Predicting post-mortem α-Synuclein pathology by the combined presence of probable REM sleep behavior disorder and hyposmia

Tremblay, C., Adler, C. H., Shill, H. A., Driver-Dunckley, E., Mehta, S., Choudhury, P., Belden, C., Shprecher, D. R., Lee-Iannotti, J. K., Atri, A., Serrano, G. E. et Beach, T. G. (2025). Predicting post-mortem α-Synuclein pathology by the combined presence of probable REM sleep behavior disorder and hyposmia. Movement Disorders Clinical Practice, 12 (2). pp. 157-165. ISSN 2330-1619 DOI 10.1002/mdc3.14244

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Résumé

Abstract

Background
Idiopathic rapid eye movement sleep behavior disorder (RBD) is a strong known predictor of a final clinicopathological diagnosis of a Lewy type α-synucleinopathy (LTS). Olfactory dysfunction is an early symptom of synucleinopathies and has been repeatedly associated with the presence of post-mortem LTS.

Objective
To assess the combined value of a clinician diagnosis of probable RBD (PRBD) and hyposmia in predicting the post-mortem presence of LTS in a broader, less-selected, volunteer elderly population.

Methods
We studied 652 autopsied subjects from the Arizona Study of Aging and Neurodegenerative Disorders, which were evaluated for PRBD, had completed annual movement and cognitive assessments, and had at least one the University of Pennsylvania Smell Identification Test (UPSIT) olfactory test.

Results
Histological evidence of LTS was significantly more frequent in those who had PRBD (112/152: 73.7%) than those without (177/494: 35.8%) (P < 0.001). LTS was more frequent in cases with PRBD and a low UPSIT score (90.8%) compared to cases with PRBD only (73.7%) (P < 0.001) or cases with a low UPSIT score only (69.4%) (P < 0.001). Sensitivity of PRBD diagnosis for predicting LTS was 38.8% and specificity 88.8%, whereas sensitivity of a low UPSIT score was 74.4% and specificity 73.4% (Youden's index = 0.276 for PRBD, 0.478 for UPSIT). When combining both measures, sensitivity was 34.3% and specificity increased to 97.2%.

Conclusion
PRBD, diagnosed without sleep study confirmation, combined with a reduced olfactory performance is highly specific for predicting post-mortem presence of LTS. The combination of both measures may provide a cost-effective means of predicting LTS in a broader community.

Type de document:	Article
Mots-clés libres:	Mayo sleep questionnaire Olfaction Parkinson's disease REM sleep behavior disorder UPSIT
Date de dépôt:	25 sept. 2026 12:45
Dernière modification:	25 sept. 2026 12:45
Version du document déposé:	Version officielle de l'éditeur
URI:	https://depot-e.uqtr.ca/id/eprint/13144

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