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To sleep, perchance to dement: RBD and cognitive decline in Parkinson's disease

Up to 80% of people with Parkinson’s disease (PD) will develop dementia during their disease course. In some cases, the onset of dementia is relatively early, while in others it tends to be a late feature. Regardless of disease duration, current age is currently the biggest risk factor identified for dementia risk. The development of disease-modifying treatments to delay or abort the onset of cognitive decline in PD will bring a number of challenges, not least the identification of subgroups of patients most likely to benefit in a timely and cost–effective way. In this context, derivation of a risk ‘‘matrix,’’ using clinical and possibly other supportive biomarker data (eg, functional imaging using amyloid-binding ligands, cerebrospinal fluid analysis, or genotypic markers) to categorize patients into high, medium, and low risk, would be a logical and helpful move forward. Other than age, motor phenotype, early visual hallucinations, certain patterns of mild cognitive impairment, and possibly mood disturbance have all been associated with an increased risk of developing dementia in PD (PDD), although the positive predictive value for these features has either yet to be established or is suboptimal.