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Subtle gait changes in patients with REM sleep behavior disorder

Authors

  • Eric M. McDade DO,

    1. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    Current affiliation:
    1. Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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    • Dr. McDade and Dr. Boot contributed equally to this work.

  • Brendon P. Boot MBBS,

    1. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    Current affiliation:
    1. Department of Neurology, Brigham and Women's Hospital, Brookline, MA, USA
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    • Dr. McDade and Dr. Boot contributed equally to this work.

  • Teresa J. H. Christianson BSc,

    1. Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    2. Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • V. Shane Pankratz PhD,

    1. Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    2. Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Bradley F. Boeve MD,

    Corresponding author
    1. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    • Correspondence to: Dr. Bradley F. Boeve, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; bboeve@mayo.edu

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  • Tanis J. Ferman PhD,

    1. Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
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  • Kevin Bieniek BS,

    1. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    Current affiliation:
    1. Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
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  • John H. Hollman PT, PhD,

    1. Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Rosebud O. Roberts MBChB,

    1. Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    2. Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Michelle M. Mielke PhD,

    1. Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    2. Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • David S. Knopman MD,

    1. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Ronald C. Petersen PhD, MD

    1. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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  • Funding agencies: NIH, National Institute on Aging (NAI) (U01 AG006786, P50 AG016574, AG015866, R01 AG034676); the Robert H. and Clarice Smith and Abigail Van Buren Alzheimers Disease Research Program of the Mayo Foundation; Mangurian Foundation.

  • Relevant conflicts of interest/financial disclosures: E.M.M., B.P.B., T.J.H.C., J.H.H., K.B.: Nothing to report. V.S.P. receives research support from the NIH. B.F.B. has served as an investigator for clinical trials sponsored by Cephalon, Inc., Allon Pharmaceuticals and GE Healthcare; he receives royalties from the publication of a book entitled Behavioral Neurology of Dementia (Cambridge Medicine, 2009); he serves on the Scientific Advisory Board of the Tau Consortium; he has received honoraria from the American Academy of Neurology; he receives research support from the National Institute on Aging and the Mangurian Foundation. T.J.F receives support from the National Institute on Aging and the Mangurian Foundation. R.O.R. is supported by the NIH/NIA and the Driskill Foundation. M.M.M. receives support from the NIH/NIA and the Lewy Body Dementia Association. D.S.K. serves as Deputy Editor for Neurology; served on a Data Safety Monitoring Board for Lilly Pharmaceuticals; served as a consultant to TauRx, was an investigator in clinical trials sponsored by Baxter, Elan Pharmaceuticals, and Forest Pharmaceuticals in the past 2 years; and receives research support from the NIH. R.C.P. serves on scientific advisory boards for Pfizer, Inc., Janssen Alzheimer Immunotherapy, Elan Pharmaceuticals, and GE Healthcare; receives royalties from the publication of Mild Cognitive Impairment (Oxford University Press, 2003); and receives research support from the NIH/NIA.

ABSTRACT

Many people with rapid eye movement (REM) sleep behavior disorder (RBD) have an underlying synucleinopathy, the most common of which is Lewy body disease. Identifying additional abnormal clinical features may help in identifying those at greater risk of evolving to a more severe syndrome. Because gait disorders are common in the synucleinopathies, early abnormalities in gait in those with RBD could help in identifying those at increased risk of developing overt parkinsonism and/or cognitive impairment. We identified 42 probable RBD subjects and 492 controls using the Mayo Sleep Questionnaire and assessed gait velocity, cadence, and stride dynamics with an automated gait analysis system. Cases and controls were similar in age (79.9 ± 4.7 and 80.1 ± 4.7, P = 0.74), Unified Parkinson's Disease Rating Scale Part III (UPDRS) score (3.3 ± 5.5 and 1.9 ± 4.1, P = 0.21) and Mini–Mental State Examination scores (27.2 ± 1.9 and 27.7 ± 1.6, P = 0.10). A diagnosis of probable RBD was associated with decreased velocity (−7.9 cm/s; 95% confidence interval [CI], −13.8 to −2.0; P < 0.01), cadence (−4.4 steps/min; 95% CI, −7.6 to −1.3; P < 0.01), significantly increased double limb support variability (30%; 95% CI, 6–60; P = 0.01), and greater stride time variability (29%; 95% CI, 2–63; P = 0.03) and swing time variability (46%; 95% CI, 15–84; P < 0.01). Probable RBD is associated with subtle gait changes prior to overt clinical parkinsonism. Diagnosis of probable RBD supplemented by gait analysis may help as a screening tool for disorders of α-synuclein. © 2013 International Parkinson and Movement Disorder Society

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