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Across modalities, functional magnetic resonance imaging (fMRI) may be better suited to identify changes between neural networks in the earliest stages of Lewy body diseases when structural changes may be subtle or absent. This review synthesizes the findings from all fMRI studies of RBD to gain further insight into the pathophysiology and progression of Lewy body diseases. A total of 32 studies were identified using a systematic review conducted according to PRISMA guidelines between January 2000 to February 2024 for original fMRI studies in patients with either isolated RBD (iRBD) or RBD secondary to PD. Common functional alterations were detectable in iRBD patients compared with healthy controls across brainstem nuclei, basal ganglia, frontal and occipital lobes, and whole brain network measures. Patients with established PD and RBD demonstrated decreased functional connectivity across the whole brain and brainstem nuclei, but increased functional connectivity in the cerebellum and frontal lobe compared with those PD patients without RBD. Finally, longitudinal changes in resting state functional connectivity were found to track with disease progression. Currently, fMRI studies in RBD have demonstrated early signatures of neurodegeneration across both motor and non\u2010motor pathways. Although more work is needed, such findings have the potential to inform our understanding of disease, help to distinguish between prodromal PD and prodromal dementia with Lewy bodies, and support the development of fMRI\u2010based outcome measures of phenoconversion and progression in future disease modifying trials. \u00a9 2024 The Author(s).\n                    <jats:italic>Movement Disorders<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.\n                  <\/jats:p>","DOI":"10.1002\/mds.29898","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T05:19:43Z","timestamp":1719465583000},"page":"1679-1696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Understanding\n                    <scp>REM<\/scp>\n                    Sleep Behavior Disorder through Functional\n                    <scp>MRI<\/scp>\n                    : A Systematic Review"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7150-4142","authenticated-orcid":false,"given":"Lachlan","family":"Churchill","sequence":"first","affiliation":[{"name":"Central Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Chi","family":"Chen","sequence":"additional","affiliation":[{"name":"Brain Dynamic Centre Westmead Institute for Medical Research  Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon J.G.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Macquarie Medical School and Macquarie University Centre for Parkinson's Disease Research, Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales 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