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Limbic Vulnerability Characterises REM Sleep Behaviour Disorder Across Prodromal and Established Lewy Body Disease
Churchill L, Konuri A, Anderson J, Ignatavicius A, Lewis SJ, Matar E.. Research Square, 2026-10-14
Topic: Brain imaging, connectivity and assessment
Isolated rapid eye movement sleep behaviour disorder (iRBD) strongly predicts future Lewy body disease and identifies a more aggressive, non-motor phenotype in Parkinson’s disease (PD). Limbic degeneration may contribute to this phenotype with abnormalities reported separately in iRBD and PD with RBD (PD-RBD). However, whether limbic vulnerability reflects RBD status independent of disease stage remains unknown. We investigated multimodal limbic vulnerability across prodromal and established disease using structural and functional MRI from 175 polysomnography-confirmed isolated RBD (iRBD), 79 Parkinson’s disease with RBD (PD-RBD), 250 Parkinson’s disease without RBD (PD-nRBD) and 54 healthy controls from the Parkinson’s Progression Markers Initiative. Hippocampal, amygdala and anterior cingulate measures were integrated into structural, functional and multimodal Limbic Vulnerability Indices. iRBD showed greater structural and multimodal limbic vulnerability than healthy controls and PD-nRBD, while PD-RBD showed greater structural and multimodal vulnerability than PD-nRBD. Greater limbic vulnerability was associated with RBD symptom burden, reduced dopamine transporter binding and cognitive impairment. In iRBD, greater structural and multimodal limbic vulnerability predicted future incident hallucinations. These findings identify limbic vulnerability as a feature associated with the RBD phenotype across disease stages and suggest a role in neuropsychiatric progression.
Key findings
- Greater limbic vulnerability was associated with RBD symptom burden, reduced dopamine transporter binding and cognitive impairment.
- These findings identify limbic vulnerability as a feature associated with the RBD phenotype across disease stages and suggest a role in neuropsychiatric progression.
Study details
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 21 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 13 of the 62 points we could judge it on, which is 21 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 13 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 13 of the 62 points we could judge it on is 21 out of 100. |
| Total | 21 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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APA 7th
Churchill, L., Konuri, A., Anderson, J., Ignatavicius, A., Lewis, S. J., & Matar, E. (2026). Limbic Vulnerability Characterises REM Sleep Behaviour Disorder Across Prodromal and Established Lewy Body Disease. Research Square. https://doi.org/10.21203/rs.3.rs-11109305/v1
Vancouver
Churchill L, Konuri A, Anderson J, Ignatavicius A, Lewis SJ, Matar E. Limbic Vulnerability Characterises REM Sleep Behaviour Disorder Across Prodromal and Established Lewy Body Disease. Research Square. 2026. doi:10.21203/rs.3.rs-11109305/v1.
BibTeX
@article{churchill2026-ace85e9d,
author = {Churchill, L. and Konuri, A. and Anderson, J. and Ignatavicius, A. and Lewis, S. J. and Matar, E.},
title = {{Limbic Vulnerability Characterises REM Sleep Behaviour Disorder Across Prodromal and Established Lewy Body Disease}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-11109305/v1},
url = {https://doi.org/10.21203/rs.3.rs-11109305/v1}
}