0888 Individuals with REM sleep behavior disorder show increased parkinsonism with comorbid neurotrauma: A NAPS Consortium substudy

Abstract Introduction Introduction: Rapid eye movement (REM) sleep behavior disorder (RBD) is strongly associated with progressive phenoconversion to an overt synucleinopathy (e.g., parkinsonism). Neurotrauma [i.e., traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD)], increases the odds of RBD diagnosis by ~2.5-fold and is associated with an increased later diagnosis of Parkinson’s Disease (PD), a service-connected illness in Veterans. Thus, RBD and neurotrauma are both independently associated with parkinsonism; however, it is unclear how neurotrauma influences neurological symptoms and exam findings in patients with RBD. Methods Methods: Participants ≥18 years of age with overnight polysomnogram-confirmed RBD were enrolled between 8/2018 to 4/2021 as part of the North American Prodromal Synucleinopathy (NAPS) Consortium. Standardized assessments for RBD, TBI, and PTSD history, as well as cognitive, motor, sensory and autonomic function were completed. This sub-study applied a cross-sectional, case-control (1:4 ratio) analysis comparing cases (n=24; RBD+TBI+PTSD) to controls (n=96; RBD) matched for age (±2 years), sex, and years of education (±2 years). Results Results: Participants with neurotrauma reported an earlier age of RBD symptom onset and more severe RBD phenotype, more severe anxiety and depression, greater frequency of hypertension, and significantly worse cognitive, motor, and autonomic function compared to participants without neurotrauma. Conclusion Conclusion: This cross-sectional, matched case:control study showed that individuals with comorbid neurotrauma and RBD have significantly worse neurological outcomes related to common features of early parkinsonism. Although confirmatory longitudinal studies are still ongoing, these results may be a sign of further/faster progression of synucleinopathy in those with comorbid neurotrauma and RBD. Support (if any) Support: NIH R34 AG056639, NIH U19 AG071754, VA RRD 1K2 RX002947, Parkinsons Center of Oregon