Characterization of Depressive and Anxiety Symptoms in Idiopathic REM Sleep Behavior Disorder

Article type: Research Article

Authors: Honeycutt, Lucy^a | Gagnon, Jean-François^{b; c} | Pelletier, Amélie^{b; d} | Montplaisir, Jacques Y.^{b; e} | Gagnon, Geneviève^f | Postuma, Ronald B.^{a; b; d; *}

Affiliations: [a] Department of Neurology, McGill University, Montreal General Hospital, Montreal, 7 QC, Canada | [b] Centre d’Études Avancées en Médecine du Sommeil, CIUSSS-NÎM-Hĉpital du Sacré-Coeur de Montréal, Montreal, QC, Canada | [c] Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada | [d] Department of Neurology, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada | [e] Department of Psychiatry, Université de Montreal, Montreal, QC, Canada | [f] Department of Psychology, McGill University, Montreal, QC, Canada

Correspondence: [*] Correspondence to: Ronald B. Postuma, MD, MSc, Department of Neurology, L7-305 Montreal General Hospital, 1650 Cedar Ave, Montreal, QC, H3G1A4, Canada. E-mail: ron.postuma@mcgill.ca.

Abstract: Background:Depression and anxiety are common in synucleinopathies and often present during prodromal stages, including idiopathic/isolated REM sleep behavior disorder (iRBD). However, the specific profiles of depression/anxiety and their predictive values for phenoconversion remain unclear. Objective:To assess the predominant manifestations, predictive value, and changes over time in depressive and anxiety symptoms in iRBD. Methods:Patients with polysomnography-confirmed iRBD (n = 114) and healthy controls (n = 44) were recruited. The Beck Depression Inventory and Beck Anxiety Inventory were administered at baseline, which was repeated prospectively over follow-up. Factor solutions were generated to delineate symptom clusters within the scales, and to help disentangle primary mood symptoms from other neurodegenerative confounds. Total scores, individual scale items, and factors were evaluated to 1) compare patients and controls, 2) assess progression of symptoms over time, and 3) assess predictive value for phenoconversion. Results:At baseline, iRBD patients had more severe depressive (9.0 = 6.7 vs 5.8 = 4.8) and anxiety (7.0 = 7.9 vs 4.5 = 6.0) symptoms than controls. Increased scores were seen in numerous individual scale items and most scales’ factors. For depressive symptoms, there was no progression of total scores or factors over time. However, anxiety scores worsened slightly over prospective follow-up (annual slope = 0.58 points, p < 0.05). Over an average 2.4 = 3.1-year follow-up, 37 patients phenoconverted and 72 remained disease-free. Neither baseline depressive nor anxiety symptoms predicted phenoconversion to clinical neurodegenerative disease. Conclusions:Depressive and anxiety symptoms are common in iRBD. However, they do not predict phenoconversion and show only modest progression over time, solely for anxiety.

Keywords: REM sleep behaviour disorder, depression, anxiety, progression, prodromal

DOI: 10.3233/JPD-212625

Journal: Journal of Parkinson's Disease, vol. 11, no. 3, pp. 1409-1416, 2021