Impaired Visual Perception in Rapid Eye Movement Sleep Behavior Disorder

Objective: Patients with idiopathic REM sleep behavior disorder (iRBD) often develop synucleinopathies (Parkinson's disease [PD], in particular). Cognitive disorders affecting different domains have been reported in patients with iRBD. Dysexecutive disorders seem to predominate, but there is no consensus on the nature of visuospatial disorders in iRBD. The objective is to identify and characterize visuospatial disorders in patients with REM sleep behavior disorder (RBD - either idiopathic or associated with PD). Methods: Fifteen patients with iRBD, 30 patients with PD (15 of whom had RBD), and 20 healthy control subjects underwent an extensive assessment of visuospatial functions. Two computerized tasks were used: a Biederman task (to assess the 3 levels of visuoperceptive processing) and a Posner paradigm (to assess visual attention). Results: The visual priming effects classically described for the Biederman task in healthy controls were not found in iRBD patients. Patients with iRBD were no quicker in naming objects with the same general structure as previously presented objects but did have a normal priming effect for strictly identical objects. Parkinson's disease patients with RBD had poorer visuoperceptive performance levels than PD patients without RBD. There were no significant differences between the 4 groups in the Posner attentional task. Conclusions: First, this study confirms the presence of visuoperceptive dysfunction in iRBD patients and revealed a selective defect in intermediate visuoperceptive processing (i.e., general object representation). Second, RBD in PD appeared to be associated with poorer visuoperceptive abilities. Third, this visuoperceptive dysfunction in RBD patients was not associated with impaired attention.