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Significance of hyposmia in isolated REM sleep behavior disorder

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Abstract

Objective

To determine if hyposmia in isolated REM sleep behavior disorder (IRBD) predicts short-term conversion to any α-synucleinopathy and declines with time.

Methods

Olfaction was tested using the University of Pennsylvania Smell Identification Test (UPSIT-40) in 140 consecutive patients with polysomnography-confirmed IRBD and in 77 matched controls. Patients were followed-up during 5.6 ± 3.9 (range 0.2–13) years. Twenty-one patients underwent serial UPSIT-40 evaluations at 1–3 and 4–6 years after baseline.

Results

UPSIT-40 score was lower in patients than in controls (20.2 ± 6.5 vs. 28.6 ± 5.0; p < 0.001). Hyposmia (UPSIT-40 score < 19 points) occurred in 42.9% patients. Forty-three (30.7%) patients developed Parkinson disease (PD = 27), dementia with Lewy bodies (DLB = 13) and multiple system atrophy (MSA = 3). Kaplan–Meier analysis showed that hyposmics had higher risk than normosmics to develop a synucleinopathy at the short term (p = 0.030). UPSIT-40 score was similar between patients who developed PD and DLB (p = 0.136). Normal smell occurred in all three (100%) IRBD patients who developed MSA, 12 of 27 (44%) who developed PD, and 4 of 13 (31%) that developed DLB. Serial UPSIT-40 evaluations showed no changes with time (p = 0.518).

Conclusion

In IRBD, hyposmia is a short-term risk for synucleinopathies but cannot distinguish underlying PD from DLB. Normosmia not only occurs in latent MSA but also in latent PD and DLB. In future IRBD neuroprotective trails, individuals at entry could be enriched for hyposmia, whereas serial evaluation of smell would not be useful to monitor the efficacy of a therapeutic intervention.

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Availability of data and material

The data that support the findings of this study are available by request to the corresponding author.

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Funding

This study was not funded.

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Author notes

  1. Alex Iranzo and Paula Marrero-González contributed equally.

Authors and Affiliations

  1. Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Alex Iranzo, Paula Marrero-González, Mónica Serradell, Carles Gaig & Joan Santamaria

  2. Otorhinolaryngology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, CIBER Enfermedades Respiratorias, Bunyola, Spain

    Isabel Vilaseca

Authors
  1. Alex Iranzo
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  2. Paula Marrero-González
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  3. Mónica Serradell
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  4. Carles Gaig
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  5. Joan Santamaria
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  6. Isabel Vilaseca
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Corresponding author

Correspondence to Alex Iranzo.

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Conflicts of interest

None of the authors had conflicts of interest or competing interests regarding this study.

Ethical approval

This human study has been approved by our local ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Iranzo, A., Marrero-González, P., Serradell, M. et al. Significance of hyposmia in isolated REM sleep behavior disorder. J Neurol 268, 963–966 (2021). https://doi.org/10.1007/s00415-020-10229-3

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  • DOI: https://doi.org/10.1007/s00415-020-10229-3

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