Session Schedule

Find a specific presentation in the session by navigating to the timestamp indicated below.

0:00:00
Introduction

0:03:35
Clinical biomarkers in iRBD: Foundations for precision and integration
Luca Baldelli (Italy)

0:20:22
Molecular and metabolic imaging biomarkers: What’s missing?
Beatrice Orso (Italy)

0:34:28
Electrophysiology and digital biomarkers: Automated monitoring of progression and phenoconversion in iRBD
Matteo Cesari (Austria)

 0:49:54
Recent developments in diagnostic, prognostic, and disease-monitoring wet biomarkers in iRBD
Bei Huang (Hong Kong)

1:07:10
The ideal biomarker(s): From big data to personalized medicine
Bradley Boeve (United States)

1:17:00
Question and answer

Summary

Isolated REM Sleep Behavior Disorder (iRBD) usually represents an early clinical manifestation of alpha-synucleinopathies. Notably, over 80% of individuals with iRBD phenoconvert during long-term follow-up, making iRBD a critical prodromal stage for synucleinopathies.
Recent research has highlighted the need to shift from a syndromic to a biological framework for defining alpha-synucleinopathies. However, despite growing emphasis on diagnostic biomarkers in these diseases, current studies often fall short in providing actionable tools for practicing clinicians.
While diagnostic biomarkers are vital for identifying alpha-synucleinopathy at its prodromal stage, there is an urgent need to develop robust prognostic biomarkers. These tools would enable the prediction of clinical trajectories in iRBD patients, including disease progression, type and rate of phenoconversion, and ultimate severity. This is critical for identifying patients at the highest short-term risk of phenoconversion, who may serve as the ideal candidates for future disease-modifying therapies.
The success of disease-modifying clinical trials depends on the identification and validation of reliable biomarkers that reflect the ongoing neurodegenerative process. Ultimately, these biomarkers could enable precise patient stratification for enrollment in trials, enhancing their design and outcomes.
With this in mind, Luca Baldelli will focus on clinical biomarkers, exploring their current utility, accessibility, and limitations in precision. He will discuss whether these well-established biomarkers can serve as a reliable foundation for integrating other modalities, ultimately improving diagnostic and prognostic accuracy.
Beatrice Orso will discuss the importance of neuroimaging biomarkers, focusing on what is currently being endorsed by the new research criteria, highlighting the need to address the lack of thresholds for abnormality in molecular and metabolic imaging techniques, as well as the need for studies targeting the predictive value of cutoffs used to define abnormality.
Matteo Cesari will cover electrophysiological and digital biomarkers, emphasizing their role in detecting subtle physiological changes and their potential for non-invasive monitoring. He will highlight recent advancements in digital health technologies and their application to tracking disease progression and conversion. The role of artificial intelligence will also be discussed.
Bei Huang will review the history and major breakthroughs in wet biomarkers, the prospects and limitations of their clinical applications, and the need to establish an international RBD biomedical database. She will also elaborate on the potential of gut-based markers in diagnosis and prediction of disease progression.
Bradley F. Boeve will open a discussion on the ideal single or set of biomarkers, envisioning a future where big data and personalized medicine converge. He will delve into how biomarker-driven strategies can revolutionize clinical trials and therapeutic approaches, ultimately paving the way for more effective disease-modifying treatments.
By focusing on iRBD as a window into the early stages of neurodegeneration, this symposium aims to illuminate the critical gaps in research and identify pathways toward a biomarker-driven future in alpha-synucleinopathy management.