Early cortical atrophy in REM sleep behavior disorder

Introduction

The presence of cortical atrophy (focal or diffuse) prior to the development of symptoms of cognitive impairment could predict the earliest cases of neurodegenerative disease in patients with CRSD. We reviewed the usefulness of cranial CT and MRI as early markers of cortical atrophy in patients with RSBD at our center.

Patients and methods

Retrospective observational descriptive analysis of patients diagnosed with RSBD from October 2012 to October 2022. All with cranial CT or MRI, evaluated by a neuroradiologist.

Results

54 patients were included, 21 women (38.88%), 33 men (61.12%), mean age at diagnosis of TCSR: 69.04 ± 12.625. Of the 54 patients, 44 (81.48%) had imaging tests consistent with their age, and 10 had atrophy greater than expected for their age. Of the 54 patients, 21 (38.88%) with a diagnosis of neurodegenerative disease, 33 (61.12%) persist as idiopathic, almost all with more than 5 years of evolution (range of 1 to 10 years of evolution without diagnosis). Of the 10 (18.52%) patients with greater atrophy, all were diagnosed with neurodegenerative disease (8 in 1 year, 2 in 8 years).

Conclusions

Almost half of our series have developed a neurodegenerative disease in the first 10 years of evolution. The majority of them presented global cortical atrophy measured by the GCA scale in the first year of diagnosis, without other neurological symptoms. Patients who did not show cortical atrophy at diagnosis have not yet developed the neurodegenerative disease in 10 years of evolution. In our experience, the absence of cortical atrophy on cranial MRI or CT (measured by scales such as GCA) at the diagnosis of CRST seems to predict slower progression cases. These data should be corroborated with larger series.