The Study In Clinical Symptoms And Diffusion Tensor Imaging In Parkinson's Disease With REM Sleep Behavior Disorder

Objective:The incidence of Parkinson's disease with REM sleep behavior disorder is high,and the clinical symptoms are more prominent,it may belong to different PD subtypes,but the mechanism is not clear.In this study,we evaluated the clinical characteristics of PD patients with RBD,combined with Diffusion tensor imaging to explore the brain microstructure damage of PD with RBD,and analyzed the correlation between brain microstructure damage and clinical symptoms of PD patients with RBD.to explore the possible pathogenesis of PD with RBD.Methods:This study included 50 patients with PD,collecting the clinical data of all patients with PD,including: general data,Parkinson's Hoehn-Yahr stage(H-Y stage),UPDRS ? score,UPDRS ? score,mini mental state examination(MMSE),Montreal cognitive assessment scale(Mo CA)score,Hamilton anxiety scale(HAMA)and depression scale(HAMD)score,Epworth sleepiness scale(ESS),Parkinson's sleep scale(PDSS),autonomic neurosis scale(SCOPA-AUT),Quality of Life questionnaire(PDQL-39),Polysomnography,RBD screening questionnaire(RBDSQ);According to the diagnostic criteria of RBD,patients with PD were divided into two subgroups:PD+RBD group(n = 20)and PD-RBD group(n = 30).compared the differences of clinical characteristics between the two groups and analyzed the clinical related factorsaffecting RBD.The health check-up person were selected as the healthy control group(HC n=15).they are matched with patients with PD on age and sex.Compared the fractional anisotropy(FA)?Apparent diffusion coefficient(ADC)values of brain regions of interest in DTI images of PD+RBD group,PD-RBD group and HC group,and analyzed the correlation between statistically significant brain regions and clinical symptoms of patients in PD+RBD group.All data were statistically analyzed by SPSS25.0 software.Results:1.The incidence of PD with RBD was 30.96%.There was no significant difference in sex,age,onset age and onset side between PD+RBD group and PD-RBD group(p>0.05).2.Compared with PD-RBD group,the course of disease was significantly longer,H-Y stage was higher,and the scores of UPDRS?,HAMD,SCOPA-AUT,ESS,PDSS and PDQL-39 were significantly higher in PD+RBD group,the difference was statistically significant(p<0.05).but there was no significant difference in UPDRS?,motor subtype,MMSE,Mo CA and HAMA scores between the two groups(p>0.05).3.Those clinical characteristics of PD patients were significantly correlated with the occurrence of RBD,including the course of disease,H-Y stage,HAMD SCOPA-AUT,ESS,PDSS and PDQL-39(p<0.05).4.There were significant differences in FA and ADC values on DTI imaging among PD-RBD group,PD+RBD group and HC group(p<0.05).In substantia nigra,putamen and red nucleus: FA values in PD+RBD and PD-RBD groups were significantly lower than those in HC group,and the difference was statistically significant(p<0.05).and there was no significant difference between PD+RBD and PD-RBD groups(p>0.05).In midbrain tegmentum:FA values in PD+RBD group were significantly lower than those in PD-RBD group and HC group,and the difference was statistically significant(p<0.05).but there was no significant difference in FA value between PD-RBD group and HC group(p>0.05).In pontine head: the ADC value of PD+RBD group was significantly higher than PD-RBD group and HC group,and thedifference was statistically significant(p<0.05),but there was no significant difference in ADC value between PD-RBD group and HC group.(p>0.05).5.There was no significant correlation between the course of disease,H-Y stage,HAMD score,PDSS score and FA value and ADC value of midbrain tegmentum and pontine head in patients with PD and RBD(p>0.05),but there was a significant positive correlation between ESS score,SCOPA-AUT score and the decrease of FA value in midbrain tegmentum(p<0.05).Conclusions:The incidence of PD with RBD is high,and the motor symptoms and non-motor symptoms are more serious,the course of disease is longer,and the quality of life is worse.DTI functional imaging also shows brain microstructure changes(midbrain tegmentum,pontine head),which may be the pathological basis of some non-motor symptoms in PD+RBD.