Brain structural profile of multiple system atrophy patients with cognitive impairment
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”.
KeywordsMultiple system atrophy (MSA) Cognition Mini-Mental State Examination (MMSE) Dementia Neuroimaging Voxel-based morphometry
The authors thank the MSA patients who kindly participated in this study.
Compliance with ethical standards
All authors gave the final approval of this version of the manuscript to be published. We can assure that there is no one else who fulfills the criteria but has not been included as an author.
All procedures performed in this study were in accordance with the ethical standards of the Venice Research Ethics Committee (Venice, Italy) and with the 1964 Helsinki declaration. For this type of study, formal consent is not required.
Conflict of interest
The authors have no competing interest to declare.
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