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Research paper
Progression of cognitive impairments in idiopathic REM sleep behaviour disorder
  1. Soyoung Youn1,
  2. Tae Kim1,2,
  3. In-Young Yoon1,3,
  4. Jahyun Jeong1,
  5. Hye Young Kim3,
  6. Ji Won Han1,
  7. Jong-Min Kim4,
  8. Ki Woong Kim1,3,5
  1. 1Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
  2. 2Department of Psychiatry, Kyung Hee University Hospital at Gangdong, Seoul, Korea
  3. 3Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
  4. 4Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
  5. 5Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
  1. Correspondence to Professor In-Young Yoon, Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 463-707, Korea; iyoon{at}


Background Idiopathic REM (rapid eye movement) sleep behaviour disorder (iRBD) has been implicated in cognitive impairments, but there is little evidence about progression of cognitive dysfunction in iRBD.

Methods A retrospective follow-up study with patients with iRBD was performed. Conversion to neurodegenerative disorders was analysed by Kaplan-Meier survival analysis. Neuropsychological test results at baseline were compared between patients with iRBD and healthy controls. 57 patients with iRBD were successfully followed up for changes of cognitive performance over time (follow-up duration 50.84±25.38 months; range 12–108 months). Factors affecting cognitive decline were evaluated with multiple regression analysis and the subgroup analysis for groups with and without conversion was carried out.

Results Among 84 patients with iRBD, conversion occurred in 18 patients and conversion rates were estimated to be 9%, 18% and 35% at 3, 5 and 6 years from diagnosis of iRBD. Individuals with iRBD showed lower z-scores at baseline than controls in Mini-Mental Status Examination, Trail Making Test A, constructional praxis and Executive Clock Drawing Task (CLOX2). Patients with non-converting iRBD showed significant performance decline in memory (p=0.003, Digit span forward) and a worsening tendency of executive functions (p=0.007, frontal assessment battery; p=0.012, Stroop test) at follow-up tests. Cognitive decline was associated with disease duration or follow-up duration, and lower executive function at baseline increased conversion risk (p=0.031).

Conclusions Patients with iRBD have cognitive impairments at baseline and progressive cognitive decline over time. Even in idiopathic cases without development of any neurodegenerative disease, degenerative changes in cognition seem to be under way.

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