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Abstract
Objective: To investigate dopamine transmission in patients with comorbid REM sleep behavior disorder (RBD) and major depressive disorder (MDD).
Methods: This is a case-control study including 11 medicated patients with comorbid RBD and MDD (mean age 47.5 ± 8.2), 8 medicated patients with MDD only (mean age 47.9 ± 8.4), and 10 healthy participants (mean age 46.5 ± 10.6 years). They underwent clinical assessment, video-polysomnography, olfactory tests, and neuroimaging studies (18F-DOPA, 11C-raclopride, and 18F-FDG PET neuroimaging).
Results: Compared with the 2 control groups, patients with comorbid RBD and MDD had significantly lower 18F-DOPA uptake at 60 minutes in the putamen and caudate after controlling for age and sex effect (p < 0.05). There were no significant differences for the 11C-raclopride and 18F-FDG-PET. The 18F-DOPA uptake in putamens had significant inverse correlation with severity of RBD symptoms (p < 0.01) and REM-related tonic muscle activity (p < 0.01). The comorbid RBD and MDD group had more impairment in olfactory function.
Conclusion: Patients with comorbid RBD and MDD had presynaptic dopamine dysfunction and impaired olfactory function. There is a distinct possibility that the development of RBD symptoms among patients with MDD may represent an early phase of α-synucleinopathy neurodegeneration instead of a merely antidepressant-induced condition.
GLOSSARY
- BDI=
- Beck Depression Inventory;
- hControl=
- healthy participants;
- ICSD-3=
- International Classification of Sleep Disorders–III;
- MDD=
- major depressive disorder;
- pControl=
- psychiatric controls;
- PSG=
- polysomnographic;
- PD=
- Parkinson disease;
- RBD=
- REM sleep behavior disorder;
- RBDQ-HK=
- REM sleep behavior disorder screening questionnaire–Hong Kong;
- REMREEA=
- REM-related EMG activity measured from polysomnographic study;
- ROI=
- region of interest;
- SC ratio=
- ratio of substriatal (putamen and caudate) region of interest to cerebellar hemisphere;
- SCID=
- the Semi-Structured Clinical Interview for DSM-IV;
- SSRI=
- selective serotonin reuptake inhibitor;
- TA=
- time-dependent activity;
- UPDRS=
- Unified Parkinson's Disease Rating Scale;
- vPSG=
- video polysomnography
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received June 11, 2014.
- Accepted in final form October 6, 2014.
- © 2015 American Academy of Neurology
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