Brain Structural Profile of Multiple System Atrophy Patients with Cognitive Impairment

Overview

Journal J Neural Transm (Vienna)

Specialties Neurology
Physiology

Date 2016 Oct 26

PMID 27778099

Citations 25

Authors

Eleonora Fiorenzato

Luca Weis

Klaus Seppi

Marco Onofrj

Pietro Cortelli

Stefano Zanigni

Caterina Tonon

Horacio Kaufmann

Timothy Michael Shepherd

Werner Poewe

Florian Krismer

Gregor Wenning

Angelo Antonini

Roberta Biundo

Affiliations

Soon will be listed here.

Abstract

Current consensus diagnostic criteria for multiple system atrophy (MSA) consider dementia a non-supporting feature, although cognitive impairment and even frank dementia are reported in clinical practice. Mini-Mental State Examination (MMSE) is a commonly used global cognitive scale, and in a previous study, we established an MSA-specific screening cut-off score <27 to identify cognitive impairment. Finally, MSA neuroimaging findings suggest the presence of structural alterations in patients with cognitive deficits, although the extent of the anatomical changes is unclear. The aim of our multicenter study is to better characterize anatomical changes associated with cognitive impairment in MSA and to further investigate cortical and subcortical structural differences versus healthy controls (HC). We examined retrospectively 72 probable MSA patients [50 with normal cognition (MSA-NC) and 22 cognitively impaired (MSA-CI) based on MMSE <27] and compared them to 36 HC using gray- and white-matter voxel-based morphometry and fully automated subcortical segmentation. Compared to HC, MSA patients showed widespread cortical (bilateral frontal, occipito-temporal, and parietal areas), subcortical, and white-matter alterations. However, MSA-CI showed only focal volume reduction in the left dorsolateral prefrontal cortex compared with MSA-NC. These results suggest only a marginal contribution of cortical pathology to cognitive deficits. We believe that cognitive dysfunction is driven by focal fronto-striatal degeneration in line with the concept of "subcortical cognitive impairment".

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