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AAN 2023 | RBD phenoconversion and predictors of progression

Eric Geil, MD, Miami Veterans Affairs Healthcare System, Miami, FL, discusses isolated REM sleep behavior disorder (RBD) phenoconversion to alpha-synucleinopathies. The total rate of phenoconversion is between 50-90%, with a rate of 8-9% per year. Techniques for predicting which patients are at risk of phenoconversion are still in their infancy. Clinically, hyposmia and orthostatic hypotension can be monitored. In the future, genetic testing and biopsies may be the most helpful. Peripheral tissues with autonomic innervation have been shown to accumulate alpha-synuclein earlier than other tissues, so biopsies monitoring alpha-synuclein in peripheral tissue may be an important tool for predicting whether RBD patients will develop alpha-synucleinopathies. Ongoing studies are investigating potential medication to intervene during isolated RBD. Currently, the option with the most data supporting it is exercise. This interview took place at the American Academy of Neurology Annual Meeting 2023 in Boston, MA.

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