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Progression markers are needed to determine the neurodegenerative changes and to predict their conversion. Brain imaging with <jats:sup>18<\/jats:sup>F-FDG PET in iRBD is promising, but longitudinal studies are scarce. We investigated the regional brain changes in iRBD over time, related to phenoconversion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twenty iRBD patients underwent two consecutive <jats:sup>18<\/jats:sup>F-FDG PET brain scans and clinical assessments (3.7\u2009\u00b1\u20090.6\u00a0years apart). Seventeen patients also underwent <jats:sup>123<\/jats:sup>I-MIBG and <jats:sup>123<\/jats:sup>I-FP-CIT SPECT scans at baseline. Four subjects phenoconverted to Parkinson\u2019s disease (PD) during follow-up. <jats:sup>18<\/jats:sup>F-FDG PET scans were compared to controls with a voxel-wise single-subject procedure. The relationship between regional brain changes in metabolism and PD-related pattern scores (PDRP) was investigated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Individual hypometabolism t-maps revealed three scenarios: (1) normal <jats:sup>18<\/jats:sup>F-FDG PET scans at baseline and follow-up (<jats:italic>N<\/jats:italic>\u2009=\u200910); (2) normal scans at baseline but occipital or occipito-parietal hypometabolism at follow-up (<jats:italic>N<\/jats:italic>\u2009=\u20094); (3) occipital hypometabolism at baseline and follow-up (<jats:italic>N<\/jats:italic>\u2009=\u20096). All patients in the last group had pathological <jats:sup>123<\/jats:sup>I-MIBG and <jats:sup>123<\/jats:sup>I-FP-CIT SPECT. iRBD converters (<jats:italic>N<\/jats:italic>\u2009=\u20094) showed occipital hypometabolism at baseline (third scenario). At the group level, hypometabolism in the frontal and occipito-parietal regions and hypermetabolism in the cerebellum and limbic regions were progressive over time. PDRP <jats:italic>z<\/jats:italic>-scores increased over time (0.54\u2009\u00b1\u20090.36 per year). PDRP expression was driven by occipital hypometabolism and cerebellar hypermetabolism.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our results suggest that occipital hypometabolism at baseline in iRBD implies a short-term conversion to PD. This might help in stratification strategies for disease-modifying trials.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00259-023-06289-y","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T06:02:41Z","timestamp":1686636161000},"page":"3290-3301","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Occipital hypometabolism is a risk factor for conversion to Parkinson\u2019s disease in isolated REM sleep behaviour disorder"],"prefix":"10.1007","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7216-2031","authenticated-orcid":false,"given":"Giulia","family":"Carli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanne K.","family":"Meles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Janzen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Sittig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalie V.","family":"Kogan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Perani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang H.","family":"Oertel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus L.","family":"Leenders","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the REMPET Working Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"6289_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2017.157","author":"B H\u00f6gl","year":"2018","unstructured":"H\u00f6gl B, Stefani A, Videnovic A. 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He has received honoraria for educational presentations at symposia by AbbVie and Stada Pharma and in his role as a consultant\/member of an advisory board for the companies Intrabio, Lario Therapeutics, Modag, and Novartis. He holds shares from the companies BioNTech, CureVac, Formycon, Medigene, and MorphoSys. All these activities and relations are unrelated to the work submitted. There is no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}