Electroencephalogram Rhythmic and Arrhythmic Spectral Components and Functional Connectivity at Resting State May Predict the Development of Synucleinopathies in Idiopathic Rapid Eye Movement Sleep Behavior Disorder

Study Objectives Idiopathic/isolated rapid eye movement-sleep behavior disorder (iRBD) often precedes the onset of synucleinopathies. Here, we investigated whether baseline resting-state EEG advanced spectral power and functional connectivity differed between iRBD patients who converted towards a synucleinopathy at follow-up and those who did not.Methods Eighty-one participants with iRBD (66.89 +/- 6.91 years) underwent a baseline resting-state EEG recording, a neuropsychological assessment, and a neurological examination. We estimated EEG power spectral density using standard analyses and derived spectral estimates of rhythmic and arrhythmic components. Global and pairwise EEG functional connectivity analyses were computed using the weighted phase-lag index (wPLI). Pixel-based permutation tests were used to compare groups.Results After a mean follow-up of 5.01 +/- 2.76 years, 34 patients were diagnosed with a synucleinopathy (67.81 +/- 7.34 years) and 47 remained disease-free (65.53 +/- 7.09 years). Among patients who converted, 22 were diagnosed with Parkinson's disease and 12 with dementia with Lewy bodies. As compared to patients who did not convert, patients who converted exhibited at baseline higher relative theta standard power, steeper slopes of the arrhythmic component and higher theta rhythmic power mostly in occipital regions. Furthermore, patients who converted showed higher beta global wPLI but lower alpha wPLI between left temporal and occipital regions.Conclusions Analyses of resting-state EEG rhythmic and arrhythmic components and functional connectivity suggest an imbalanced excitatory-to-inhibitory activity within large-scale networks, which is associated with later development of a synucleinopathy in patients with iRBD. Graphical Abstract