The existing RBD questionnaires may overlook the prevalence, frequency and severity of the clinical symptoms. There remains an obstacle for physicians to quantitatively observe and monitor treatment progress in clinical settings without the availability of timely PSG. Screening instruments for diagnosis of RBD are limited and there are none for quantifying the severity of the disease. Li et al. developed and validated a 13-item self-reported RBD questionnaire for diagnostic and monitoring purposes (Li et al., 2010). The patient always answered and the bed partner sometimes also answered in addition to the patient. Items 1-5 (Q1-Q5) were pertinent to patients' dreams and nightmares and the last eight items (Q6-Q13) elicited information on the typical behavioral consequences as a result of patients' dream enactments. Each item assesses two scales: lifetime occurrence and recent 1-yr frequency (5 point scale: 3 times or above per week; 1-2 times per week; once or a few times per month; once or few times per year; none). Scores are weighted in 7/13 questions according to the clinical importance of the behavioral manifestations of RBD. Scores range from 0-100. In a study to validate the instrument, 107 PSG-confirmed RBD patients (mean age 62.5 y) with the diagnosis of cryptogenic RBD, symptomatic RBD (PD, dementia, PD with dementia, narcolepsy), RBD-like disorder) and 107 controls (mean age 55.3 y) participated. The best RBDQ-HK cut-off score for RBD detection was 18-19, with 82% sensitivity, 87% specificity, and 86% positive predictive value; there was high test-retest reliability. Among the RBD cases, the scores of RBDQ-HK based on patients' self-reports were slightly lower compared to those provided by both patients and their relatives (e.g., bed partner)[self-report: 40.56(21.26) vs. self and relatives: 54.89(17.34), p=0.05]. The RBDQ-HK can be completed by patients with or without other informants such as a bed partner. However, abnormal nocturnal behaviors can go unnoticed in some RBD cases (e.g., when there is no assault or injury to self or bed partner), making the sensitivity of the RBDQ-HK different between those living and sleeping on their own and those living and sleeping with others. Hence, input on RBDQ-HK from relatives of patients is encouraged as it may enhance accuracy of the diagnosis and provide a better appraisal of treatment progress.

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