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Luca Baldelli, MD, PhD, University of Bologna, Bologna, Italy, comments on the state of knowledge regarding why some patients with isolated REM sleep behavior disorder (RBD) will phenoconvert to a central α-synucleinopathy, while others will not. He notes that, while the neurodegenerative process is already underway in iRBD, some patients experience a slow, latent degeneration over many years, while others may see accelerated progression and phenoconversion. The scientific community currently lacks a clear understanding of why this variability occurs. Early detection and monitoring are essential to identify which patients may remain stable and which might need closer observation due to a higher risk of conversion. This interview took place at the European Academy of Neurology (EAN) Annual Meeting 2024 in Helsinki, Finland. These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.