategies in the Black PD population.</div></div><div><h3>Methods</h3><div>The NIH-funded Racial Disparities in PD project is an ongoing multi-center study comparing phenotype, management, and genotype between Black and White PD patients. A REDCap survey was distributed to all seven study sites to be completed by coordinators from each site. The survey included questions about recruitment strategies, effectiveness of strategies, recruitment barriers, communication strategies, and approaches to follow-up.</div></div><div><h3>Results</h3><div>The most common recruitment strategies (in order of effectiveness) are monitoring patient schedules through Epic or other software, collaborating with clinical colleagues (referrals), and flyers/posters in public spaces. Study coordinators use in-person or telephone calls as a form of recruitment communication. The major barriers to recruitment are financial or time constraints.</div></div><div><h3>Discussion</h3><div>The most effective recruitment strategies are monitoring patient schedules and collaborating with the site investigator and other clinicians. Coordinators find that approaching patients in the clinic with study flyers helps sustain recruitment. Clinician-patient relationships are also important to increase recruitment due to preexisting relationships. Fostering trust with participants greatly impacts successful recruitment. Finding solutions to participant barriers has been successful in maintaining recruitment numbers.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108173"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing a workflow algorithm for adaptive DBS programming in Parkinson's disease","authors":"Saar Anis ,&nbsp;Patricia A. Clark ,&nbsp;Shannon Shaffer ,&nbsp;Emma Hartwig ,&nbsp;Laurie Moser ,&nbsp;Jenera Scott ,&nbsp;Erica Hennigs ,&nbsp;Ellen Walter ,&nbsp;Tatiana Lopez Gonzalez ,&nbsp;David Escobar ,&nbsp;Benjamin L. Walter","doi":"10.1016/j.parkreldis.2026.108199","DOIUrl":"10.1016/j.parkreldis.2026.108199","url":null,"abstract":"<div><h3>Background</h3><div>Adaptive deep brain stimulation (aDBS) utilizing BrainSense™ technology by Medtronic Percept™ stimulator, is a recent advancement that dynamically adjusts stimulation in real-time based on the power of frequency-specific neural signals. Although clinical trials have shown the feasibility of aDBS, real-world implementation remains underreported. We describe the development and implementation of a structured workflow for aDBS activation and programming at a tertiary movement disorders center.</div></div><div><h3>Methods</h3><div>This quality improvement project included the first 50 patients with Parkinson's disease who initiated aDBS between March and September 2025 at the Cleveland Clinic. Data were abstracted from clinical records and programming logs as part of routine process evaluation. Findings were discussed with programming clinicians to identify variability and troubleshooting steps, leading to iterative refinement and consensus on a standardized workflow for aDBS activation and programming.</div></div><div><h3>Results</h3><div>The primary reasons for converting to aDBS were dyskinesias, motor fluctuations, and limited therapeutic windows on continuous DBS. Programming emphasized individualized threshold strategies (single vs. dual), ensuring each was fully optimized before transition. Successful implementation depended on three key factors: clearly defined therapeutic goals, validation of the frequency of interest, and confirmation of appropriate system adaptation through Timeline plots review and real-time signal streaming. A structured flowchart summarizing the programming and troubleshooting sequence is provided.</div></div><div><h3>Conclusions</h3><div>Implementation of aDBS in routine clinical practice is feasible with a structured, team-based workflow. Standardizing programming steps and incorporating iterative feedback support safety, consistency, and broader adoption across centers.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108199"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attenuated melanopsin-mediated activity in focal dystonia","authors":"Oliver L. Steiner ,&nbsp;Claudia Angela ,&nbsp;Sarah Melchert ,&nbsp;Désirée Mohrbach ,&nbsp;Victor Mafael ,&nbsp;Bastian Brämswig ,&nbsp;Fabian Klostermann","doi":"10.1016/j.parkreldis.2026.108207","DOIUrl":"10.1016/j.parkreldis.2026.108207","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Focal dystonia (FD) is an extrapyramidal movement disorder, but various disease aspects challenge the view of a condition only involving neuronal motor systems. Here, we were interested in potential changes of retinal functions, accessible by chromatic pupillometry.</div></div><div><h3>Methods</h3><div>Quantitative chromatic pupillometry was performed in 26 persons with FD and 20 age-/sex-matched healthy controls. Upon dark adaptation, standardized red (632 nm) and blue (462 nm) light pulses (100 cd/m²) were delivered to the pupils. Constrictions were recorded one and 6 s after the stimuli. The 1s-constriction is rod/cone-mediated, whereas the post illumination pupil response (PIPR) reflects the melanopsin-related activity of intrinsic photosensitive retinal ganglion cells (ipRGC) to blue light only.</div></div><div><h3>Results</h3><div>Compared with controls, dystonia patients did not differ in baseline pupil diameter prior to red-light stimulation. Peak transient constriction, indexed by the minimal pupil size during the 1-s light pulse, was similar between groups for both red and blue light. The blue light-specific PIPR was significantly attenuated in patients.</div></div><div><h3>Discussion</h3><div>The findings point to altered retinal light sensitivity in FD with a hypofunctional ipRGC system. This suggests an impact of the disease beyond movement-related neuronal systems.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108207"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of type 2 diabetes on the development of dementia and death in Parkinson's disease","authors":"Seung Hyun Lee ,&nbsp;Jooyoung Lee ,&nbsp;Mina Kim ,&nbsp;Da-woon Kim ,&nbsp;Yun Su Hwang ,&nbsp;Kye Won Park ,&nbsp;Sungyang Jo ,&nbsp;Ji-Hoon Kang ,&nbsp;Richard J. Cook ,&nbsp;Sun Ju Chung","doi":"10.1016/j.parkreldis.2026.108187","DOIUrl":"10.1016/j.parkreldis.2026.108187","url":null,"abstract":"<div><h3>Background</h3><div>Increasing evidence suggests that type 2 diabetes (T2DM) can influence the progression of Parkinson's disease (PD). However, it remains unclear whether T2DM increases the risk of progression to dementia and death in PD.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the impact of T2DM on the risk of developing dementia and death following a diagnosis of PD.</div></div><div><h3>Methods</h3><div>We examined 158,962 individuals (aged 60 years or older) without PD or dementia using the Korean National Health Insurance Service (NHIS)-senior cohort database. A multi-state model was used to estimate the hazard ratios characterizing the effect of T2DM on the risk of PD, dementia, and death while adjusting for potential confounding factors. Results were analyzed according to age and sex.</div></div><div><h3>Results</h3><div>T2DM increased the risk of development of PD (adjusted hazard ratio [aHR]: 1.26, 95 % confidence interval [CI]: 1.11–1.42), dementia (aHR: 1.31, 95 % CI: 1.24–1.39), or death (aHR: 1.58, 95 % CI: 1.52–1.65) compared to those without T2DM. However, after PD diagnosis, T2DM was not associated with progression to dementia (aHR: 1.09, 95 % CI: 0.96–1.48) and death (aHR: 1.10, 95 % CI: 0.85–1.42) although subgroup analysis showed an elevated risk for the progression from PD to dementia (aHR: 1.41 95 % CI: 1.06–1.89) in individuals under 70 years of age.</div></div><div><h3>Conclusions</h3><div>T2DM increases the risk of PD, dementia, and death in the elderly population. However, its effect on the progression to dementia and death may occur independently of the onset of PD, despite significant age-related heterogeneity.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108187"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating central autonomic network dysfunction in Parkinson's disease: Methodological considerations and future directions","authors":"Leqi Gao,&nbsp;Hongwei An","doi":"10.1016/j.parkreldis.2026.108223","DOIUrl":"10.1016/j.parkreldis.2026.108223","url":null,"abstract":"","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108223"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two novel iron metabolism-related genes identified as diagnostic indicators in substantia nigra of patients with Parkinson's disease","authors":"Kaidong Chen ,&nbsp;Wanyu Hao ,&nbsp;Yi Ji ,&nbsp;Binfen Xu ,&nbsp;Liujia Lu ,&nbsp;Ruixuan Zhang ,&nbsp;Yao Lu ,&nbsp;Kefei Chen ,&nbsp;Feng Wang ,&nbsp;Xiaoyun Hu ,&nbsp;Li Zhang ,&nbsp;Xiangming Fang","doi":"10.1016/j.parkreldis.2026.108218","DOIUrl":"10.1016/j.parkreldis.2026.108218","url":null,"abstract":"<div><h3>Introduction</h3><div>Parkinson's disease (PD) is a common neurodegenerative disease. Abnormal iron metabolism is closely associated with PD risk. This study aimed to identify key iron metabolism-related genes (IMRGs) in the substantia nigra (SN) that affect PD progression.</div></div><div><h3>Methods</h3><div>Differences in iron metabolism scores between PD and control groups were compared. After differential expression analysis and weighted gene co-expression network Analysis, differentially expressed-IMRGs (DE-IMRGs) were identified from IMRGs, differentially expressed genes (DEGs), and module genes. Key genes were obtained from a protein-protein interaction network, machine learning, and receiver operating characteristic curves. Correlations between key genes and nomograms, Gene Set Enrichment Analysis, immune infiltration, potential drug prediction, and consensus clustering were explored. <em>In vitro</em> experiments were conducted to verify the identified key genes.</div></div><div><h3>Results</h3><div>Iron metabolism scores differed significantly between the PD and control groups. In total, 1128 DEGs and 597 module genes were obtained, intersected with 522 IMRGs, and 23 DE-IMRGs were acquired. Eight candidate key genes were identified, followed by the identification of two key genes, Fatty Acid 2-Hydroxylase (FA2H)‌ and ‌Cytochrome P450 Family 1 Subfamily A Member 2 (CYP1A2). The nomograms of the two key genes possessed high precision for predicting PD, and 102 and 15 drugs involving CYP1A2 and FA2H were searched, respectively. The proportions of the five immune cells showed obvious differences between the PD and control groups, and CYP1A2 and FA2H were significantly correlated with many immune cells. <em>In vitro</em> experiments revealed that FA2H reduced 6-OHDA-stimulated SH-SY5Y cell viability and enhanced apoptosis.</div></div><div><h3>Conclusion</h3><div>Iron metabolism in the SN is important in the progression of PD, and two IMRGs, CYP1A2 and FA2H, are involved in the pathogenesis of PD.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108218"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motor fluctuations in Parkinson's disease leave a distinct immune fingerprint in blood","authors":"Rocío Pérez-González ,&nbsp;Anna Vázquez-Oliver ,&nbsp;Elisa Rivas-Asensio ,&nbsp;Antonia Campolongo ,&nbsp;Gràcia Pons-Pons ,&nbsp;Saül Martínez-Horta ,&nbsp;Javier Pagonabarraga ,&nbsp;Berta Pascual-Sedano ,&nbsp;Jaime Kulisevsky","doi":"10.1016/j.parkreldis.2026.108208","DOIUrl":"10.1016/j.parkreldis.2026.108208","url":null,"abstract":"<div><h3>Introduction</h3><div>Neuroinflammation is increasingly implicated in PD. Peripheral immune alterations are well described, but their link to motor complications, particularly ON-OFF fluctuations, remains unstudied. We hypothesized that such fluctuations act as intermittent stressors, transiently modulating peripheral immunity.</div></div><div><h3>Objective</h3><div>To investigate the immunological impact of motor fluctuations in PD by analyzing blood transcriptomic signatures during motor state transitions.</div></div><div><h3>Methods</h3><div>Whole-blood transcriptomic profiling with Clariom D arrays was performed in fluctuating PD (PD-Fluc) patients during OFF and ON dopaminergic states to identify relevant genes and pathways. Four natural killer (NK) cell–related genes were validated by qPCR in an expanded cohort: PD-Fluc, non-fluctuating PD (PD-NonFluc), and controls. Motor status (MDS-UPDRS III) was evaluated before each blood draw.</div></div><div><h3>Results</h3><div>Transcriptomic analysis identified 737 transcripts differentially expressed in ON vs. OFF states in PD-Fluc patients, with NK cell–related genes among the most prominently downregulated in the ON state. Gene set enrichment analysis (GSEA) further supported the downregulation of NK cell-mediated cytotoxicity pathways. qPCR validation confirmed state-dependent modulation of <em>ADGRG1</em> and <em>PRF1</em> genes in PD-Fluc patients, an effect absent in PD-NonFluc patients following dopaminergic treatment. Moreover, the expression levels of these genes were able to discriminate PD-Fluc from PD-NonFluc patients, highlighting their potential as molecular markers for disease stratification.</div></div><div><h3>Conclusion</h3><div>Motor fluctuations in PD drive dynamic changes in peripheral immunity, including up-regulation of NK cell-related genes in the OFF state, which reflects fluctuating immune activation states. These findings underscore the need for early and sustained control of motor fluctuations to protect neurological and immune integrity.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108208"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous subcutaneous apomorphine infusion to improve comfort in advanced degenerative Parkinsonian syndrome patients: a retrospective descriptive study in a home-based setting","authors":"Simon Singovski ,&nbsp;Louise Harlé ,&nbsp;Jérémie Zerbit ,&nbsp;David Grabli ,&nbsp;Clément Leclaire","doi":"10.1016/j.parkreldis.2026.108214","DOIUrl":"10.1016/j.parkreldis.2026.108214","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a scarcity of data and guidelines for therapeutic management of degenerative Parkinsonian syndromes (DPS) patients in their terminal phase. This study aims to describe the evolution of a cohort of DPS patients who were treated by continuous subcutaneous apomorphine infusion (CSAI) through a home-based program (Hospital-at-Home, HaH), after a life-threatening acute medical event.</div></div><div><h3>Methods</h3><div>This retrospective descriptive exploratory study based on medical records analysis, included 12 Parkinson's disease (PD) and 5 multiple system atrophy (MSA) patients treated by CSAI through a HaH program, during and after they suffered from a life-threatening acute medical event compromising the oral route. Outcomes were the patient's symptoms (pain, rigidity, ability to swallow and communicate), medication, CSAI-side effects and patients trajectory.</div></div><div><h3>Results</h3><div>CSAI was associated with symptom improvement in 82% of patients (14/17). The treatment was well tolerated, 35 % of patients developed CSAI-related side effects but none warranted CSAI discontinuation.</div></div><div><h3>Conclusion</h3><div>The findings point toward a potential benefit of CSAI delivered through a HaH program on symptom and comfort improvement in advanced PD and MSA patients. This positive effect was suggested in patients facing a life-threatening event compromising the oral route, whether or not they were in the immediate end-of-life phase.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108214"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-year risk of cardiovascular events and falling in Parkinson's disease with orthostatic hypotension: A nationwide cohort study","authors":"Hikaru Kamo ,&nbsp;Matthew Remz ,&nbsp;Tejas R. Mehta ,&nbsp;Rachael M. Burke ,&nbsp;Anne Brooks ,&nbsp;Adrianne Smiley ,&nbsp;Michael S. Okun ,&nbsp;Christopher W. Hess","doi":"10.1016/j.parkreldis.2026.108217","DOIUrl":"10.1016/j.parkreldis.2026.108217","url":null,"abstract":"<div><h3>Background</h3><div>Orthostatic hypotension (OH) is a frequent autonomic feature of Parkinson's disease (PD), yet its long-term clinical consequences remain insufficiently characterized, particularly regarding falls and major vascular events.</div></div><div><h3>Methods</h3><div>Adults aged ≥50 years with PD who had a 2018 hospitalization or outpatient visit and received antiparkinsonian medication were included; the first encounter served as the index. Patients with vascular events in the prior 12 months were excluded. Five-year risks were assessed using inverse probability of treatment weighting (IPTW) and propensity score matching (PSM). Logistic regression estimated ORs, negative binomial models assessed fall counts, and OH pharmacotherapy effects were evaluated.</div></div><div><h3>Results</h3><div>Among 111,368 patients with PD who met the inclusion criteria, 2598 had OH. OH was independently associated with higher 5-year fall risk (adjusted OR 1.35, 95 % CI 1.21–1.51) and more cumulative falls (IRR 1.22, 95 % CI 1.20–1.24). These associations persisted in PSM analyses. In contrast, OH was not associated with major vascular events (adjusted OR 0.99, 95 % CI 0.86–1.14). Traditional cardiovascular risk factors, including hypertension, dyslipidemia, and diabetes, were strongly associated with vascular outcomes. Among patients with OH, pharmacotherapy was associated with higher fall risk (adjusted OR 1.34, 95 % CI 1.10–1.64) but not with vascular events. Findings were consistent across sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>In this national PD cohort, both OH and its pharmacotherapy increased long-term fall risk but showed no association with major vascular events. These findings indicate distinct outcome profiles of OH, underscoring the need for focused fall-prevention and further evaluation of vascular safety.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108217"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain cholinergic imaging in isolated REM sleep behavior disorder: Distinctions and similarities with Parkinson's disease","authors":"Rebekah H. Wickens ,&nbsp;Ronald B. Postuma ,&nbsp;Olga Fliaguine ,&nbsp;Camille Legault-Denis ,&nbsp;Étienne de Villers-Sidani ,&nbsp;Alain Dagher ,&nbsp;Jean-Paul Soucy ,&nbsp;Amélie Pelletier ,&nbsp;Jean-François Gagnon ,&nbsp;Marc-André Bedard","doi":"10.1016/j.parkreldis.2026.108226","DOIUrl":"10.1016/j.parkreldis.2026.108226","url":null,"abstract":"<div><h3>Background</h3><div>Isolated rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of α-synucleinopathy such as Parkinson's disease (PD). Brain cholinergic alterations have been reported in these diseases, but direct comparisons of terminal density between iRBD and clinically manifest PD have not yet been performed.</div></div><div><h3>Objectives</h3><div>To assess brain cholinergic terminal density in iRBD using positron emission tomography (PET) with [¹⁸F]-fluoroethoxybenzovesamicol (FEOBV), and to compare findings with both healthy controls and patients with PD.</div></div><div><h3>Methods</h3><div>Forty-six participants (16 with polysomnography-confirmed iRBD, 12 with PD, and 18 controls) underwent high-resolution PET neuroimaging with FEOBV. Voxel-wise analyses and effect size mapping were conducted to compare the groups, using standardized uptake value ratios (SUVRs). Correlations were performed between whole-cortex SUVR and clinical measures.</div></div><div><h3>Results</h3><div>Compared to controls, both the iRBD and PD groups exhibited significant cortical cholinergic denervation of similar magnitudes (11–12 %). Effect size mapping revealed very large losses (Cohen's <em>d</em>s &lt; −1.5) in the posterior cortex in both patient groups, predominantly occipital-parietal in iRBD and occipital-temporal in PD. In iRBD, lower cortical uptake was associated with poorer performance on executive and visuospatial tests. Moreover, in iRBD but not in PD, there was a trend toward higher FEOBV uptake in subcortical areas, including brainstem regions.</div></div><div><h3>Conclusions</h3><div>Cholinergic denervation in iRBD is comparable in extent to that in PD, with subtle topographic distinctions, and correlates with cognitive deficits.</div></div>","PeriodicalId":19970,"journal":{"name":"Parkinsonism & related disorders","volume":"144 ","pages":"Article 108226"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}