Abstract Details

Title Clinical and Pathologic Features of Patients with REM Sleep Behavior Disorder and Parkinsonism in the Mild Cognitive Impairment Stage of Lewy Body Disease

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) S33 - Aging and Dementia: Non-Alzheimer Dementia (3:54 PM-4:06 PM)

Poster/Presentation
Number 003

Objective Whether probable REM sleep behavior disorder (pRBD) or parkinsonism at the mild cognitive impairment (MCI) stage of Lewy body disease is associated with clinical or pathologic features.

Background The clinical and pathological relationships between of pRBD and parkinsonism in LBD are still being defined.

Design/Methods Prospective data from 74 patients with MCI were followed in the Mayo Alzheimer Disease Research Center and had autopsy-confirmed limbic-transitional LBD (TLBD) or diffuse-neocortical LBD (DLBD) were examined. The sample included 34 TLBD (12 with neocortical tangles) and 40 DLBD (26 with neocortical tangles).

Results The cohort included 72% men and mean education was 15.0 ± 2.9 years. The mean age of onset of MCI was 72.8 ± 7.9 years and the mean age of death was 80.7 ±8. At the initial MCI evaluation, 53% had RBD and 31% had parkinsonism. By the final visit, 60% had pRBD and 74% had parkinsonism. In 89% (39/44), pRBD was already present at the time of the MCI diagnosis. All but one MCI patient with parkinsonism also had pRBD (96%), while 33% had pRBD without parkinsonism. Patients with pRBD at the MCI stage had a younger age of onset, a younger death age, a lower Braak NFT stage and sparse neuritic plaques but was unrelated to LBD distribution. Patients with parkinsonism also had lower AD-related pathology, but did not differ in onset age or death age from those without parkinsonism. Duration of illness was longest for patients in the TLBD group with neocortical tangles who were less likely to have pRBD or parkinsonism.

Conclusions The presence of pRBD at the time of the MCI diagnosis was associated with an earlier onset of cognitive impairment, an increased likelihood of parkinsonism, younger death age and less severe concurrent AD pathology, but was unrelated to the distribution of Lewy-related pathology.

Authors/Disclosures
Toji Miyagawa, MD, PhD (Mayo Clinic) PRESENTER	Dr. Miyagawa has nothing to disclose.
Tanis J. Ferman, PhD (Mayo Clinic Jacksonville)	Ms. Ferman has nothing to disclose.
Neill R. Graff-Radford, MD, FAAN (Mayo Clinic Jacksonville)	The institution of Dr. Graff-Radford has received research support from Biogen. The institution of Dr. Graff-Radford has received research support from Lilly. The institution of Dr. Graff-Radford has received research support from Eisai. The institution of Dr. Graff-Radford has received research support from Biogen. Dr. Graff-Radford has received publishing royalties from a publication relating to health care.
David S. Knopman, MD, FAAN (Mayo Clinic)	Dr. Knopman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for DIAN TU study. The institution of Dr. Knopman has received research support from NIH.
Jonathan Graff-Radford, MD, FAAN	Dr. Graff-Radford has received personal compensation for serving as an employee of Mayo Clinic. Dr. Graff-Radford has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NINDS/NIH. Dr. Graff-Radford has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. The institution of Dr. Graff-Radford has received research support from NIH. The institution of Dr. Graff-Radford has received research support from Eisai. The institution of Dr. Graff-Radford has received research support from Cognition therapeutics.
Rodolfo Savica, MD, PhD, FAAN (Mayo Clinic)	The institution of Dr. Savica has received research support from ACADIA Pharmaceuticals, Inc.
David T. Jones, MD (Mayo Clinic)	Dr. Jones has received intellectual property interests from a discovery or technology relating to health care.
Otto Pedraza (Mayo Clinic)	The institution of Otto Pedraza has received research support from Alzheimer's Association. Otto Pedraza has received publishing royalties from a publication relating to health care.
Julie A. Fields, PhD (Mayo Clinic)	The institution of Dr. Fields has received research support from National Institutes of Health. The institution of Dr. Fields has received research support from Patient-Centered Outcomes Research Institute.
Mary M. Machulda, PhD (Mayo Clinic)	The institution of Dr. Machulda has received research support from NIH.
Leah K. Forsberg, PhD (Mayo Clinic)	Ms. Forsberg has nothing to disclose.
Laura Allen, NP (Mayo Clinic)	Ms. Allen has nothing to disclose.
Kejal Kantarci, MD (Mayo Clinic)	The institution of Dr. Kantarci has received research support from Eli Lilly. The institution of Dr. Kantarci has received research support from NIH. The institution of Dr. Kantarci has received research support from ADDF.
Erik K. St. Louis, MD (Mayo Clinic)	The institution of Dr. St. Louis has received research support from NIH. Dr. St. Louis has received publishing royalties from a publication relating to health care. Dr. St. Louis has received publishing royalties from a publication relating to health care.
Michael Silber, MB, ChB, FAAN (Mayo Clinic)	Dr. Silber has received publishing royalties from a publication relating to health care. Dr. Silber has received personal compensation in the range of $500-$4,999 for serving as a Topic writer with UpToDate.
Melissa Murray, PhD (Mayo Clinic)	Dr. Murray has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Avid Radiopharmaceuticals. The institution of Dr. Murray has received research support from National Institute on Aging. The institution of Dr. Murray has received research support from Alzheimer's Association. The institution of Dr. Murray has received research support from Chan Zuckerberg Initiative.
Joseph E. Parisi, MD (Mayo Clinic)	Dr. Parisi has nothing to disclose.
Dennis W. Dickson, MD (Mayo Clinic)	Dr. Dickson has nothing to disclose.
Ronald C. Petersen, MD, PhD, FAAN (Mayo Clinic)	Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co.. Dr. Petersen has received personal compensation in the range of $0-$499 for serving as a Consultant for Eisai, Inc.. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novo Nordisk. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has a non-compensated relationship as a Board of Directors with American Brain Foundation that is relevant to AAN interests or activities.
Bradley F. Boeve, MD, FAAN (Mayo Clinic)	Dr. Boeve has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Rainwater Charitable Foundation. The institution of Dr. Boeve has received research support from Alector. The institution of Dr. Boeve has received research support from EIP Pharma. The institution of Dr. Boeve has received research support from Transposon. The institution of Dr. Boeve has received research support from Cognition Therapeutics. Dr. Boeve has received publishing royalties from a publication relating to health care.

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