Sleep medicine · 2025
Refining α-synucleinopathy risk in isolated REM sleep behavior disorder patients using repeated olfactory testing.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Dall'Antonia Irene, Nepožitek Jiří, Hlavnička Jan, Rusz Jan, Peřinová Pavla, Dostálová Simona, Zogala David, Ibarburu Lorenzo Y Losada Veronika, Bezdicek Ondrej, Nikolai Tomáš, Růžička Evžen, Šonka Karel, Dušek Petr
Аннотация
OBJECTIVE: This study investigated the prognostic utility of repeated olfactory testing in patients with isolated REM sleep behavior disorder (iRBD) for predicting phenoconversion to overt α-synucleinopathies.
METHODS: We analyzed 59 iRBD patients (mean age: 66.9 ± 7.2 years; 91.5 % male) who underwent olfactory testing using the University of Pennsylvania Smell Identification Test at baseline and at a two-year follow-up. Patients were classified into persistent hyposmia, persistent normosmia, or unstable olfactory function groups. Clinical, cognitive, and dopamine transporter single photon emission CT (DAT-SPECT) parameters were assessed longitudinally.
RESULTS: Olfactory function remained stable in most patients. The persistent hyposmia group (n = 37, 62.7 %) exhibited higher age, worse DAT-SPECT indices, and significant progression in MDS-UPDRS III over two years. In contrast, the persistent normosmia group (n = 11, 18.6 %) showed no significant neurodegenerative changes and had a 0 % phenoconversion rate over ∼5 years. Phenoconversion occurred in 20.3 % of patients, predominantly among those with persistent hyposmia (9/12 converters) and in patients from the unstable olfactory group (3/12 converts). While baseline hyposmia alone did not predict phenoconversion, repeated hyposmia significantly increased the risk (p < 0.05).
CONCLUSION: Repeated olfactory testing improves risk stratification in iRBD. Persistent normosmia is associated with a lower risk of phenoconversion, whereas persistent hyposmia predicts neurodegeneration. Serial olfactory assessments may serve as a cost-effective tool for identifying high-risk patients and refining recruitment for neuroprotective trials.
METHODS: We analyzed 59 iRBD patients (mean age: 66.9 ± 7.2 years; 91.5 % male) who underwent olfactory testing using the University of Pennsylvania Smell Identification Test at baseline and at a two-year follow-up. Patients were classified into persistent hyposmia, persistent normosmia, or unstable olfactory function groups. Clinical, cognitive, and dopamine transporter single photon emission CT (DAT-SPECT) parameters were assessed longitudinally.
RESULTS: Olfactory function remained stable in most patients. The persistent hyposmia group (n = 37, 62.7 %) exhibited higher age, worse DAT-SPECT indices, and significant progression in MDS-UPDRS III over two years. In contrast, the persistent normosmia group (n = 11, 18.6 %) showed no significant neurodegenerative changes and had a 0 % phenoconversion rate over ∼5 years. Phenoconversion occurred in 20.3 % of patients, predominantly among those with persistent hyposmia (9/12 converters) and in patients from the unstable olfactory group (3/12 converts). While baseline hyposmia alone did not predict phenoconversion, repeated hyposmia significantly increased the risk (p < 0.05).
CONCLUSION: Repeated olfactory testing improves risk stratification in iRBD. Persistent normosmia is associated with a lower risk of phenoconversion, whereas persistent hyposmia predicts neurodegeneration. Serial olfactory assessments may serve as a cost-effective tool for identifying high-risk patients and refining recruitment for neuroprotective trials.