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Risk Factors for Phenoconversion in Rapid Eye Movement Sleep Behavior Disorder
Zhang H, Iranzo A, Högl B, Arnulf I, Ferini-Strambi L, Manni R, Miyamoto T, Oertel WH et al.. Annals of neurology, 2022-01-24
Topic: Brain proteins, microglia and lab models
Objective This study was undertaken to follow up predictive factors for α-synuclein-related neurodegenerative diseases in a multicenter cohort of idiopathic/isolated rapid eye movement sleep behavior disorder (iRBD). Methods Patients with iRBD from 12 centers underwent a detailed assessment for potential environmental and lifestyle risk factors via a standardized questionnaire at baseline. Patients were then prospectively followed and received assessments for parkinsonism or dementia during follow-up. The cumulative incidence of parkinsonism or dementia was estimated with competing risk analysis. Cox regression analyses were used to evaluate the predictive value of environmental/lifestyle factors over a follow-up period of 11 years, adjusting for age, sex, and center. Results Of 319 patients who were free of parkinsonism or dementia, 281 provided follow-up information. After a mean follow-up of 5.8 years, 130 (46.3%) patients developed neurodegenerative disease. The overall phenoconversion rate was 24.2% after 3 years, 44.8% after 6 years, and 67.5% after 10 years. Patients with older age (adjusted hazard ratio [aHR] = 1.05) and nitrate derivative use (aHR = 2.18) were more likely to phenoconvert, whereas prior pesticide exposure (aHR = 0.21-0.64), rural living (aHR = 0.53), lipid-lowering medication use (aHR = 0.59), and respiratory medication use (aHR = 0.36) were associated with lower phenoconversion risk. Risk factors for those converting to primary dementia and parkinsonism were generally similar, with dementia-first converters having lower coffee intake and beta-blocker intake, and higher occurrence of family history of dementia. Interpretation Our findings elucidate the predictive values of environmental factors and comorbid conditions in identifying RBD patients at higher risk of phenoconversion. ANN NEUROL 2022;91:404-416.
Key findings
- Results Of 319 patients who were free of parkinsonism or dementia, 281 provided follow-up information.
- The overall phenoconversion rate was 24.2% after 3 years, 44.8% after 6 years, and 67.5% after 10 years.
- Patients with older age (adjusted hazard ratio [aHR] = 1.05) and nitrate derivative use (aHR = 2.18) were more likely to phenoconvert, whereas prior pesticide exposure (aHR = 0.21-0.64), rural living (aHR = 0.53), lipid-lowering medication use (aHR = 0.59), and respiratory medication use (aHR = 0.36) were associated with lower phenoconversion risk.
- Interpretation Our findings elucidate the predictive values of environmental factors and comorbid conditions in identifying RBD patients at higher risk of phenoconversion.
Why it matters
This study followed people with a sleep disorder to see who developed neurodegenerative disease, including dementia. It found that older age and use of nitrate derivatives were linked to higher risk, while some other factors were linked to lower risk, but it does not test any treatment or cure for Alzheimer's disease.
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Study details
- Participants319
- Effect size46.3%; 24.2%; 44.8%
- Evidence strengthModerate
How this study scored 58/100
Published in a leading specialty journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Annals of neurology) |
| Journal's citation record | 3 / 4 | Annals of Neurology: journal h-index 437 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| 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 | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 2 / 4 | 319 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| 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 | 4 / 7 | Cited 61 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 10.2 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 3 / 6 | Cited 6.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 37 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Ronald B. Postuma: h-index 90 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Washington University in St. Louis: institution h-index 1,962 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 26 institution(s) in 10 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 34981563) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 58 / 100 | — |
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Read the original
- DOI: 10.1002/ana.26298
- PubMed: 34981563
- Original source →
- Free full text: Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Zhang, H., Iranzo, A., Högl, B., Arnulf, I., Ferini-Strambi, L., Manni, R., et al. (2022). Risk Factors for Phenoconversion in Rapid Eye Movement Sleep Behavior Disorder. Annals of neurology. https://doi.org/10.1002/ana.26298
Vancouver
Zhang H, Iranzo A, Högl B, Arnulf I, Ferini-Strambi L, Manni R, et al. Risk Factors for Phenoconversion in Rapid Eye Movement Sleep Behavior Disorder. Annals of neurology. 2022. doi:10.1002/ana.26298. PMID: 34981563.
BibTeX
@article{zhang2022-34981563,
author = {Zhang, H. and Iranzo, A. and Högl, B. and Arnulf, I. and Ferini-Strambi, L. and Manni, R. and Miyamoto, T. and Oertel, W. H. and others},
title = {{Risk Factors for Phenoconversion in Rapid Eye Movement Sleep Behavior Disorder}},
journal = {Annals of neurology},
year = {2022},
doi = {10.1002/ana.26298},
pmid = {34981563},
url = {https://doi.org/10.1002/ana.26298}
}
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