Longitudinal Changes in Diffusion Tensor Imaging Along the Perivascular Space in REM sleep behavior
Poster No:
93
Submission Type:
Abstract Submission
Authors:
JUNGICK BYUN1, Won Chul Shin1, Ki-Young Jung2
Institutions:
1Kyung Hee University Hospital at Gangdong, Seoul, Seoul, 2Seoul National University Hospital, Seoul, Seoul
First Author:
Co-Author(s):
Introduction:
Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) often progresses to neurodegenerative diseases characterized by alpha-synuclein pathology. The glymphatic system plays a crucial role in clearing waste products, including alpha-synuclein, and its dysfunction is believed to contribute to neurodegeneration. Diffusion tensor imaging along the perivascular space (DTI-ALPS) evaluates water movement along perivascular spaces and is a validated measure of glymphatic function. This study investigated whether DTI-ALPS differs in iRBD patients who develop neurodegenerative disease and tracked longitudinal changes in DTI-ALPS using repeated imaging.
Methods:
Fifty patients with video-polysomnography-confirmed iRBD who underwent baseline magnetic resonance imaging (MRI) were followed for at least 3 years. Twenty age- and sex-matched controls were also included. DTI-ALPS indices were calculated and compared between iRBD patients who converted to a neurodegenerative disease (iRBD-C) and those who did not (iRBD-NC), as well as with the controls. Thirty iRBD patients and 5 controls underwent repeat MRI after a mean of 40.9 ± 10.1 months.
Results:
The mean duration of RBD symptoms was 5.6 ± 4.7 years. Fourteen iRBD patients converted to Parkinson's disease (PD) (n=10), multiple system atrophy with cerebellar features (MSA-C) (n=3), or dementia with Lewy bodies (DLB) (n=1) after 25.8 ± 20.3 months from baseline imaging. At baseline, DTI-ALPS index differed significantly between controls, iRBD-C, and iRBD-NC groups (p=0.035). Post-hoc analysis revealed lower DTI-ALPS index in the iRBD-C group compared to controls (p=0.033). Longitudinal follow-up showed a significant decrease in DTI-ALPS index in iRBD patients (baseline 1.38 ± 0.17, follow-up 1.34 ± 0.17, p=0.003). Compared to controls, the DTI-ALPS index in iRBD patients was lower only at follow-up (p=0.018), but not at baseline (p=0.106).
·(Left) Value of diffusion-tensor imaging analysis along the perivascular space (ALPS) reflecting perivascular glymphatic flow in three groups [control group, iRBD patients who converted to a neurodege
Conclusions:
Difference in baseline ALPS index was observed between the controls and RBD-C but not between the controls and RBD-NC. Thirty of the iRBD patients underwent follow-up image, and showed significant longitudinal decrease in the ALPS index, even though clinical marker unchanged during follow-up. Baseline DTI-ALPS index was associated with phenoconversion to alpha-synucleinopathy in iRBD patients. Decreases in DTI-ALPS index on serial imaging may reflect neurodegenerative progression in iRBD.
Disorders of the Nervous System:
Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s) 1
Modeling and Analysis Methods:
Diffusion MRI Modeling and Analysis 2
Keywords:
Other - REM sleep behavior disorder; DTI-ALPS; neurodegeneration
1|2Indicates the priority used for review
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Provide references using APA citation style.
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