Clinical Features Of Rem Sleep Behavior Disorder In Parkinson''s Disease And Its Relationship With Serum Iron Metabolism Related Proteins

Objective To study the clinical characteristics of patients with Parkinson's disease(PD)complicated with Rem sleep Behavior Disorder(RBD)and its relationship with serum iron and related proteins,and to explore the possible mechanism of iron metabolism related proteins in its occurrence.Methods 50 patients with primary PD who visited the department of neurology of Dalian central hospital from September 2016 to December 2018 were continuously collected and included in the healthy control group for the following study: 1.Evaluation of Rem sleep Behavior Disorder Using Rapid eye movement sleep Behavior Disorder Screening Questionnaire(RBDSQ)evaluation and distinguish whether PD patients combined Rem sleep Behavior Disorder(RBD)symptoms,Divided by 6 points,A score greater than or equal to 6 points indicates a probable RBD(PRBD)with PD,which is the PD-PRBD group;a score less than 6 points indicates an unprobable RBD with PD,which is the PD-PRBD group.2.Evaluation of clinical symptoms of PD patients(1)Collect and sort out demographic data of PD patients.(2)The Hoehn-Yahr(H-Y)stage,the unified PD rating scale part ?(UPDRS ?),Webster evaluation scale movement symptoms of PD patients.(3)Montreal Cognitive Assessment(MoCA),Mini-Mental State Examination,(MMSE)and Hamilton Depression Scale(HAMD)and PD modified apathy scale rating scale(MAES),Restless Leg Syndrome Rating Scale(RLSRS),Hamilton Anxiety Scale(HAMA),Argentine Hyposmia Rating Scale(AHRS),Epworth Sleeping Scale(ESS)and Non-motor Symptom Quest(NMSQ),To assess the non-motor symptoms of PD patients.(4)Parkinson Disease Quality of Life Questionnaire-39(PDQL-39)and Activity of Daily Living Scale(ADL)were used to evaluate the quality of life and daily living ability of PD patients.3.Collection and detection of serology PD patients and the control group were taken respectively fasting venous blood,PD patients before the blood stop drug for PD related 10-12 hours,and at the same time to take 4ml 4? centrifugal blood of 10 minutes,the speed of 3000 r/min,after centrifugal supernatant,repackaging,to-80 ? storage.The levels of serum iron,ferritin,transferrin and-synuclein oligomers in PD patients and the control group were detected by enzyme-linked immunosorbent assay(ELISA).4.Statistical method Kolmogorov-smirnov method was used to detect the normality of all data.For normal distribution data,t-test was used.For non-normal distribution data,non-parametric test is used.The data were expressed as percentage,and the chi-square test was used for comparison and analysis between groups.SPSS 23.0 software was used for statistical processing.Results: 1.Incidence of PD with PRBD and demographic data(1)Among the 50 PD patients,31 cases(62%)were associated with PRBD and were included in the PD-PRBD group.19 cases PD patients without PRBD,accounting for 38%,were included in the PD-NPRBD group.The scores of PD-PRBD group and PD-NPRBD group were [9(6,12)scores vs.2(0,4)scores].(2)The age of patients in the PD-PRBD group was significantly higher than that in the PD-NRBD group [76(51,87)vs 67(54,86),P < 0.05].There was no significant difference between the two groups in gender,education level,course of disease and side of onset(P > 0.05).2.Relationship between PD with PRBD and motor symptoms Compared with the PD-NPRBD group,the UPDRS-III and H-Y staging scores of the PD-PRBD group were higher,respectively: [(42.77±15.20)points vs.(28.35±11.96)points,P < 0.05],[(2.5(1.5 ~5.0))points vs.(2.0(1.0~3.0),P < 0.05].There was no significant difference in Webster's score(P > 0.05).Further analysis showed that the scores of myotonia and bradykinesia in PD-PRBD group were significantly higher than those in PD-NPRBD group,which were [(8.78±4.42)scores vs.(5.61±3.50)scores,P < 0.05],[(16.11±7.31)scores vs.(9.65±4.67)scores,P < 0.05].There was no significant difference in tremor scores between the two groups(P > 0.05).3.Relationship between PD with PRBD and non-motor symptoms MAES and HAMD scores of PD-PRBD group were significantly higher than those of PD-NPRBD group,respectively [(21.58±7.75)points vs.(16.00±7.48)points,P<0.05],[23.50(3.00~55.00)points vs.14.00(1.00~45.00)points,P<0.05].MoCA score of PD-PRBD group was significantly lower than that of PD-NPRBD group [(17.84±5.50)scores vs.(21.63±5.34)scores,P<0.05].The number of non-motor symptoms of PD-PRBD combination was significantly higher than that of PD-NPRBD group [(18.67±3.14)points vs.(15.2±5.51)points,P<0.05].There was no significant difference between PD-PRBD group and PD-NPRBD group in other non-motor symptoms,including HAMA,MMSE,ESS,AHRS and RLSRS scores(P > 0.05).4.Influence of PD with PRBD on patients' quality of life and daily living ability The ADL score of PD-PRBD group was significantly higher than that of PD-NPRBD group [39(24,79)points vs.33(18,64)points,P<0.05].The PDQL-39 score of PD-PRBD group was significantly lower than that of PD-NPRBD group [(102.7±23.4 points vs.119.0±23.1 points),P<0.05].5.Level of serology(1)The average levels of serum iron,transferrin,and?-synuclein oligomers in the PD group were significantly higher than those in the healthy control group,respectively [(17.54±6.35)umol/ ml vs.(14.26±6.13)umol/ml,P<0.05],[(0.112±0.062)nmol/Lvs,(0.066±0.041)nmol/L,P<0.05],[(2.729±0.807)ng/ml vs.(1.362± 0.769)ng/ml,P<0.05].There was no significant difference in ferritin level between the two groups,P > 0.05.(2)The levels of transferrin and ?-synuclein oligomers in the PD-PRBD group were significantly higher than those in the PD-NPRBD group,and the results were respectively [(0.140±0.062)nmol/Lvs.(0.073±0.038)nmol/L,P<0.05],[(2.910± 0.688)ng/ ml vs.(1.867±0.862)ng/ml,P<0.05].There was no significant difference in serum iron and ferritin levels between the two groups(P > 0.05).Conclusion 1.The incidence of PD with PRBD is high,so PRBD is one of the common non-motor symptoms in PD patients.2.PD patients with PRBD are older.3.PD patients with PRBD have more severe motor symptoms,mainly manifested in myotonia and bradykinesia.4.PD patients with PRBD have more non-motor symptoms,more severe indifference,depression and cognitive impairment,and have a serious impact on the quality of life and daily life ability of patients.5.The occurrence of PD-RBD may be related to iron,transferrin,and ?-synuclein oligomers.Peripheral iron metabolism disorder may be involved in the occurrence and development of PD-PRBD.