The Motor Dysfunction Seen in Isolated REM Sleep Behavior Disorder

Abstract Background Isolated Rapid Eye Movement (REM) sleep Behavior Disorder (iRBD) requires quantitative tools to detect incipient Parkinson's disease (PD). Methods A motor battery was designed and compared with the Movement Disorder Society‐Unified Parkinson's Disease Rating Scale part III (MDS‐UPDRS‐III) in people with iRBD and controls. This included two keyboard‐based tests (BRadykinesia Akinesia INcoordination tap test and Distal Finger Tapping) and two dual tasking tests (walking and finger tapping). Results We included 33 iRBD patients and 29 controls. The iRBD group performed both keyboard‐based tapping tests more slowly ( P < 0.001, P = 0.020) and less rhythmically ( P < 0.001, P = 0.006) than controls. Unlike controls, the iRBD group increased their walking duration ( P < 0.001) and had a smaller amplitude ( P = 0.001) and slower ( P = 0.007) finger tapping with dual task. The combination of the most salient motor markers showed 90.3% sensitivity for 89.3% specificity (area under the ROC curve AUC, 0.94), which was higher than the MDS‐UPDRS‐III (minus action tremor) (69.7% sensitivity, 72.4% specificity; AUC, 0.81) for detecting motor dysfunction. Conclusion Speed, rhythm, and dual task motor deterioration might be accurate indicators of incipient PD in iRBD. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.