• anxiety
• depression
• disease registries
• mood disorder
• neurodegeneration
• RBD
• REM behaviour disorder
• sleep disorder
• sleep medicine
• synucleinopathy

Isolated REM behaviour disorder (iRBD) is a REM sleep parasomnia with a high risk of phenoconversion to synucleinopathy. For this thesis, data were collected from iRBD patients of the French (n=141) and Pisa subset (n=23) of the Italian national registry, focusing on mood disorders assessed with the Hospital Anxiety and Depression Scale (HADSA and HADSD).
The aims were to explore: anxiety and depression longitudinal evolution, their role in phenoconversion, their clinical correlations and their correlation with other mood scales.
In the French cohort a decrease of HADSA (-1.1, p 0.012) and HADSD (-0.7, p 0.039) scores was detected in the first year after RBD diagnosis, to then remain stable for anxiety and increase (+0.24, p 0.016) yearly for depression. HADSA was increased in women (p 0.001), by sleepiness (p< 0.001). HADSD increase was associated with progressive cognitive impairment (p 0.03). Anxiety did not increase the risk of conversion to synucleinopathy (p.2017) but depression did (HR 1.26, p 0.011).
In patients from Pisa, mood disorder history increased HADSA and HADSD scores by 3 and 4 units (p 0.03, p 0.01). The PAS anxiety scale and its subscale PAS A correlated significantly with HADSA (rho 0.551 to 0.645) but there was a lack of agreement with a consistent bias where HADSA scores were 5.3 to 1.7 points lower.
In summary, after a transient initial amelioration of mood alteration depression symptoms worsened over time in RBD, in associated with cognitive worsening and an increasing the risk of phenoconversion. Anxiety levels instead were stable and did not impact on conversion. Despite moderate-strong correlations with other scales, anxiety measurements agreement was low and potentially biased.