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Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy. J Neural Transm (Vienna) 2016; 123:1435-1442. [PMID: 27334897 DOI: 10.1007/s00702-016-1589-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
To determine if Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting cognitive abnormalities in patients with probable progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) compared with Parkinson's disease (PD). In this multicenter observational study, MMSE and MoCA were administered in a random order to 130 patients: 35 MSA, 30 PSP and 65 age, and education and gender matched-PD. We assessed between-group differences for MMSE, MoCA, and their subitems. Receiver-operating characteristic (ROC) curves were calculated. The mean MMSE was higher than the mean MoCA score in each MSA (27.7 ± 2.4 vs. 22.9 ± 3.0, p < 0.0001), PSP (26.0 ± 2.9 vs. 18.2 ± 3.9, p < 0.0001), and PD (27.3 ± 2.0 vs. 22.3 ± 3.5, p < 0.0001). MoCA total score as well as its letter fluency subitem differentiated PSP from MSA and PD with high specificity and moderate sensitivity. More specifically, a cut-off score of 7 F-words or less per minute would support a diagnosis of PSP (PSP vs. PD: 86 % specificity, 70 % sensitivity; PSP vs. MSA: 71 % specificity, 70 % sensitivity). By contrast, MMSE presented an overall ceiling effect for most subitems, except for the pentagon scores, where PSP did less well than MSA or PD patients. These preliminary results suggest that PSP and MSA, similar to PD patients, may present normal MMSE and reduced MoCA performance. Overall, MoCA is more sensitive than MMSE in detecting cognitive impairment in atypical parkinsonism and together with verbal fluency would be a useful test to support PSP diagnosis.
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Takaya M, Atsumi M, Hirose T, Ishii K, Shirakawa O. Cognitive impairment before changes appear on [18F]-fluoro-D-glucose positron emission tomography images in a patient with possible early-stage cerebellar-predominant multiple system atrophy. Psychogeriatrics 2016; 16:216-221. [PMID: 26115081 DOI: 10.1111/psyg.12134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/11/2015] [Accepted: 03/30/2015] [Indexed: 11/28/2022]
Abstract
Multiple system atrophy (MSA) is a sporadic, rapidly progressive neurodegenerative disorder characterized by autonomic dysfunction combined with parkinsonism or cerebellar ataxia. Patients with MSA typically suffer from cognitive disorders and rapid eye movement sleep behaviour disorder. 18 F-fluorodeoxyglucose-positron emission tomography is used to assess MSA. However, the relationship between the clinical features and findings on 18 F-fluorodeoxyglucose-positron emission tomography in patients with MSA has not yet been investigated. Here we report a case of possible early-stage cerebellar-type MSA. We concluded that cerebellar-type MSA or other factors, such as rapid eye movement sleep behaviour disorder or obstructive sleep apnoea cognitive impairment, could appear before changes are visible on 18 F-fluorodeoxyglucose-positron emission tomography images. Additionally, we concluded that the cognitive impairment could derive from cerebellar-type MSA itself, not from other factors such as rapid eye movement sleep behaviour disorder or sleep apnoea syndrome.
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Affiliation(s)
- Masahiko Takaya
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan
| | | | - Tomoyuki Hirose
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan
| | - Kazunari Ishii
- Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan
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Barker RA, Williams-Gray CH. Review: The spectrum of clinical features seen with alpha synuclein pathology. Neuropathol Appl Neurobiol 2016; 42:6-19. [DOI: 10.1111/nan.12303] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/06/2016] [Accepted: 01/10/2016] [Indexed: 12/15/2022]
Affiliation(s)
- R. A. Barker
- Department of Clinical Neurosciences; John van Geest Centre for Brain Repair; University of Cambridge; Cambridge UK
| | - C. H. Williams-Gray
- Department of Clinical Neurosciences; John van Geest Centre for Brain Repair; University of Cambridge; Cambridge UK
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Editors T. Muscle Decline in Aging and Neuromuscular Disorders - Mechanisms and Countermeasures: Terme Euganee, Padova (Italy), April 13-16, 2016. Eur J Transl Myol 2016; 26:5904. [PMID: 27054021 PMCID: PMC4821223 DOI: 10.4081/ejtm.2016.5904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Not available.
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Ceponiene R, Edland S, Reid T, Al Rizaiza A, Litvan I. Neuropsychiatric symptoms and their impact on quality of life in multiple system atrophy. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2015.1131476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- R. Ceponiene
- Department of Neurosciences, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C112, La Jolla, CA 92037, USA
- Southern California Physician Medical Group, Kaiser Permanente, 4405 Vandever Ave, San Diego, CA 92120, USA
| | - S.D. Edland
- Department of Neurosciences, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C112, La Jolla, CA 92037, USA
- Department of Family and Preventive Medicine, Division of Biostatistics and Bioinformatics, University of California, San Diego, 9500 Gilman Dr. La Jolla, La Jolla, CA, USA
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr. La Jolla, La Jolla, CA, USA
| | - T.N. Reid
- University of Louisville, 1911 S 3rd Street, Louisville, KY 40208, USA
| | - A. Al Rizaiza
- Department of Neurosciences, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C112, La Jolla, CA 92037, USA
| | - I. Litvan
- Department of Neurosciences, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C112, La Jolla, CA 92037, USA
- University of Louisville, 1911 S 3rd Street, Louisville, KY 40208, USA
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Cao B, Wei QQ, Ou R, Yang J, Shang HF. Association of serum uric acid level with cognitive function among patients with multiple system atrophy. J Neurol Sci 2015; 359:363-6. [PMID: 26671143 DOI: 10.1016/j.jns.2015.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Oxidative stress is involved in the pathogenesis of multiple system atrophy (MSA) and cognitive impairment. Uric acid has an anti-oxidative effect. Our objective is to clarify the correlations between serum uric acid and cognitive function as well as frontal lobe function in Chinese MSA patients. METHODS All of MSA patients were evaluated using Addenbrooke's Cognitive Examination-Revised (ACE-R), Frontal Assessment Battery (FAB), and Unified MSA Rating Scale (UMSARS). The fasting serum uric acid concentrations of MSA patients were measured. RESULTS A total of 89 probable MSA patients with a mean age of 58.6 ± 10.0 years old and disease duration of 2.6 ± 1.5 years were included. Thirty-three patients (37.1%) had global cognitive deficits according to ACE-R. Based on FAB, 35 patients (39.3%) had frontal lobe dysfunction. After adjusting for educational years, patients with cognitive deficits had lower uric acid level than patients without cognitive deficits. Patients with frontal lobe dysfunction had lower uric acid level after adjusting for UMSARS scores. In a forward multiple linear regression, uric acid level and educational years were the variables predicting the ACE-R score (F=36.540, R(2)=0.459, p=0.0001), uric acid accounting for 14% of the total variables. Uric acid was the only variable contributing to the FAB score (F=18.551, R(2)=0.176, p=0.0001). CONCLUSION Our study suggested that low level of serum uric acid was associated with cognitive deficits in MSA. Low uric acid level predicting cognitive decline in MSA needs more studies.
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Affiliation(s)
- Bei Cao
- Department of Neurology, West China Hospital, SiChuan University, 610041 Chengdu, Sichuan, People's Republic of China
| | - Qian-Qian Wei
- Department of Neurology, West China Hospital, SiChuan University, 610041 Chengdu, Sichuan, People's Republic of China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, SiChuan University, 610041 Chengdu, Sichuan, People's Republic of China
| | - Jing Yang
- Department of Neurology, West China Hospital, SiChuan University, 610041 Chengdu, Sichuan, People's Republic of China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, SiChuan University, 610041 Chengdu, Sichuan, People's Republic of China.
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Cao B, Zhao B, Wei QQ, Chen K, Yang J, Ou R, Wu Y, Shang HF. The Global Cognition, Frontal Lobe Dysfunction and Behavior Changes in Chinese Patients with Multiple System Atrophy. PLoS One 2015; 10:e0139773. [PMID: 26431430 PMCID: PMC4591982 DOI: 10.1371/journal.pone.0139773] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/17/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies on cognition in multiple system atrophy (MSA) patients are limited. METHODS A total of 110 MSA patients were evaluated using Addenbrooke's Cognitive Examination-Revised (ACE-R), Frontal Assessment Battery (FAB), Frontal Behavioral Inventory (FBI), and Unified MSA Rating Scale (UMSARS) tests. Fifty-five age-, sex-, education- and domicile-matched healthy controls were recruited to perform the FAB and ACE-R scales. RESULTS Approximately 32.7% of the patients had global cognitive deficits with the most impaired domain being verbal fluency and visuospatial ability (26.4%), followed by memory (24.5%), language (20%) and orientation/attention (20%) based on a cut-off score of ACE-R ≤ 70. A total of 41.6% of the patients had frontal lobe dysfunction, with inhibitory control (60.9%) as the most impaired domain based on a cut-off score of FAB ≤14. Most patients (57.2%) showed moderate frontal behavior changes (FBI score 4-15), with incontinence (64.5%) as the most impaired domain. The binary logistic regression model revealed that an education level < 9 years (OR:13.312, 95% CI:2.931-60.469, P = 0.001) and UMSARS ≥ 40 (OR: 2.444, 95%CI: 1.002-5.962, P< 0.049) were potential determinants of abnormal ACE-R, while MSA-C (OR: 4.326, 95%CI: 1.631-11.477, P = 0.003), an education level < 9 years (OR:2.809 95% CI:1.060-7.444, P = 0.038) and UMSARS ≥ 40 (OR:5.396, 95%CI: 2.103-13.846, P < 0.0001) were potential determinants of abnormal FAB. CONCLUSIONS Cognitive impairment is common in Chinese MSA patients. MSA-C patients with low education levels and severe motor symptoms are likely to experience frontal lobe dysfunction, while MSA patients with low education levels and severe motor symptoms are likely to experience global cognitive deficits. These findings strongly suggest that cognitive impairment should not be an exclusion criterion for the diagnosis of MSA.
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Affiliation(s)
- Bei Cao
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
| | - Qian-Qian Wei
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
| | - Ke Chen
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
| | - RuWei Ou
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
| | - Ying Wu
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, China
- * E-mail:
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Kim JS, Yang JJ, Lee DK, Lee JM, Youn J, Cho JW. Cognitive Impairment and Its Structural Correlates in the Parkinsonian Subtype of Multiple System Atrophy. NEURODEGENER DIS 2015. [PMID: 26202063 DOI: 10.1159/000430953] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Previous studies indicate that patients with the parkinsonian subtype of multiple system atrophy (MSA-P) experience cognitive impairment. This study aimed to identify the existence of cognitive impairments and the different topographic patterns of morphological changes in MSA-P by means of imaging analysis, and also whether these morphological changes could be associated with cognitive dysfunctions in MSA-P. METHODS We recruited 15 nondemented probable MSA-P patients and 32 normal controls (NC) for neuropsychological testing and MRI. We analyzed morphological changes using cortical thickness analysis, voxel-based morphometry (VBM) and cerebellar volumetry. Multiple linear regression analysis was performed to evaluate the correlation of each cognitive score with the mean thickness of significant cortical-thinning clusters, mean gray-matter density of VBM clusters and cerebellar volume. RESULTS The scores on the Digit Span Test, the Seoul Verbal Learning Test (immediate and delayed), the phonemic Controlled Oral Word Association Test and the Stroop color test were significantly lower in the MSA-P group than in the NC group. We found two clusters exhibiting significant cortical thinning in the right paracentral lobule and parahippocampal gyrus. VBM analysis revealed significant gray-matter atrophy in the MSA-P group in the bilateral basal ganglia, cerebellum and temporal and frontal cortical areas. Multiple linear regression analysis demonstrated that cognitive dysfunction correlated significantly with thinning in the neocortex, cerebellum and striatum. CONCLUSIONS Our data demonstrate that cortical and cerebellar atrophy and striatal degeneration are associated with cognitive impairment in patients with MSA-P.
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Affiliation(s)
- Ji Sun Kim
- Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
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59
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Atrofia multisistemica. Neurologia 2015. [DOI: 10.1016/s1634-7072(15)70513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Poewe W, Seppi K, Fitzer-Attas CJ, Wenning GK, Gilman S, Low PA, Giladi N, Barone P, Sampaio C, Eyal E, Rascol O. Efficacy of rasagiline in patients with the parkinsonian variant of multiple system atrophy: a randomised, placebo-controlled trial. Lancet Neurol 2015; 14:145-52. [DOI: 10.1016/s1474-4422(14)70288-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Neuropsychiatric Manifestations in Atypical Parkinsonian Syndromes. NEUROPSYCHIATRIC SYMPTOMS OF MOVEMENT DISORDERS 2015. [DOI: 10.1007/978-3-319-09537-0_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Stanzani-Maserati M, Gallassi R, Calandra-Buonaura G, Alessandria M, Oppi F, Poda R, Sambati L, Provini F, Cortelli P. Cognitive and sleep features of multiple system atrophy: review and prospective study. Eur Neurol 2014; 72:349-59. [PMID: 25322750 DOI: 10.1159/000364903] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The profile and degree of cognitive impairment in Multiple System Atrophy (MSA) and the impact of sleep disorders, REM sleep behavior disorder (RBD) in particular, in parkinsonism-related cognitive deficits are currently being debated. SUMMARY We reviewed the cognitive, affective and sleep findings in MSA and also carried out a longitudinal investigation of 10 MSA patients. At the first evaluation, 3 patients showed isolated cognitive deficits. After a mean of 16 months, these patients remained unchanged, while 1 patient worsened from a normal condition. No significant differences emerged when the cognitive, affective and video-polysomnographic findings of MSA-P and MSA-C were compared. Depression was present in half of the patients, although it did not influence their cognitive performance. Comparisons between the first and second evaluation data showed significant worsening in visual attention and in ADL/IADL and UMSARS. KEY MESSAGES Isolated cognitive deficits are evidenced in a minority of MSA patients with the absence of a clear-cut diagnosis of dementia in the early stages of the disease. Attention and executive functions are often impaired. This study with a short follow-up period showed that RBD, although present in almost all patients affected by MSA, does not appear a clear early marker of cognitive impairment. Future longer-term studies with a larger patient sample are thus encouraged.
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Ciolli L, Krismer F, Nicoletti F, Wenning GK. An update on the cerebellar subtype of multiple system atrophy. CEREBELLUM & ATAXIAS 2014; 1:14. [PMID: 26331038 PMCID: PMC4552412 DOI: 10.1186/s40673-014-0014-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/24/2014] [Indexed: 01/05/2023]
Abstract
Multiple system atrophy is a rare and fatal neurodegenerative disorder characterized by progressive autonomic failure, ataxia and parkinsonism in any combination. The clinical manifestations reflect central autonomic and striatonigral degeneration as well as olivopontocerebellar atrophy. Glial cytoplasmic inclusions, composed of α-synuclein and other proteins are considered the cellular hallmark lesion. The cerebellar variant of MSA (MSA-C) denotes a distinctive motor subtype characterized by progressive adult onset sporadic gait ataxia, scanning dysarthria, limb ataxia and cerebellar oculomotor dysfunction. In addition, there is autonomic failure and variable degrees of parkinsonism. A range of other disorders may present with MSA-C like features and therefore the differential diagnosis of MSA-C is not always straightforward. Here we review key aspects of MSA-C including pathology, pathogenesis, diagnosis, clinical features and treatment, paying special attention to differential diagnosis in late onset sporadic cerebellar ataxias.
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Affiliation(s)
- Ludovico Ciolli
- Sapienza University, Via di Grottarossa, 1035-00189 Rome, Italy ; Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ferdinando Nicoletti
- IRCSS NEUROMED, Pozzilli, Isernia Italy ; Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University, School of Medicine and Psychology, Rome, Italy
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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64
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Jellinger KA. Neuropathology of multiple system atrophy: New thoughts about pathogenesis. Mov Disord 2014; 29:1720-41. [DOI: 10.1002/mds.26052] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/29/2014] [Accepted: 09/16/2014] [Indexed: 12/14/2022] Open
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Gatto E, Demey I, Sanguinetti A, Parisi V, Etcheverry JL, Rojas G, Wenning GK. Cognition in a multiple system atrophy series of cases from Argentina. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:773-6. [DOI: 10.1590/0004-282x20140127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/21/2014] [Indexed: 11/21/2022]
Abstract
Cognitive dysfunction may occur in 17-40% of patients with multiple system atrophy (MSA). It has been suggested a milder cognitive impairment in cerebellar (MSA-C) than in parkinsonian variant (MSA-P). However, differences in cognitive profiles remain under discussion. Objective To evaluate cognitive features in a series of patients with “probable MSA” from Argentina. Method After informed consent was obtained, an extensive cognitive tests battery was administered. Nine patients (6 MSA-P and 3 MSA-C) composed the sample. Results Depression was detected in 43% of patients. Seven patients showed at least one cognitive domain impairment. Temporospatial orientation, visuospatial abilities, executive and attentional functions, episodic memory and language were compromised in MSA-P, while MSA-C dysfunction was restricted to attentional and executive domains. Conclusion Despite the small sample size, our findings could suggest a more widespread cognitive impairment in MSA-P than MSA-C.
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Affiliation(s)
- Emilia Gatto
- Instituto Neurociencias de Buenos Aires, Argentina; Sanatorio de la Trinidad Mitre, Argentina
| | | | | | | | | | - Galeno Rojas
- Instituto Neurociencias de Buenos Aires, Argentina
| | - Gregor K. Wenning
- Sanatorio de la Trinidad Mitre, Argentina; Department of Neurology Medical University Innsbruck, Austria
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Jecmenica-Lukic M, Petrovic IN, Pekmezovic T, Kostic VS. Clinical outcomes of two main variants of progressive supranuclear palsy and multiple system atrophy: a prospective natural history study. J Neurol 2014; 261:1575-83. [PMID: 24888315 DOI: 10.1007/s00415-014-7384-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/22/2014] [Accepted: 05/15/2014] [Indexed: 01/31/2023]
Abstract
Progressive supranuclear palsy (PSP) and parkinsonian subtype of multiple system atrophy (MSA-P) are, after Parkinson's disease (PD), the most common forms of neurodegenerative parkinsonism. Clinical heterogeneity of PSP includes two main variants, Richardson syndrome (PSP-RS) and PSP-parkinsonism (PSP-P). Clinical differentiation between them may be impossible at least during the first 2 years of the disease. Little is known about the differences in natural course of PSP-RS and PSP-P and, therefore, in this study we prospectively followed the clinical outcomes of consecutive, pathologically unconfirmed patients with the clinical diagnoses of PSP-RS (51 patients), PSP-P (21 patients) and MSA-P (49 patients). Estimated mean survival time was 11.2 years for PSP-P, 6.8 years for PSP-RS, and 7.9 years for MSA-P, where a 5-year survival probabilities were 90, 66 and 78 %, respectively. More disabling course of PSP-RS compared to PSP-P was also highlighted through the higher number of milestones reached in the first 3 years of the disease, as well as in the trend to reach all clinical milestones earlier. We found that PSP-P variant had a more favorable course with longer survival, not only when compared to PSP-RS, but also when compared to another form of atypical parkinsonism, MSA-P.
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Affiliation(s)
- Milica Jecmenica-Lukic
- Clinic of Neurology, School of Medicine, University of Belgrade, Ul. Dr Subotića 6, 11000, Belgrade, Serbia,
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Celebi O, Temuçin ÇM, Elibol B, Saka E. Cognitive profiling in relation to short latency afferent inhibition of frontal cortex in multiple system atrophy. Parkinsonism Relat Disord 2014; 20:632-6. [DOI: 10.1016/j.parkreldis.2014.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
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Stankovic I, Krismer F, Jesic A, Antonini A, Benke T, Brown RG, Burn DJ, Holton JL, Kaufmann H, Kostic VS, Ling H, Meissner WG, Poewe W, Semnic M, Seppi K, Takeda A, Weintraub D, Wenning GK. Cognitive impairment in multiple system atrophy: a position statement by the Neuropsychology Task Force of the MDS Multiple System Atrophy (MODIMSA) study group. Mov Disord 2014; 29:857-67. [PMID: 24753321 DOI: 10.1002/mds.25880] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/02/2014] [Accepted: 02/10/2014] [Indexed: 01/14/2023] Open
Abstract
Consensus diagnostic criteria for multiple system atrophy consider dementia as a nonsupporting feature, despite emerging evidence demonstrating that cognitive impairments are an integral part of the disease. Cognitive disturbances in multiple system atrophy occur across a wide spectrum from mild single domain deficits to impairments in multiple domains and even to frank dementia in some cases. Frontal-executive dysfunction is the most common presentation, while memory and visuospatial functions also may be impaired. Imaging and neuropathological findings support the concept that cognitive impairments in MSA originate from striatofrontal deafferentation, with additional contributions from intrinsic cortical degeneration and cerebellar pathology. Based on a comprehensive evidence-based review, the authors propose future avenues of research that ultimately may lead to diagnostic criteria for cognitive impairment and dementia associated with multiple system atrophy.
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Affiliation(s)
- Iva Stankovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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