アプローチは見事。
機能的疾患から
器質的疾患への変容は
以前も取り上げましたが、
機能的疾患の代表である
大うつが、
RBDを併発して来ると、
器質的疾患である
αシヌクレイノパチーの
初期段階の可能性ありと。
嗅覚機能障害も
この仮説を
支持すると思います。
Reduced
striatal
Authors
Wing YK1,
Lam SP2,
Zhang J2,
Leung E2,
Ho CL2,
Chen S2,
Cheung MK2,
Li SX2,
Chan JW2,
Mok V2,
Tsoh J2,
Chan A2,
Ho CK2.
Author information
1From the Department
of Psychiatry
and
the Department
of Medicine
and Therapeutics,
Faculty of Medicine,
The Chinese University
of Hong Kong,
Shatin, Hong Kong SAR;
and Nuclear Medicine & PET,
Hong Kong
Reduced
striatal
dopamine
transmission
in
in
REM sleep
behavior disorder
comorbid with
depression.
Authors
Wing YK1,
Lam SP2,
Zhang J2,
Leung E2,
Ho CL2,
Chen S2,
Cheung MK2,
Li SX2,
Chan JW2,
Mok V2,
Tsoh J2,
Chan A2,
Ho CK2.
Author information
1From the Department
of Psychiatry
and
the Department
of Medicine
and Therapeutics,
Faculty of Medicine,
The Chinese University
of Hong Kong,
Shatin, Hong Kong SAR;
and Nuclear Medicine & PET,
Hong Kong
Sanatorium & Hospital.
2From the Department
of Psychiatry
and
the Department
of Medicine
and Therapeutics,
Faculty of Medicine,
The Chinese University
of Hong Kong,
Shatin, Hong Kong SAR;
and Nuclear Medicine & PET,
Hong Kong
2From the Department
of Psychiatry
and
the Department
of Medicine
and Therapeutics,
Faculty of Medicine,
The Chinese University
of Hong Kong,
Shatin, Hong Kong SAR;
and Nuclear Medicine & PET,
Hong Kong
Sanatorium & Hospital.
Journal
Neurology. 2015 Jan 7.
pii: 10.1212/
WNL.0000000000001215.
Abstract
OBJECTIVE:
CONCLUSION:
Journal
Neurology. 2015 Jan 7.
pii: 10.1212/
WNL.0000000000001215.
Abstract
OBJECTIVE:
To investigate
dopamine transmission
in patients with
comorbid REM sleep
behavior disorder
(RBD) and
major
depressive disorder
(MDD).
METHODS:
METHODS:
This is a case-control study
including
11 medicated patients
with comorbid RBD and MDD
(mean age 47.5 ± 8.2),
8 medicated patients
with MDD only
(mean age 47.9 ± 8.4),
and
10 healthy participants
(mean age 46.5 ± 10.6 years).
They underwent
clinical assessment,
video-polysomnography,
olfactory tests,
and neuroimaging studies
((18)F-DOPA, (11)C-raclopride,
and
(18)F-FDG PET neuroimaging).
RESULTS:
RESULTS:
Compared with
the 2 control groups,
patients
with comorbid RBD and MDD
had significantly
lower (18)F-DOPA uptake
at 60 minutes
in the putamen and caudate
after controlling for age
and sex effect (p < 0.05).
There were
no significant differences
for the (11)C-raclopride
and (18)F-FDG-PET.
The (18)F-DOPA uptake
in putamens
had significant
inverse correlation with
severity of RBD symptoms
(p < 0.01)
and
REM-related
tonic muscle activity
(p < 0.01).
The comorbid
RBD and MDD group
had more impairment
in olfactory function.
CONCLUSION:
Patients
with comorbid RBD and MDD
had presynaptic
dopamine dysfunction
and
impaired olfactory function.
There is a distinct possibility
that the development
of RBD symptoms
among patients with MDD
may represent
an early phase
of α-synucleinopathy
neurodegeneration
instead of a
merely
antidepressant
-induced condition.