Cholinergic Nucleus 4 Degeneration and Cognitive Impairment in Isolated Rapid Eye Movement Sleep Behavior Disorder

Mov Disord. 2023 Mar;38(3):474-479. doi: 10.1002/mds.29306. Epub 2023 Jan 4.

Abstract

Background: Cholinergic nucleus 4 (Ch4) degeneration is associated with cognitive impairment in Parkinson's disease and dementia with Lewy bodies, but it is unknown if Ch4 degeneration is also present in isolated rapid eye movement sleep behavior disorder (iRBD).

Objective: The aim was to determine if there is evidence of Ch4 degeneration in patients with iRBD and if it is associated with cognitive impairment.

Methods: We analyzed the clinical and neuropsychological data of 35 iRBD patients and 35 age- and sex-matched healthy controls. Regional gray matter density (GMD) was calculated for Ch4 using probabilistic maps applied to brain magnetic resonance imaging (MRI).

Results: Ch4 GMD was significantly lower in the iRBD group compared to controls (0.417 vs. 0.441, P = 0.02). Ch4 GMD was also found to be a significant predictor of letter number sequencing (β-coefficient = 58.31, P = 0.026, 95% confidence interval [7.47, 109.15]), a measure of working memory.

Conclusions: iRBD is associated with Ch4 degeneration, and Ch4 degeneration in iRBD is associated with impairment in working memory. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: cholinergic basal forebrain; cognitive impairment; magnetic resonance imaging; rapid eye movement sleep behavior disorder; voxel-based morphometry; working memory.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Basal Nucleus of Meynert* / diagnostic imaging
  • Basal Nucleus of Meynert* / pathology
  • Cognitive Dysfunction* / complications
  • Cognitive Dysfunction* / diagnostic imaging
  • Cognitive Dysfunction* / pathology
  • Female
  • Gray Matter / diagnostic imaging
  • Gray Matter / pathology
  • Hippocampus / diagnostic imaging
  • Hippocampus / pathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Neural Pathways
  • Olfactory Bulb / diagnostic imaging
  • Olfactory Bulb / pathology
  • REM Sleep Behavior Disorder* / complications
  • REM Sleep Behavior Disorder* / diagnostic imaging
  • REM Sleep Behavior Disorder* / pathology