A Comprehensive, Multimodal Characterization of Prodromal PD in Subjects With RBD (7T-RBD)
Comprehensive characterization of early-stage Parkinson's disease in patients with REM sleep behavior disorder
Parkinson's disease (PD) is the fastest-growing neurodegenerative disorder worldwide, significantly affecting quality of life and causing substantial social and economic burdens. Currently, treatments for Parkinson's disease primarily manage symptoms through medication and lifestyle changes but cannot stop disease progression. By the time Parkinson's disease is diagnosed, substantial nerve-cell loss has already occurred in specific brain areas. Identifying early signs of PD before symptoms fully develop is essential for improving future treatment strategies.
This research project aims to deeply understand the earliest stages of Parkinson's disease by studying patients with REM sleep behavior disorder (RBD). RBD is a condition characterized by unusual movements or behaviors during dream sleep, caused by nerve-cell loss in the brainstem. Importantly, more than 80% of individuals with RBD eventually develop Parkinson's disease or related conditions, such as Dementia with Lewy Bodies or Multiple System Atrophy.
Study Goals:
Our study will examine multiple potential biomarkers (measurable indicators) that could help identify early stages of Parkinson's disease. These include:
- Brain structure changes: The Investigators will use advanced imaging methods (7-Tesla MRI) to closely examine specific brain regions known to be affected early in Parkinson's disease, particularly the substantia nigra and the locus coeruleus (LC). The LC helps regulate sleep and wakefulness, and studies have shown it is damaged in patients with RBD and Parkinson's disease. Additionally, the investigators will use specialized imaging (Pe2i-PET and MIBG-scintigraphy) to measure dopamine availability and changes in heart nerve function.
- Abnormal protein buildup (ɑ-synuclein): In Parkinson's disease, nerve-cell death is linked to abnormal clumping of a protein called ɑ-synuclein within cells. Detecting this abnormal protein buildup early might help identify who is at risk of developing Parkinson's disease. The investigators aim to explore how levels of ɑ-synuclein aggregation relate to other early signs of the disease.
- Functional changes in brain and body: Polysomnography, an overnight sleep test recording brain (EEG) and heart (ECG) activity, is the best method for diagnosing RBD. The investigators will also measure brain activity during wakefulness to further understand early changes.
- Symptoms and physical tests: Participants will undergo thorough clinical assessments, including motor and cognitive tests, as well as tests evaluating autonomic (automatic nervous system) function, such as cardiovascular responses using a tilt-table test.
Together, these extensive assessments will provide a detailed understanding of how Parkinson's disease begins and progresses. This knowledge can greatly improve early diagnosis, allowing earlier and potentially more effective treatments for individuals at high risk.
Study Design:
The investigators will recruit:
- 50 individuals diagnosed with REM sleep behavior disorder
- 50 control participants without major psychiatric or neurological disease, matched by age and gender
THe investigation team have a complete, detailed plan and will begin collecting data as soon as ethical approval is granted.
Main Hypotheses:
Although our extensive data will allow many analyses, the investigation team specifically predict:
- Individuals with RBD will show more significant damage in the locus coeruleus compared to controls.
- Greater damage in the locus coeruleus will correlate with more severe cognitive issues, sleep problems, and autonomic dysfunction.
- Cognitive issues in RBD patients might correlate with specific patterns of damage in different parts of the locus coeruleus. For example, memory problems might be linked to more damage in the front (rostral) part of this region.
Impact:
This study will significantly enhance early detection of Parkinson's disease, paving the way for personalized medical approaches and potentially more effective treatments. Conducted by a multidisciplinary team of experts in brain imaging, sleep medicine, autonomic function, and protein aggregation, this research supports Denmark's leadership in precision clinical imaging and aligns closely with hospital research strategies aimed at understanding and treating chronic diseases. Ultimately, our goal is to improve personalized patient care for Parkinson's disease in the future.
Study Overview
Status
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Sune G Thomsen, MD
- Phone Number: +4552176251
- Email: sune.gram.thomsen.01@regionh.dk
Study Locations
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Hvidovre, Denmark, 2650
- Recruiting
- Danish Research Centre for Magnetic Resonance
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Contact:
- Sune G Thomsen, MD
- Phone Number: +4552176251
- Email: sune.gram.thomsen.01@regionh.dk
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
We have 2 groups; Subjects diagnosed with REM-sleep behaviour disorder via polysomnography Healthy, age- and gendermatched controls.
Our RBD-group will be recruited via an ongoing cohort at a different site (Danish center for sleep medicine), where subjects diagnosed with RBD via polysomnography will be asked to also participate in our cohort, should they fulfill our inclusion criteria.
Controls will be recruited via our own institutions webpage, as well as advertisements on other danish websites such as trialtree.dk.
Description
Inclusion Criteria:
Both groups - The ability to give informed consent
For RBD-group
- Verified REM-sleep behaviour disorder via polysonography
- No other significant neurological and psychiatric ilness
For Healthy controls
- Age matched to RBD-group
Exclusion Criteria:
- Ferrous objects in or around the body
- Pacemaker or other implanted electronic devices
- Drug abuse unrelated to medication or alcohol abuse over a period of 6 months prior to the experiment
- Other major immunological, cardiac, neurological or neuropsychiatric disorders
- Claustrophobia
- Incapability of giving informed consent
- Unwillingness to be informed about abnormal findings.
- Participation in clinical trials involving drug testing over a period of 6 months prior to the experiment.
- Disease symptoms leading to excessive movement inside the scanner (e.g., excessive tremor)
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
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Control Participants
Control participants without known major psychiatric or neurological disease.
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RBD-subjects
Subjects diagnosed with RBD via polysomnography.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Structural disintegraiton of the Locus Coeruleus
Time Frame: Baseline
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One of the main hypotheses is that there will be a strutural pattern of disintegration in the Locus Coeruleus (LC) in our RBD-cohort when compared to controls.
This will be seen as a change in neuromelanin Contrast-to-Noise-Ratio (CNR) in the LC.
We expect this pattern to have a caudo-rostral gradient, as other studies have shown in subjects with Parkinson's Disease.
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Baseline
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Differences in neuromelanin-CNR in the Substantia Nigra pars Compacta in RBD-subjects compared to controls
Time Frame: Baseline
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As with the Locus Coeruleus, it is expected to see altered neuromelanin signal from the SNc in RBD subjects compared to controls
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Baseline
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Motor-task performance
Time Frame: Baseline
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The investigators expect to see group-level differences in motor-task performance with an in-house designed motor-test battery, validated before being put into use.
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Baseline
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Cognitive test performance
Time Frame: Baseline
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The investigators expect to see group-level differences in cognitive test performance, tested with particular tests from the CANTAB-battery, between RBD-subjects and controls, with controls performing better..
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Baseline
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Resting-state EEG
Time Frame: Baseline
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Preliminary data from another study (Manuscript under review) at our site has shown that the aperiodic part of resting-state EEG is able to clearly separate subjects with clinically established Parkinson's Disease from controls. We will test whether this also holds true in the prodromal RBD-state using a short resting-state EEG recording. |
Baseline
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Correlation between LC and autonomic dysfunction.
Time Frame: Baseline
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Loss of LC-CNR will positively correlate with increased burden of autonomic symptoms in RBD-subjects.
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Baseline
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Autonomic, sympathic responses to arousing stimuli
Time Frame: Baseline
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Autonomic responses (Pupil dilation, skin conductance) to arousing stimuli will be changed in RBD-subjects compared to controls, correlating with lowered LC-CNR
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Baseline
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Cardiac sympathetic measures
Time Frame: Baseline
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Cardiac sympathetic nervous function, measures using MIBG-SPECT will be changed in RBD-subjects compared to controls, and correlate positively to the degree of cellular degeneration in the LC.
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Baseline
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Longitudinal outcomes
Time Frame: Through study completion, an average of 1 year
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At follow up, subjects with more progressive cognitive deficits measured via MOCA and CANTAB are hypothesized to show more pronounced change in rostral LC-CNR.
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Through study completion, an average of 1 year
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Longitudinal outcomes
Time Frame: Through study completion, an average of 1 year
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Conversion rates to clinical ɑ-syn (PD, MSA, DLB) will be higher in subjects showing peripheral ɑ-synuclein pathology in blood and/or skin.
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Through study completion, an average of 1 year
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Longitudinal outcomes
Time Frame: Through study completion, an average of 1 year
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Subjects converting to DLB will display more rostral change in LC-CNR than subjects converting to other ɑ-syn.
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Through study completion, an average of 1 year
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Collaborators and Investigators
Publications and helpful links
General Publications
- Doppler K, Jentschke HM, Schulmeyer L, Vadasz D, Janzen A, Luster M, Hoffken H, Mayer G, Brumberg J, Booij J, Musacchio T, Klebe S, Sittig-Wiegand E, Volkmann J, Sommer C, Oertel WH. Dermal phospho-alpha-synuclein deposits confirm REM sleep behaviour disorder as prodromal Parkinson's disease. Acta Neuropathol. 2017 Apr;133(4):535-545. doi: 10.1007/s00401-017-1684-z. Epub 2017 Feb 8.
- Borghammer P, Van Den Berge N. Brain-First versus Gut-First Parkinson's Disease: A Hypothesis. J Parkinsons Dis. 2019;9(s2):S281-S295. doi: 10.3233/JPD-191721.
- Miglis MG, Zitser J, Schneider L, During E, Jaradeh S, Freeman R, Gibbons CH. Cutaneous alpha-synuclein is correlated with autonomic impairment in isolated rapid eye movement sleep behavior disorder. Sleep. 2021 Dec 10;44(12):zsab172. doi: 10.1093/sleep/zsab172.
- Sakakibara R, Tateno F, Aiba Y, Ogata T, Kishi M, Terada H, Inaoka T, Nakatsuka T, Matsuoka K. MIBG Myocardial Scintigraphy Identifies Premotor PD/DLB During a Negative DAT Scan Period: Second Report. Mov Disord Clin Pract. 2018 Nov 9;6(1):46-50. doi: 10.1002/mdc3.12697. eCollection 2019 Jan.
- Pitton Rissardo J, Fornari Caprara AL. Cardiac 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy in Parkinson's Disease: A Comprehensive Review. Brain Sci. 2023 Oct 18;13(10):1471. doi: 10.3390/brainsci13101471.
- Madelung CF, Lokkegaard A, Fuglsang SA, Marques MM, Boer VO, Madsen KH, Hejl AM, Meder D, Siebner HR. High-resolution mapping of substantia nigra in Parkinson's disease using 7 tesla magnetic resonance imaging. NPJ Parkinsons Dis. 2025 May 6;11(1):113. doi: 10.1038/s41531-025-00972-7.
- Madelung CF, Meder D, Fuglsang SA, Marques MM, Boer VO, Madsen KH, Petersen ET, Hejl AM, Lokkegaard A, Siebner HR. Locus Coeruleus Shows a Spatial Pattern of Structural Disintegration in Parkinson's Disease. Mov Disord. 2022 Mar;37(3):479-489. doi: 10.1002/mds.28945. Epub 2022 Feb 3.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Mental Disorders
- Metabolic Diseases
- Neurodegenerative Diseases
- Sleep Wake Disorders
- Movement Disorders
- Parkinsonian Disorders
- Basal Ganglia Diseases
- Proteostasis Deficiencies
- Parasomnias
- REM Sleep Parasomnias
- Nutritional and Metabolic Diseases
- Synucleinopathies
- Parkinson Disease
- REM Sleep Behavior Disorder
- Parkinson Disease 4, Autosomal Dominant Lewy Body
Other Study ID Numbers
- 7T-RBD
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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