World Sleep 2022 | The importance of disease modifying therapy in iRBD
Aleksander Videnovic, MD, Massachusetts General Hospital, Harvard Medical School, Boston, MA, explains the drive to focus on disease-modifying therapies for patients diagnosed with isolated REM behavior disorder (iRBD). It is now widely accepted that iRBD represents a prodrome for neurodegenerative diseases, including Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy. Dr Videnovic postulates that early intervention in iRBD would translate into greatly reduced pathological burden in later disease stages. This interview took place during the World Sleep Congress 2022 in Rome, Italy.
Transcript (edited for clarity)
Why is RBD important for these neurodegenerative diseases and clinical trials in that space? Well, we now clearly understand that REM sleep behavior disorder, although a sleep disorder, also represents a prodrome into a neurodegeneration that is associated with accumulation of this pathological alpha-synuclein protein, and hence these disorders that RBD is a prodrome of what we call synucleinopathies...
Why is RBD important for these neurodegenerative diseases and clinical trials in that space? Well, we now clearly understand that REM sleep behavior disorder, although a sleep disorder, also represents a prodrome into a neurodegeneration that is associated with accumulation of this pathological alpha-synuclein protein, and hence these disorders that RBD is a prodrome of what we call synucleinopathies. Alright, and this is especially true for individuals with the REM sleep behavior disorder who are age 50 or above. This is a group that has a very, very high risk of developing one of these neurodegenerative disorders as the disease progresses, and certainly if they have a well diagnosed and confirmed, which is very important, isolated REM sleep behavior disorder.
The idea here is since REM sleep behavior disorder starts many, many years, sometimes before the onset of these other neurodegenerative disorders, that if we apply potential therapeutic strategies early on in this process of neurodegeneration, for example, while the patient is having isolated REM sleep behavior disorder, we have a much bigger chance of modifying that neurodegenerative process, and it helps to arrest it of course. Then if we wait, if somebody progresses to develop what we now diagnose with Parkinson’s disease or with dementia with Lewy body, then neuronal loss and pathology in the brain can be quite advanced and we may not be able to reverse, or stop the process at that point.
That’s why the study of disease modifying therapies in REM sleep behavior disorder is becoming increasingly important for all of these neurodegenerative disorders that are associated with REM sleep behavior disorder. Specifically these are Parkinson’s disease, dementia with Lewy body and multiple system atrophy.
Read more...
