EBioMedicineOct 8, 2026

Understanding early brain types and gut imbalance in isolated REM sleep behavior disorder linked to α-synuclein problems

Gut-Brain Axis Weekly Brief ↗PubMed ↗DOI ↗

Updated Oct 9, 2026

Abstract

Two distinct clinical-neuroimaging biotypes have been identified in isolated REM sleep behavior disorder (iRBD).

Biotype 1 is characterized by widespread atrophy in cortical, subcortical, and cerebellar regions, along with motor and cognitive deficits.
Biotype 2 shows preserved brain structure and neurocognition.
The gut-brain axis may play a role in early alpha-synucleinopathies.
The relationship between the gut-brain axis and the divergent phenotypes of iRBD has not yet been investigated.

Simplified

Isolated/idiopathic REM sleep behaviour disorder (iRBD) is a specific prodrome of α-synucleinopathies. We previously identified two distinct clinical-neuroimaging biotypes in iRBD: Biotype 1, marked by widespread cortical-subcortical-cerebellar atrophy with motor and cognitive deficits, and Biotype 2, with preserved brain structure and neurocognition. Converging evidence implicates the gut-brain axis in early α-synucleinopathy, yet its role in these divergent iRBD phenotypes remains unexplored.

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Understanding early brain types and gut imbalance in isolated REM sleep behavior disorder linked to α-synuclein problems

Abstract

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