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Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials
Postuma RB, Gagnon JF, Bertrand JA, Génier Marchand D, Montplaisir JY.. Neurology, 2015-02-13
Topic: Brain proteins, microglia and lab models
Objective To precisely delineate clinical risk factors for conversion from idiopathic REM sleep behavior disorder (RBD) to Parkinson disease, dementia with Lewy bodies, and multiple system atrophy, in order to enable practical planning and stratification of neuroprotective trials against neurodegenerative synucleinopathy. Methods In a 10-year prospective cohort, we tested prodromal Parkinson disease markers in 89 patients with idiopathic RBD. With Kaplan-Meier analysis, we calculated risk of neurodegenerative synucleinopathy, and using Cox proportional hazards, tested the ability of prodromal markers to identify patients at higher disease risk. By combining predictive markers, we then designed stratification strategies to optimally select patients for definitive neuroprotective trials. Results The risk of defined neurodegenerative synucleinopathy was high: 30% developed disease at 3 years, rising to 66% at 7.5 years. Advanced age (hazard ratio [HR] = 1.07), olfactory loss (HR = 2.8), abnormal color vision (HR = 3.1), subtle motor dysfunction (HR = 3.9), and nonuse of antidepressants (HR = 3.5) identified higher risk of disease conversion. However, mild cognitive impairment (HR = 1.8), depression (HR = 0.63), Parkinson personality, treatment with clonazepam (HR = 1.3) or melatonin (HR = 0.55), autonomic markers, and sex (HR = 1.37) did not clearly predict clinical neurodegeneration. Stratification with prodromal markers increased risk of neurodegenerative disease conversion by 200%, and combining markers allowed sample size reduction in neuroprotective trials by >40%. With a moderately effective agent (HR = 0.5), trials with fewer than 80 subjects per group can demonstrate definitive reductions in neurodegenerative disease. Conclusions Using stratification with simply assessed markers, it is now not only possible, but practical to include patients with RBD in neuroprotective trials against Parkinson disease, multiple system atrophy, and dementia with Lewy bodies.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Postuma, R. B., Gagnon, J. F., Bertrand, J. A., Génier Marchand, D., & Montplaisir, J. Y. (2015). Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials. Neurology. https://doi.org/10.1212/wnl.0000000000001364
Vancouver
Postuma RB, Gagnon JF, Bertrand JA, Génier Marchand D, Montplaisir JY. Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials. Neurology. 2015. doi:10.1212/wnl.0000000000001364. PMID: 25681454.
BibTeX
@article{postuma2015-25681454,
author = {Postuma, R. B. and Gagnon, J. F. and Bertrand, J. A. and Génier Marchand, D. and Montplaisir, J. Y.},
title = {{Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials}},
journal = {Neurology},
year = {2015},
doi = {10.1212/wnl.0000000000001364},
pmid = {25681454},
url = {https://doi.org/10.1212/wnl.0000000000001364}
}
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Key findings
- Results The risk of defined neurodegenerative synucleinopathy was high: 30% developed disease at 3 years, rising to 66% at 7.5 years.
- Advanced age (hazard ratio [HR] = 1.07), olfactory loss (HR = 2.8), abnormal color vision (HR = 3.1), subtle motor dysfunction (HR = 3.9), and nonuse of antidepressants (HR = 3.5) identified higher risk of disease conversion.
- Stratification with prodromal markers increased risk of neurodegenerative disease conversion by 200%, and combining markers allowed sample size reduction in neuroprotective trials by >40%.
Why it matters
In people with idiopathic REM sleep behavior disorder, the risk of developing a neurodegenerative synucleinopathy was 30% at 3 years and 66% at 7.5 years. Certain markers (advanced age, olfactory loss, abnormal color vision, subtle motor dysfunction, and nonuse of antidepressants) identified higher risk, and combining markers increased risk by 200%, which could help select patients for future neuroprotective trials.
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Study details
- Study designprospective cohort
- Participants89
- Effect sizeHR = 2.8; HR = 3.1; HR = 3.9
- Evidence strengthModerate
How this study scored 71/100
Published in a leading specialty journal, and it is a prospective cohort study, followed forward from enrollment. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A prospective cohort study, followed forward from enrollment |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2015 — within 20 year(s) of the newest study here |
| Sample size | 1 / 4 | 89 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 438 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 33.7 citations a year over 13 year(s) since 2015 |
| Impact for its field and year | 5 / 6 | Cited 33.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 15 other studies in this library |
| Still being cited | 3 / 4 | Cited 78 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Jacques Yves Montplaisir: h-index 117 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | McGill University: institution h-index 1,373 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 25681454) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 71 / 100 | — |
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