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Katunina EA, Shipilova NN, Farnieva IA, Isaeva ZS, Dzugaeva FK, Belikova LP, Batsoeva DO. [Cognitive impairment in multiple system atrophy - exclusion criteria or an integral part of the clinical picture?]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:86-91. [PMID: 38696156 DOI: 10.17116/jnevro202412404286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
Multiple system atrophy (MSA) is a severe, orphan disease characterized by a steady increase in symptoms of parkinsonism, cerebellar disorders, and autonomic failure. In addition to autonomic failure, which is considered the defining symptom of this type of atypical parkinsonism, there are a range of other non-motor clinical manifestations, such as sleep disorders, pain syndrome, anxiety-depressive disorders, cognitive impairment (CI). CI, especially severe CI, has long been considered as a distinctive feature of MCA. Recently, there have been many clinical studies with pathomorphological or neuroimaging confirmation, indicating a high prevalence of cognitive disorders in MCA. In this article, we discuss the pathogenetic mechanisms of the development of MCA and CI in MCA, as well as the range of clinical manifestations of cognitive dysfunction.
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Affiliation(s)
- E A Katunina
- Federal center of brain research and neurotechnologies, Moscow, Russia
- Pirogov Russian National Research Medical University Moscow, Russi, Pirogov Russian National Research Medical University Moscow, Russia
| | - N N Shipilova
- Federal center of brain research and neurotechnologies, Moscow, Russia
- Pirogov Russian National Research Medical University Moscow, Russi, Pirogov Russian National Research Medical University Moscow, Russia
| | - I A Farnieva
- North Caucasian Multidisciplinary Medical Center, Beslan, Russia
| | - Z S Isaeva
- Pirogov City Clinical Hospital No. 1, Moscow, Russia
| | - F K Dzugaeva
- North Caucasian Multidisciplinary Medical Center, Beslan, Russia
| | - L P Belikova
- Pirogov City Clinical Hospital No. 1, Moscow, Russia
| | - D O Batsoeva
- North Caucasian Multidisciplinary Medical Center, Beslan, Russia
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Jellinger KA. Mild cognitive impairment in multiple system atrophy: a brain network disorder. J Neural Transm (Vienna) 2023; 130:1231-1240. [PMID: 37581647 DOI: 10.1007/s00702-023-02682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
Cognitive impairment (CI), previously considered as a non-supporting feature of multiple system atrophy (MSA), according to the second consensus criteria, is not uncommon in this neurodegenerative disorder that is clinically characterized by a variable combination of autonomic failure, levodopa-unresponsive parkinsonism, motor and cerebellar signs. Mild cognitive impairment (MCI), a risk factor for dementia, has been reported in up to 44% of MSA patients, with predominant impairment of executive functions/attention, visuospatial and verbal deficits, and a variety of non-cognitive and neuropsychiatric symptoms. Despite changing concept of CI in this synucleinopathy, the underlying pathophysiological mechanisms remain controversial. Recent neuroimaging studies revealed volume reduction in the left temporal gyrus, and in the dopaminergic nucleus accumbens, while other morphometric studies did not find any gray matter atrophy, in particular in the frontal cortex. Functional analyses detected decreased functional connectivity in the left parietal lobe, bilateral cuneus, left precuneus, limbic structures, and cerebello-cerebral circuit, suggesting that structural and functional changes in the subcortical limbic structures and disrupted cerebello-cerebral networks may be associated with early cognitive decline in MSA. Whereas moderate to severe CI in MSA in addition to prefrontal-striatal degeneration is frequently associated with cortical Alzheimer and Lewy co-pathologies, neuropathological studies of the MCI stage of MSA are unfortunately not available. In view of the limited structural and functional findings in MSA cases with MCI, further neuroimaging and neuropathological studies are warranted in order to better elucidate its pathophysiological mechanisms and to develop validated biomarkers as basis for early diagnosis and future adequate treatment modalities in order to prevent progression of this debilitating disorder.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Chen B, He J, Xu M, Cao C, Song D, Yu H, Cui W, Guang Fan G. Automatic classification of MSA subtypes using Whole-brain gray matter function and Structure-Based radiomics approach. Eur J Radiol 2023; 161:110735. [PMID: 36796145 DOI: 10.1016/j.ejrad.2023.110735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND This study aims to develop a radiomics method based on the function and structure of whole-brain gray matter to accurately classify multiple system atrophy with predominant Parkinsonism (MSA-P) or predominant cerebellar ataxia (MSA-C). METHODS We enrolled 30 MSA-C and 41 MSA-P cases for the internal cohort and 11 MSA-C and 10 MSA-P cases for the external test cohort. We extracted 7,308 features, including gray matter volume (GMV), mean amplitude of low-frequency fluctuation (mALFF), mean regional homogeneity (mReHo), degree of centrality (DC), voxel-mirrored homotopic connectivity (VMHC), and resting-state functional connectivity (RSFC) from 3D-T1 and Rs-fMR data. Feature selection was conducted with t-test and least absolute shrinkage and selection operator (Lasso). Classification was performed using the support vector machine with linear and RBF kernel (SVM-linear/SVM-RBF), random forest and logistic regression. Model performance was assessed via receiver operating characteristic (ROC) curve and compared with DeLong's test. RESULTS Feature selection resulted in 12 features, including 1 ALFF, 1 DC and 10 RSFC. All the classifiers showed remarkable classification performance, especially the RF model which exhibited AUC values of 0.91 and 0.80 in the validation and test datasets, respectively. The brain functional activity and connectivity in the cerebellum, orbitofrontal lobe and limbic system were important features to distinguish MSA subtypes with the same disease severity and duration. CONCLUSION Radiomics approach has the potential to support clinical diagnostic systems and to achieve high classification accuracy for distinguishing between MSA-C and MSA-P patients at the individual level.
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Affiliation(s)
- Boyu Chen
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Jiachuan He
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Ming Xu
- Shenyang University of Technology, Shenyang 110001, Liaoning, PR China
| | - Chenghao Cao
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China; Department of Radiology, First University Hospital of West China University, Chengdu, Sichuan, PR China
| | - Dandan Song
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Hongmei Yu
- Department of Neurology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Wenzhuo Cui
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China
| | - Guo Guang Fan
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, PR China.
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Shi Z, Zhang J, Zhao P, Li X, Liu S, Wu H, Jia P, Ji Y. Characteristics of Mild Cognitive Impairment and Associated Factors in MSA Patients. Brain Sci 2023; 13:brainsci13040582. [PMID: 37190547 DOI: 10.3390/brainsci13040582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Mild cognitive impairment (MCI) in multiple-system atrophy (MSA) patients is common but remains poorly characterized, and the related factors are unclear. This retrospective study included 200 consecutive patients with a clinical diagnosis of possible or probable MSA, 102 MSA patients with MCI (MSA-MCI), and 98 MSA patients with normal cognition (MSA-NC). Cognitive profiles were compared between MSA-MCI and MSA-NC patients using the MoCA. In addition, demographic as well as major motor and nonmotor symptom differences were compared between MSA-MCI and MSA-NC patients. The median MMSE score was 26 points. Overall, MSA-MCI was observed in 51% of patients, with predominant impairment in visuospatial, executive, and attention functions compared with MSA-NC patients. MSA-MCI patients were older (p = 0.015) and had a later onset age (p = 0.024) and a higher frequency of hypertension, motor onset, and MSA with the predominant parkinsonism (MSA-P) phenotype than MSA-NC patients. The positive rate of orthostatic hypotension (OH) in MSA-MCI patients was significantly decreased and depression/anxiety was significantly increased compared with MSA-NC patients (p = 0.004). Multivariate logistic analysis showed that motor onset was independently associated with MCI in MSA patients. MSA-MCI patients had impairment in visuospatial, executive, and attention functions. More prominent memory impairment was observed in MSA-P than in MSA-C patients. Motor onset was independently associated with MCI in MSA patients. MCI was commonly presented in MSA with more prominent memory impairment in MSA-P. Future follow-up studies are warranted to identify more factors that influence cognitive impairment in MSA.
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Abdelnour C, Poston KL. Cognitive Impairment in Neurodegenerative Movement Disorders. Semin Neurol 2023; 43:81-94. [PMID: 36940727 DOI: 10.1055/s-0043-1764204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Patients with neurodegenerative movement disorders can develop cognitive impairment during the disease. Cognitive symptoms have been associated with decreased quality of life, higher caregiver burden, and earlier institutionalization, and are therefore critical for physicians to understand and address. The evaluation of cognitive performance of patients with neurodegenerative movement disorders is important for providing adequate diagnosis, management, prognosis, and support patients and their caregivers. In this review, we discuss the features of the cognitive impairment profile of commonly encountered movement disorders: Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, corticobasal syndrome, and Huntington's disease. In addition, we provide neurologists with practical guidance and evaluation tools for the assessment and management of these challenging patients.
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Affiliation(s)
- Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Jellinger KA. Morphological differences between the two major subtypes of multiple system atrophy with cognitive impairment. Parkinsonism Relat Disord 2023; 107:105273. [PMID: 36603328 DOI: 10.1016/j.parkreldis.2022.105273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/17/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the neuropathology between two types of multiple system atrophy - parkinsonism-predominant (MSA-P) and cerebellar ataxia-predominant (MSA-C) with cognitive impairment. MATERIAL & METHODS 35 cases of MSA-P (mean age at death 60.5 ± 7.8 years) and 15 cases of MSA-C (mean age at death 61.3 ± 6.8 years), 35.% of which associated with mild to moderate cognitive impairment and one with severe dementia, were examined neuropathologically with semiquantitative evaluation of both α-synuclein and Alzheimer pathologies, including cerebral amyloid angiopathy (CAA) and other co-pathologies. RESULTS While the mean age at death of both MSA subgroups was similar, the age at onset and duration of disease were slightly higher in the MSA-C group. In line with the classification, the αSyn pathology glial and neuronal inclusions in both the cortex and brainstem were significantly higher in the MSA-P group. With regard to the Alzheimer disease pathology, tau load in cases with mild to moderate cognitive impairment was slightly but not significantly higher in the MSA-P group, one with severe dementia showing fully developed Alzheimer co-pathology, while the amyloid-β (Aβ) load including the CAA was higher in the MSA-C group. The presence of Lewy co-pathology in this series (20%), being similar to that of other MSA cohorts, was more frequent in MSA cases with mild to severe cognitive impairment, but did not differ between the two subgroups and seems not essentially important for MCI in MSA. CONCLUSIONS In agreement with previous clinical studies that reported more severe cognitive dysfunction in patients with MSA-P, the present neuropathological study showed increased tau pathology in MSA-P and one with severe Alzheimer co-pathology, but only slightly increased amyloid pathology in the MSA-C group. Lewy co-pathology was more frequent in MSA-P cases with cognitive decline. In view of the limited data about the pathobiological basis of cognitive impairment in MSA, further studies to elucidate the differences between the two phenotypes are urgently needed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria.
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Structural and metabolic correlates of neuropsychological profiles in multiple system atrophy and Parkinson's disease. Parkinsonism Relat Disord 2023; 107:105277. [PMID: 36621156 DOI: 10.1016/j.parkreldis.2022.105277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite increased recognition of cognitive impairment in Multiple System Atrophy (MSA), its neuroanatomical correlates are not well defined. We aimed to explore cognitive profiles in MSA with predominant parkinsonism (MSA-P) and Parkinson's disease (PD) and their relationship to frontostriatal structural and metabolic changes. METHODS Detailed clinical and neuropsychological evaluation was performed together with diffusion tensor imaging (DTI) and [18F]-fluoro-deoxyglucose positron emission tomography ([18F]-FDG-PET) in patients with MSA-P (n = 11) and PD (n = 11). We compared clinical and neuropsychological data to healthy controls (n = 9) and correlated neuropsychological data with imaging findings in MSA-P and PD. RESULTS Patients with MSA-P showed deficits in executive function (Trail Making Test B-A) and scored higher in measures of depression and anxiety compared to those with PD and healthy controls. Widespread frontostriatal white matter tract reduction in fractional anisotropy was seen in MSA-P and PD compared to an imaging control group. Stroop Test interference performance correlated with [18F]-FDG uptake in the bilateral dorsolateral prefrontal cortex (DLPFC) and with white matter integrity between the striatum and left inferior frontal gyrus (IFG) in PD. Trail Making Test performance correlated with corticostriatal white matter integrity along tracts from the bilateral IFG in MSA-P and from the right DLPFC in both groups. CONCLUSION Executive dysfunction was more prominent in patients with MSA-P compared to PD. DLPFC metabolism and frontostriatal white matter integrity seem to be a driver of executive function in PD, whereas alterations in corticostriatal white matter integrity may contribute more to executive dysfunction in MSA-P.
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Jellinger KA. Pathomechanisms of depression in multiple system atrophy. J Neural Transm (Vienna) 2023; 130:1-6. [PMID: 36348076 DOI: 10.1007/s00702-022-02560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Multiple system atrophy (MSA) is a rapidly progressing neurodegenerative disorder of uncertain etiology that is characterized by various combinations of Parkinsonism, autonomic, cerebellar and motor dysfunctions, with poor prognosis. Little is known about modifiable factors, such as depression, that has negative effects on quality of life in MSA. Depression, with an estimated prevalence of about 43%, is among the most common neuropsychiatric disorders in MSA similar to other atypical Parkinsonian disorders, the frequency of which is associated with increased disease progression, disease severity and autonomic dysfunctions. Depression in MSA, like in Parkinson disease, has been related to a variety of pathogenic mechanisms associated with the underlying neurodegenerative process, such as involvement of serotonergic neuron groups in the brainstem, prefrontal cortical dysfunctions, and altered functional fronto-temporal-thalamic connectivities with disturbances of mood related and other essential resting-state brain networks. The pathophysiology and pathogenesis of depression in MSA, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for adequate treatment to improve the quality of life in this fatal disease.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Nasri A, Gharbi A, Sghaier I, Mrabet S, Souissi A, Gargouri A, Djebara MB, Kacem I, Gouider R. Determinants of cognitive impairment in multiple system atrophy: Clinical and genetic study. PLoS One 2022; 17:e0277798. [PMID: 36508411 PMCID: PMC9744291 DOI: 10.1371/journal.pone.0277798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Classically, cognitive impairment (CI) was not considered as a paramount feature of multiple system atrophy(MSA) in both parkinsonian(MSA-P) and cerebellar(MSA-C) motor-subtypes. Yet, growing evidence indicates currently the commonness of such deficits among MSA patients in different populations. Our aim was to evaluate the cognitive profile of MSA Tunisian patients and to analyze the underlying clinical and genetic determinants. METHODS In a retrospective cross-sectional study, clinically-diagnosed MSA patients were included. All subjects underwent clinical and neuropsychological assessments to characterize their cognitive profile. The associations with their APOE genotype status were analyzed. Determinant of CI were specified. RESULTS We included 71 MSA patients. Female gender(sex-ratio = 0.65) and MSA-P subtype(73%) were predominant. Mean age of disease onset was 59.1years. CI was found in 85.7% of patients(dementia in 12.7% and Mild cognitive impairment(MCI) in 73% of patients mainly of multiple-domain amnestic type(37.3%)). Mean MMSE score was lower among MSA-P compared to MSA-C(23.52 vs. 26.47;p = 0.027). Higher postural instability gait disorder(PIGD) and MDS-UPDRS-III scores were noted in demented MSA patients(p = 0.019;p = 0.015 respectively). The main altered cognitive domain was attention(64.8%). Executive functions and mood disorders were more affected in MSA-P(p = 0.029,p = 0.035 respectively). Clinical and neurophysiological study of dysautonomia revealed no differences across cognitive subtypes. APOE genotyping was performed in 51 MSA patients with available blood samples. Those carrying APOEε4 had 1.32 fold higher risk to develop CI, with lower MMSE score(p = 0.0001). Attention and language were significantly altered by adjusting the p value to APOEɛ4 carriers(p = 0.046 and p = 0.044 respectively). Executive dysfunction was more pronounced among MSA-PAPOEε4 carriers(p = 0.010). CONCLUSION In this study, the main determinants of CI in Tunisian MSA patients were MSA-P motor-subtype, mainly of PIGD-phenotype, disease duration and APOEε4 carrying status, defining a more altered cognitive phenotype. This effect mainly concerned executive, attention and language functions, all found to be more impaired in APOEε4 carriers with variable degrees across MSA motor-subtypes.
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Affiliation(s)
- Amina Nasri
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Alya Gharbi
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Ikram Sghaier
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Saloua Mrabet
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Amira Souissi
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Amina Gargouri
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Mouna Ben Djebara
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Imen Kacem
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Riadh Gouider
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
- * E-mail:
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The Cognitive Profile of Atypical Parkinsonism: A Meta-Analysis. Neuropsychol Rev 2022; 33:514-543. [PMID: 35960471 DOI: 10.1007/s11065-022-09551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 07/04/2022] [Indexed: 10/15/2022]
Abstract
Atypical Parkinsonism (AP) syndromes are characterized by a wide spectrum of non-motor symptoms including prominent attentional and executive deficits. However, the cognitive profile of AP and its differences and similarities with that of Parkinson's Disease (PD) are still a matter of debate. The present meta-analysis aimed at identifying patterns of cognitive impairment in AP by comparing global cognitive functioning, memory, executive functions, visuospatial abilities, language, non-verbal reasoning, and processing speed test performances of patients with AP relative to healthy controls and patients with PD. All investigated cognitive domains showed a substantial impairment in patients with AP compared to healthy controls. When AP syndromes were considered separately, their cognitive functioning was distributed along a continuum from Multiple Systemic Atrophy at one extreme, with the least impaired cognitive profile (similar to that observed in PD) to Progressive Supranuclear Palsy, with the greatest decline in global cognitive and executive functioning (similar to Corticobasal Syndrome). These findings indicate that widespread cognitive impairment could represent an important clinical indicator to distinguish AP from other movement disorders.
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Maass F, Hermann P, Varges D, Nuhn S, van Riesen C, Jamous A, Focke NK, Hewitt M, Leha A, Bähr M, Zerr I. Prospective CERAD Neuropsychological Assessment in Patients With Multiple System Atrophy. Front Neurol 2022; 13:881369. [PMID: 35928131 PMCID: PMC9344909 DOI: 10.3389/fneur.2022.881369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
The objective of the study was to characterize the pattern of cognitive dysfunction in patients with multiple system atrophy (MSA) applying a standardized neuropsychological assessment. A total of 20 patients with the diagnosis of probable or possible MSA were enrolled for neuropsychological assessment applying the CERAD plus battery. All patients were tested at baseline and 14/20 patients received additional follow-up assessments (median follow-up of 24 months). Additionally, relationship between cortical thickness values/subcortical gray matter volumes and CERAD subitems was evaluated at baseline in a subgroup of 13/20 patients. Trail Making Test (TMT) was the most sensitive CERAD item at baseline with abnormal performance (z-score < −1.28) in one or both pathological TMT items (TMT-A, TMT-B) in 60% of patients with MSA. Additionally, there was a significant inverse correlation between the volume of the left and the right accumbens area and the TMT A item after adjusting for age (left side: p = 0.0009; right side p = 0.003). Comparing both subtypes, patients with MSA-C had significant lower values in phonemic verbal fluency (p = 0.04) and a trend for lower values in semantic verbal fluency (p = 0.06) compared to MSA-P. Additionally, patients with MSA-C showed significantly worse performance in the TMT-B task (p = 0.04) and a trend for worse performance in the TMT-A task (p = 0.06). Concerning longitudinal follow-up, a significant worsening in the TMT-B (p = 0.03) can be reported in MSA. In conclusion, frontal-executive dysfunction presents the hallmark of cognitive impairment in MSA.
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Affiliation(s)
- Fabian Maass
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Fabian Maass
| | - Peter Hermann
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Daniela Varges
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Sabine Nuhn
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph van Riesen
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Ala Jamous
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Niels K. Focke
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Manuel Hewitt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Leha
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Cluster of Excellence Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), University Medical Center Göttingen, Göttingen, Germany
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
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Lazzeri G, Franco G, Difonzo T, Carandina A, Gramegna C, Vergari M, Arienti F, Naci A, Scatà C, Monfrini E, Dias Rodrigues G, Montano N, Comi GP, Saetti MC, Tobaldini E, Di Fonzo A. Cognitive and Autonomic Dysfunction in Multiple System Atrophy Type P and C: A Comparative Study. Front Neurol 2022; 13:912820. [PMID: 35785342 PMCID: PMC9243310 DOI: 10.3389/fneur.2022.912820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple System Atrophy (MSA) is a rare neurodegenerative disease, clinically defined by a combination of autonomic dysfunction and motor involvement, that may be predominantly extrapyramidal (MSA-P) or cerebellar (MSA-C). Although dementia is generally considered a red flag against the clinical diagnosis of MSA, in the last decade the evidence of cognitive impairment in MSA patients has been growing. Cognitive dysfunction appears to involve mainly, but not exclusively, executive functions, and may have different characteristics and progression in the two subtypes of the disease (i.e., MSA-P and MSA-C). Despite continued efforts, combining in-vivo imaging studies as well as pathological studies, the physiopathological bases of cognitive involvement in MSA are still unclear. In this view, the possible link between cardiovascular autonomic impairment and decreased cognitive performance, extensively investigated in PD, needs to be clarified as well. In the present study, we evaluated a cohort of 20 MSA patients (9 MSA-P, 11 MSA-C) by means of a neuropsychological battery, hemodynamic assessment (heart rate and arterial blood pressure) during rest and active standing and bedside autonomic function tests assessed by heart rate variability (HRV) parameters and sympathetic skin response (SSR) in the same experimental session. Overall, global cognitive functioning, as indicated by the MoCA score, was preserved in most patients. However, short- and long-term memory and attentional and frontal-executive functions were moderately impaired. When comparing MSA-P and MSA-C, the latter obtained lower scores in tests of executive functions and verbal memory. Conversely, no statistically significant difference in cardiovascular autonomic parameters was identified between MSA-P and MSA-C patients. In conclusion, moderate cognitive deficits, involving executive functions and memory, are present in MSA, particularly in MSA-C patients. In addition, our findings do not support the role of dysautonomia as a major driver of cognitive differences between MSA-P and MSA-C.
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Affiliation(s)
- Giulia Lazzeri
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulia Franco
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Teresa Difonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelica Carandina
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chiara Gramegna
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maurizio Vergari
- Neurophysiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Arienti
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Anisa Naci
- Neurophysiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Costanza Scatà
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Edoardo Monfrini
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Nicola Montano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giacomo P. Comi
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maria Cristina Saetti
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Tobaldini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- *Correspondence: Alessio Di Fonzo
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Jecmenica-Lukic M, Petrovic IN, Pekmezovic T, Tomic A, Stankovic I, Svetel M, Kostic VS. The Profile and Evolution of Neuropsychiatric Symptoms in Multiple System Atrophy: Self- and Caregiver Report. J Neuropsychiatry Clin Neurosci 2022; 33:124-131. [PMID: 33261525 DOI: 10.1176/appi.neuropsych.20030057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent research shows that patients with multiple system atrophy (MSA) have significant cognitive and neuropsychiatric comorbidities that can color the clinical presentation of the disease and affect their quality of life. The aims of this study were to determine the neuropsychiatric profile in a cohort of patients with the parkinsonian type of MSA (MSA-P) and their dynamic changes over a 1-year follow-up period and to compare rates of neuropsychiatric symptoms (NPSs) reported by caregivers and the patients themselves. METHODS Forty-seven patients were assessed at baseline; of these, 25 were assessed again after 1 year. NPS assessment tools included the Neuropsychiatric Inventory (NPI), the Beck Depression Inventory, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Apathy Evaluation Scale. RESULTS The prevalence of NPSs in patients with MSA-P was very high, with depression, sleep disturbances, apathy, and anxiety being the most frequently occurring features. The evolution of NPSs was found to be independent of motor, autonomic, and cognitive symptoms. None of the scales measuring NPSs, including the NPI, were capable of detecting changes over the 1-year follow-up period. Although the overall prevalence of depression, apathy, and anxiety obtained from caregivers and the patients themselves was similar, reports from these two sources cannot be considered interchangeable. CONCLUSIONS The progression of neuropsychiatric symptoms was not a subject of rapid change in MSA-P, in contrast to the observed motor, autonomic, and cognitive deterioration. These findings suggest the need to investigate the utility of available instruments in capturing the evolution of NPSs in MSA over time.
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Affiliation(s)
- Milica Jecmenica-Lukic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Igor N Petrovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Tatjana Pekmezovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Aleksandra Tomic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Iva Stankovic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Marina Svetel
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
| | - Vladimir S Kostic
- Clinic of Neurology, School of Medicine, University of Belgrade, Serbia (Jecmenica-Lukic, Petrovic, Pekmezovic, Tomic, Stankovic, Svetel, Kostic); and Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia (Pekmezovic)
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14
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Shen C, Chen QS, Zuo CT, Liu FT, Wang J. The Frontal and Cerebellar Metabolism Related to Cognitive Dysfunction in Multiple System Atrophy. Front Aging Neurosci 2022; 14:788166. [PMID: 35221987 PMCID: PMC8871713 DOI: 10.3389/fnagi.2022.788166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/11/2022] [Indexed: 12/17/2022] Open
Abstract
Background Cognitive dysfunctions have been reported in multiple system atrophy (MSA). However the underlying mechanisms remain to be elucidated. This study aimed to explore the possible cerebral metabolism associated with domain-specific cognitive performances in MSA. Methods A total of 84 patients were diagnosed as probable or possible MSA, comprised of 27 patients as MSA with predominant parkinsonism (MSA-P) and 57 patients as MSA with predominant cerebellar ataxia (MSA-C). The comprehensive neuropsychological tests and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging were performed. Z-score was calculated to non-dimensionalize and unify indicators of different tests in the domains of executive function, attention, language, memory, and visuospatial function. Correlations between specific Z-score and cerebral 18F-FDG uptake were analyzed using statistical parametric mapping. The cognition-related metabolic differences between patients with MSA-P and MSA-C were analyzed using the post-hoc test. Results Z-scores of the domains including attention, executive function, and language correlated positively with the metabolism in the superior/inferior frontal gyrus and cerebellum, but negatively with that in the insula and fusiform gyrus (p < 0.001). No significant differences in neuropsychological performances and frontal metabolism were found between patients with MSA-P and MSA-C. Only lower metabolism in the cerebellum was observed in MSA-C. Conclusion Metabolic changes in the frontal lobe and cerebellum may participate in the cognitive impairments of patients with MSA. Nevertheless, cognitive and corresponding metabolic differences between the two subtypes of MSA still need more exploration.
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Affiliation(s)
- Cong Shen
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi-Si Chen
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuan-Tao Zuo
- Positron Emission Tomography (PET) Center at Huashan Hospital, Institute of Functional and Molecular Medical Imaging, Human Phenome Institute, Fudan University, Shanghai, China
| | - Feng-Tao Liu
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Feng-Tao Liu,
| | - Jian Wang
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
- Jian Wang,
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15
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Dash S, Mahale R, Netravathi M, Kamble NL, Holla V, Yadav R, Pal PK. Cognition in Patients With Multiple System Atrophy (MSA) and Its Neuroimaging Correlation: A Prospective Case-Control Study. Cureus 2022; 14:e21717. [PMID: 35242481 PMCID: PMC8885304 DOI: 10.7759/cureus.21717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Cognition has been reported to be involved in patients with multiple system atrophy (MSA), although initially it was considered an exclusion in the diagnosis of MSA. We assessed cognition in these patients and compared it with age and education matched healthy controls and correlated with the gray matter volume using voxel-based morphometry (VBM). Materials and methods This was a prospective, case-control, single-center study. Thirty patients with MSA (20 MSA-C (cerebellar variant) and 10 MSA-P (Parkinsonian variant)) and 25 age- and educational level-matched healthy controls were included. All the patients and controls underwent detailed neuropsychological tests and MRI brain. A battery of neuropsychological tests like Stroop test, digit span forward and backward, digit symbol substitution time test, animal naming test, color trail test and auditory verbal learning test were used to assess the various domain of cognition, which include mainly attention, executive function, memory, new learning, mental and motor speed. The gray matter volume was determined using VBM and correlated with neuropsychological scores. Results Attention, execution, verbal and visual memory, verbal fluency, and new learning were impaired in patients with MSA. MSA-P had more impairment in motor and mental speed, working memory, executive functions, and focused attention compared to MSA-C. Patients with MSA-C had more impairment in new learning, immediate recall, verbal fluency, and sustained attention compared to MSA-P. However, it was not statistically significant. There was a significant correlation between the various cognitive domains and atrophy of frontotemporal cortical areas, insula, caudate, thalamus, and cerebellum. Conclusion Cognition is impaired in patients with MSA-C and MSA-P and is likely due to the neurodegenerative process involving the cortical and subcortical structures. Long-term follow-up studies are required to find out the progression of these cognitive changes.
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Affiliation(s)
- Santosh Dash
- Neurology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Rohan Mahale
- Neurology, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - M Netravathi
- Neurology, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - Nitish L Kamble
- Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, IND
| | - Vikram Holla
- Neurology, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - Ravi Yadav
- Neurology, National Institute of Mental Health and Neurosciences, Bangalore, IND
| | - Pramod K Pal
- Neurology, National Institute of Mental Health and Neurosciences, Bangalore, IND
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16
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Lv Q, Pan Y, Chen X, Wei J, Wang W, Zhang H, Wan J, Li S, Zhuang Y, Yang B, Ma D, Ren D, Zhao Z. Depression in multiple system atrophy: Views on pathological, clinical and imaging aspects. Front Psychiatry 2022; 13:980371. [PMID: 36159911 PMCID: PMC9492977 DOI: 10.3389/fpsyt.2022.980371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 01/09/2023] Open
Abstract
Multiple system atrophy (MSA) is a common atypical parkinsonism, characterized by a varying combination of autonomic, cerebellar, and pyramidal systems. It has been noticed that the patients with MSA can be accompanied by some neuropsychiatric disorders, in particular depression. However, there is limited understanding of MSA-related depression. To bridge existing gaps, we summarized research progress on this topic and provided a new perspective regarding pathological, clinical, and imaging aspects. Firstly, we synthesized corresponding studies in order to investigate the relationship between depression and MSA from a pathological perspective. And then, from a clinical perspective, we focused on the prevalence of depression in MS patients and the comparison with other populations. Furthermore, the associations between depression and some clinical characteristics, such as life quality and gender, have been reported. The available neuroimaging studies were too sparse to draw conclusions about the radiological aspect of depression in MSA patients but we still described them in the presence of paper. Finally, we discussed some limitations and shortcomings existing in the included studies, which call for more high-quality basic research and clinical research in this field.
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Affiliation(s)
- Qiuyi Lv
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yuxin Pan
- Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Xing Chen
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jingpei Wei
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Wei Wang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Hua Zhang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jifeng Wan
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shiqiang Li
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yan Zhuang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Baolin Yang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Dayong Ma
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Dawei Ren
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Zijun Zhao
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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Cuoco S, Carotenuto I, Cappiello A, Scannapieco S, Russillo MC, Andreozzi V, Forino L, Amboni M, Picillo M, Erro R, Barone P, Pellecchia MT. Relationship Between Orthostatic Hypotension and Cognitive Functions in Multiple System Atrophy: A Longitudinal Study. Front Neurol 2021; 12:711358. [PMID: 34539557 PMCID: PMC8446504 DOI: 10.3389/fneur.2021.711358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The aim of this study is to investigate the impact of orthostatic hypotension (OH) on cognitive functions in patients with multiple system atrophy (MSA) followed over time. Methods: Thirty-two MSA patients were enrolled and underwent a comprehensive neuropsychological battery; at baseline (T0) 15 out of 32 patients presented OH, assessed by means of orthostatic standing test. All patients underwent a follow-up (T1) evaluation 12 months after baseline. Thirteen out of 32 patients also underwent a second follow-up (T2) evaluation at 24 months. Changes over time on different neuropsychological tasks were compared between patients with and without OH by means of Mann-Whitney's U-test. Moreover, clinical categories of normal cognition, mild cognitive impairment, and dementia were determined, and changes at T1 and T2 in global cognitive status were compared between patients with and without OH. Results: At T0, patients with OH had better performance on words/non-words repetition task (p = 0.02) compared to patients without OH. Compared to patients without OH, patients with OH performed worse on semantic association task (p < 0.01) at T1 and on Stroop test-error effect (p = 0.04) at T2. The percentage of patients with worsened cognitive status at T1 was higher among patients with OH than among patients without OH (93 vs. 59%, p = 0.03). OH (β = -4.67, p = 0.01), education (β = 0.45, p = 0.02), age (β = 0.19, p = 0.03), and Montreal Cognitive Assessment battery (MOCA) score at T0 (β = -0.26, p = 0.04) were significant predictors of global cognitive status worsening at T1. Discussion: We found that global cognitive status worsened at 1-year follow-up in 93% of patients with OH, and OH, along with age, education, and MOCA score, predicted cognitive worsening over time. To clarify the relationship between OH and cognitive dysfunction in MSA, we suggest the use of clinical categories of normal cognition, mild cognitive impairment, and dementia in further longitudinal studies on MSA patients with and without OH.
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Affiliation(s)
- Sofia Cuoco
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Immacolata Carotenuto
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Arianna Cappiello
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Sara Scannapieco
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Claudia Russillo
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Valentina Andreozzi
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Lorenzo Forino
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Marianna Amboni
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Marina Picillo
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Roberto Erro
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
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18
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Rascol O, Cochen de Cock V, Pavy-Le Traon A, Foubert-Samier A, Thalamas C, Sommet A, Rousseau V, Perez-Lloret S, Fabbri M, Azulay JP, Corvol JC, Couratier P, Damier P, Defebvre L, Durif F, Geny C, Houeto JL, Remy P, Tranchant C, Verin M, Tison F, Meissner WG. Fluoxetine for the Symptomatic Treatment of Multiple System Atrophy: The MSA-FLUO Trial. Mov Disord 2021; 36:1704-1711. [PMID: 33792958 DOI: 10.1002/mds.28569] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There are no effective treatments for multiple system atrophy (MSA). OBJECTIVE The objective of this study was to assess the efficacy and safety of the serotonin reuptake inhibitor fluoxetine (40 mg/d) for the symptomatic treatment of MSA. METHODS This was a double-blind, parallel-group, placebo-controlled, randomized trial in patients with "probable" MSA. The primary outcome was the change from baseline to week 12 in the mean total score of the Unified MSA Rating Scale (UMSARS Parts I + II). Secondary outcomes included change from baseline to week 6 in total UMSARS, and change from baseline to week 12 in the Scales for Outcomes in Parkinson Disease-Autonomic Dysfunction, Beck Depression Inventory, and different domains of the MSA-Quality of Life Questionnaire. Exploratory outcomes included change from baseline to week 12 in the UMSARS Parts I and II separately and change from baseline to week 24 in the total UMSARS score. RESULTS A total of 81 patients were randomly assigned, with no significant difference in the primary outcome (-2.13 units [95% confidence interval, CI, -4.55 to 0.29]; P = 0.08). There was a greater reduction on fluoxetine in the change from baseline to 12-week in UMSARS Part II (exploratory outcome: -1.41 units [95% CI, -2.84; 0.03]; p = 0.05) and in MSA-QoL emotional/social dimension (secondary outcome: -6.99 units [95% CI, -13.40; -0.56]; p < 0.03). A total of 5 deaths occurred (3 on fluoxetine and 2 on placebo). CONCLUSION The MSA-FLUO failed to demonstrate fluoxetine superiority over placebo on the total UMSARS score, whereas trends in motor and emotional secondary/exploratory outcomes deserve further investigation. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Olivier Rascol
- French Reference Center for MSA, Centre d'Investigation Clinique de Toulouse CIC1436, Departments of Neurosciences and Clinical Pharmacology, NS-Park/FCRIN Network, NeuroToul COEN Center, University Hospital of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
| | - Valérie Cochen de Cock
- Department of Neurology, Beau Soleil Clinic, Montpellier, France
- EuroMov Digital Health in Motion, University of Montpellier IMT Mines Ales, Montpellier, France
| | - Anne Pavy-Le Traon
- French Reference Center for MSA, Department of Neurosciences, Centre d'Investigation Clinique de Toulouse CIC1436, UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), University Hospital of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
| | - Alexandra Foubert-Samier
- French Reference Centre for MSA, NS-Park/FCRIN Network, University Hospital Bordeaux, Bordeaux, France
| | - Claire Thalamas
- Centre d'Investigation Clinique de Toulouse CIC 1436, Department of Clinical Pharmacology, University Hospital of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
| | - Agnes Sommet
- Centre d'Investigation Clinique de Toulouse CIC 1436, Department of Clinical Pharmacology, University Hospital of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
| | - Vanessa Rousseau
- Centre d'Investigation Clinique de Toulouse CIC 1436, Department of Clinical Pharmacology, University Hospital of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
| | - Santiago Perez-Lloret
- Centro de Altos Estudios en Ciencias Humanas y de la Salud (CAECIHS), Universidad Abierta Interamericana (UAI)-Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Faculty of Medicine, Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Margherita Fabbri
- Department of Neurosciences, Toulouse Parkinson Expert Center, Centre d'Investigation Clinique de Toulouse CIC1436, NS-Park/FCRIN Network, University Hospital of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
| | - Jean Philippe Azulay
- Aix-Marseille Université et Assistance Publique-Hôpitaux de Marseille; Movement Disorders Unit, NS-Park/FCRIN Network, La Timone Hospital, Marseille, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Paris Brain Institute-ICM, Department of Neurology, Centre d'Investigation Clinique Neurosciences, NS-Park/FCRIN Network, Pitié-Salpêtrière Hospital, Paris, France
| | - Philippe Couratier
- Centre de compétence AMS, NS-Park/FCRIN Network, CHU Limoges, Limoges, France
| | - Philippe Damier
- CHU Nantes, Inserm, Centre d'investigation clinique 0004, Hôpital Laennec, Nantes, France
| | - Luc Defebvre
- Service de Neurologie et Pathologie du Mouvement, NS-Park/FCRIN Network, CHU Lille, INSERM 1172, University of Lille, Lille, France
| | - Franck Durif
- Neurology Department, University Hospital Center, Clermont-Ferrand, France; NS-Park/FCRIN Network, Equipe d'Accueil 7280 Clermont Auvergne University, Clermont-Ferrand, France
| | - Christian Geny
- Department of Neurology, EuroMov, University of Montpellier, CHRU Montpellier, Montpellier, France
| | - Jean-Luc Houeto
- Service de Neurologie, Centre Expert Parkinson, centre de compétence AMS, NS-Park/FCRIN Network, CHU de Limoges, Limoges cedex, France
| | - Philippe Remy
- Centre Expert Parkinson, NS-Park/FCRIN Network, CHU Henri Mondor, AP-HP, Equipe NPI, IMRB, INSERM et Faculté de Santé UPE-C, Créteil, France
| | - Christine Tranchant
- Service de Neurologie, NS-Park/FCRIN Network, Hôpitaux Universitaires de Strasbourg, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Marc Verin
- Centre Expert Parkinson-Bretagne, NS-Park/FCRIN Network, University Hospital of Rennes, EA 4712 "Behavior and Basal Ganglia", University of Rennes 1, Institut des Neurosciences Cliniques de Rennes, Rennes, France
| | - François Tison
- Service de Neurologie des Maladies Neurodégénératives, French Reference Center for MSA, NS-Park/FCRIN Network, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
| | - Wassilios G Meissner
- Service de Neurologie des Maladies Neurodégénératives, French Reference Center for MSA, NS-Park/FCRIN Network, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
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A study on the characteristics of cognitive function in patients with multiple system atrophy in China. Sci Rep 2021; 11:4995. [PMID: 33654145 PMCID: PMC7925668 DOI: 10.1038/s41598-021-84393-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Nonmotor symptoms in patients with multiple system atrophy (MSA) have received an increasing amount of attention in recent years, but no research on MSA patients' cognitive characteristics has been conducted in China. To evaluate the cognitive function of MSA patients in China. Using a case–control study design, 256 MSA patients and 64 controls were evaluated by the Montreal cognitive assessment (MoCA) scale to characterize their cognitive function. Like the controls, 60.5% of the patients with MSA had cognitive impairment, but the characteristics of cognitive impairment between the two groups were different. The cognitive impairment in MSA patients was prominent in the cognitive domains of visuospatial/executive functions, naming, attention, and orientation; particularly, the visuospatial/executive functions were the most significantly impaired, while impairment in language function was mainly seen in the controls. Besides, impairments in visuospatial/executive functions, attention, language, and orientation were more prominent in MSA-P (MSA with predominant Parkinsonism) patients than in MSA-C (MSA with predominant cerebellar ataxia). The cognitive impairments were more severe in patients with probable MSA than in patients with possible MSA. In addition, the results showed that the level of cognitive function was negatively correlated with the severity of MSA. This study, which characterized the cognitive function of MSA patients with the largest sample size known so far in China, found that patients with MSA do have cognitive impairment and display specific characteristics. Therefore, the cognitive impairment of MSA should be paid more attention. The study has been registered in the Chinese Clinical Trial Registry (ChiCTR) (Registration No: ChiCTR1900022462).
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Vigen TR, Brudek T, Pakkenberg B, Olesen MV. Quantitative Cellular Changes in the Thalamus of Patients with Multiple System Atrophy. Neuroscience 2021; 459:142-152. [PMID: 33577952 DOI: 10.1016/j.neuroscience.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 01/10/2023]
Abstract
The thalamus is a brain region consisting of anatomical and functional connections between various spinal, subcortical, and cortical regions, which has a putative role in the clinical manifestation of Multiple System Atrophy (MSA). Previous stereological studies have reported significant anatomical alterations in diverse brain regions of MSA patients, including the cerebral cortex, basal ganglia and white matter, but no quantitative studies have examined the thalamus. To establish the extent of thalamic involvement, we applied stereological methods to estimate the total number of neurons and glial cells (oligodendrocytes, astrocytes and microglia) as well as the volume in two thalamic sub-regions, the mediodorsal nucleus (MDT) and the anterior principal nucleus (APn), in brains from ten MSA patients and 11 healthy control subjects. Compared to healthy controls, MSA patients had significantly fewer neurons (26%) in the MDT, but not the APn. We also found significantly more astrocytes (32%) and microglia (54%) in the MDT, with no such changes in the APn. Finally, we saw no group differences in the total number of oligodendrocytes. Our findings show a region-specific loss of thalamic neurons that occurs without loss of oligodendrocytes, whereas thalamic microgliosis seems to occur alongside astrogliosis. These pathological changes in the thalamus may contribute to the cognitive impairment seen in most patients with MSA.
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Affiliation(s)
- Tanya R Vigen
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Tomasz Brudek
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Bente Pakkenberg
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark.
| | - Mikkel V Olesen
- Research Laboratory for Stereology and Neuroscience, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
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21
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Lin J, Xu X, Hou Y, Yang J, Shang H. Voxel-Based Meta-Analysis of Gray Matter Abnormalities in Multiple System Atrophy. Front Aging Neurosci 2020; 12:591666. [PMID: 33328969 PMCID: PMC7729009 DOI: 10.3389/fnagi.2020.591666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/28/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose: This study aimed to identify consistent gray matter volume (GMV) changes in the two subtypes of multiple system atrophy (MSA), including parkinsonism subtype (MSA-P), and cerebellar subtype (MSA-C), by conducting a voxel-wise meta-analysis of whole brain voxel-based morphometry (VBM) studies. Method: VBM studies comparing MSA-P or MSA-C and healthy controls (HCs) were systematically searched in the PubMed, Embase, and Web of Science published from 1974 to 20 October 2020. A quantitative meta-analysis of VBM studies on MSA-P or MSA-C was performed using the effect size-based signed differential mapping (ES-SDM) method separately. A complementary analysis was conducted using the Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) method, which allows a familywise error rate (FWE) correction for multiple comparisons of the results, for further validation of the results. Results: Ten studies were included in the meta-analysis of MSA-P subtype, comprising 136 MSA-P patients and 211 HCs. Five studies were included in the meta-analysis of MSA-C subtype, comprising 89 MSA-C patients and 134 HCs. Cerebellum atrophy was detected in both MSA-P and MSA-C, whereas basal ganglia atrophy was only detected in MSA-P. Cerebral cortex atrophy was detected in both subtypes, with predominant impairment of the superior temporal gyrus, inferior frontal gyrus, temporal pole, insula, and amygdala in MSA-P and predominant impairment of the superior temporal gyrus, middle temporal gyrus, fusiform gyrus, and lingual gyrus in MSA-C. Most of these results survived the FWE correction in the complementary analysis, except for the bilateral amygdala and the left caudate nucleus in MSA-P, and the right superior temporal gyrus and the right middle temporal gyrus in MSA-C. These findings remained robust in the jackknife sensitivity analysis, and no significant heterogeneity was detected. Conclusion: A different pattern of brain atrophy between MSA-P and MSA-C detected in the current study was in line with clinical manifestations and provided the evidence of the pathophysiology of the two subtypes of MSA.
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Affiliation(s)
- Junyu Lin
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xinran Xu
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Laboratory of Neurodegenerative Disorders, Department of Neurology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
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22
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Sambati L, Calandra-Buonaura G, Giannini G, Cani I, Provini F, Poda R, Oppi F, Stanzani Maserati M, Cortelli P. Cognitive Profile and Its Evolution in a Cohort of Multiple System Atrophy Patients. Front Neurol 2020; 11:537360. [PMID: 33329297 PMCID: PMC7719742 DOI: 10.3389/fneur.2020.537360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: Cognitive decline is not a characteristic feature of multiple system atrophy (MSA), but recent evidence suggests cognitive impairment as an integral part of the disease. We aim to describe the cognitive profile and its progression in a cohort of patients with MSA. Methods: We retrospectively selected patients referred to our department with a clinical diagnosis of MSA who were evaluated at least once a year during the course of the disease and underwent a comprehensive neuropsychological evaluation. Results: At the first evaluation (T0), 37 out of 60 patients (62%) were cognitively impaired, mainly (76%) in attention and executive functioning. Thirteen patients were impaired in one cognitive domain and 24 in more than one cognitive domain. Six out of the 24 had dementia. Twenty patients underwent a follow-up evaluation (T1) after a mean of 16.6 ± 9.3 months from the first evaluation (T0). Eight out of 20 patients were cognitively normal at both T0 and T1. Seven out of 12 patients presented with stable cognitive impairment at T1, while cognitive decline progressed in five patients. Patients with progression in cognitive decline performed significantly worse at T0 than cognitively stable patients. Education was significantly different between patients with and without cognitive impairment. No other differences in demographic and clinical variables and autonomic or sleep disturbances were found. Patients with dementia were older at disease onset and at T0 and had lower education and disease duration at T0 compared to those in other groups. Conclusions: In patients with MSA, we observed three different cognitive profiles: normal cognition, stable selective attention-executive deficits, and progressive cognitive deficits evolving to dementia. The detection of cognitive impairment in patients with suspected MSA suggests the need for comprehensive and longitudinal neuropsychological evaluation.
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Affiliation(s)
- Luisa Sambati
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Giulia Giannini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Ilaria Cani
- Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Federica Provini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Roberto Poda
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federico Oppi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Pietro Cortelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Università di Bologna, Bologna, Italy
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23
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Chelban V, Catereniuc D, Aftene D, Gasnas A, Vichayanrat E, Iodice V, Groppa S, Houlden H. An update on MSA: premotor and non-motor features open a window of opportunities for early diagnosis and intervention. J Neurol 2020; 267:2754-2770. [PMID: 32436100 PMCID: PMC7419367 DOI: 10.1007/s00415-020-09881-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/27/2023]
Abstract
In this review, we describe the wide clinical spectrum of features that can be seen in multiple system atrophy (MSA) with a focus on the premotor phase and the non-motor symptoms providing an up-to-date overview of the current understanding in this fast-growing field. First, we highlight the non-motor features at disease onset when MSA can be indistinguishable from pure autonomic failure or other chronic neurodegenerative conditions. We describe the progression of clinical features to aid the diagnosis of MSA early in the disease course. We go on to describe the levels of diagnostic certainty and we discuss MSA subtypes that do not fit into the current diagnostic criteria, highlighting the complexity of the disease as well as the need for revised diagnostic tools. Second, we describe the pathology, clinical description, and investigations of cardiovascular autonomic failure, urogenital and sexual dysfunction, orthostatic hypotension, and respiratory and REM-sleep behavior disorders, which may precede the motor presentation by months or years. Their presence at presentation, even in the absence of ataxia and parkinsonism, should be regarded as highly suggestive of the premotor phase of MSA. Finally, we discuss how the recognition of the broader spectrum of clinical features of MSA and especially the non-motor features at disease onset represent a window of opportunity for disease-modifying interventions.
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Affiliation(s)
- Viorica Chelban
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK.
- Neurobiology and Medical Genetics Laboratory, "Nicolae Testemitanu" State University of Medicine and Pharmacy, 165, Stefan cel Mare si Sfant Boulevard, 2004, Chişinău, Republic of Moldova.
| | - Daniela Catereniuc
- Neurobiology and Medical Genetics Laboratory, "Nicolae Testemitanu" State University of Medicine and Pharmacy, 165, Stefan cel Mare si Sfant Boulevard, 2004, Chişinău, Republic of Moldova
- Department of Neurology, Epileptology and Internal Diseases, Institute of Emergency Medicine, 1, Toma Ciorba Street, 2004, Chişinău, Republic of Moldova
- Department of Neurology nr. 2, Nicolae Testemitanu" State University of Medicine and Pharmacy, 165, Stefan cel Mare si Sfant Boulevard, 2004, Chişinău, Republic of Moldova
| | - Daniela Aftene
- Department of Neurology, Epileptology and Internal Diseases, Institute of Emergency Medicine, 1, Toma Ciorba Street, 2004, Chişinău, Republic of Moldova
- Department of Neurology nr. 2, Nicolae Testemitanu" State University of Medicine and Pharmacy, 165, Stefan cel Mare si Sfant Boulevard, 2004, Chişinău, Republic of Moldova
| | - Alexandru Gasnas
- Department of Neurology, Epileptology and Internal Diseases, Institute of Emergency Medicine, 1, Toma Ciorba Street, 2004, Chişinău, Republic of Moldova
- Department of Neurology nr. 2, Nicolae Testemitanu" State University of Medicine and Pharmacy, 165, Stefan cel Mare si Sfant Boulevard, 2004, Chişinău, Republic of Moldova
- Cerebrovascular Diseases and Epilepsy Laboratory, Institute of Emergency Medicine, 1, Toma Ciorba Street, 2004, Chişinău, Republic of Moldova
| | - Ekawat Vichayanrat
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, UCL NHS Trust, London, WC1N 3BG, UK
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, UCL NHS Trust, London, WC1N 3BG, UK
| | - Stanislav Groppa
- Neurobiology and Medical Genetics Laboratory, "Nicolae Testemitanu" State University of Medicine and Pharmacy, 165, Stefan cel Mare si Sfant Boulevard, 2004, Chişinău, Republic of Moldova
- Department of Neurology, Epileptology and Internal Diseases, Institute of Emergency Medicine, 1, Toma Ciorba Street, 2004, Chişinău, Republic of Moldova
- Department of Neurology nr. 2, Nicolae Testemitanu" State University of Medicine and Pharmacy, 165, Stefan cel Mare si Sfant Boulevard, 2004, Chişinău, Republic of Moldova
| | - Henry Houlden
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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24
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Early autonomic and cognitive dysfunction in PD, DLB and MSA: blurring the boundaries between α-synucleinopathies. J Neurol 2020; 267:3444-3456. [PMID: 32594302 PMCID: PMC7320652 DOI: 10.1007/s00415-020-09985-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 02/08/2023]
Abstract
Differential diagnosis between Parkinson's disease, dementia with Lewy bodies and multiple system atrophy can be difficult, especially because in early phase they might present with overlapping clinical features. Notably, orthostatic hypotension and cognitive dysfunction are common nonmotor aspects of parkinsonian syndromes and can be both present from the earliest stages of all α-synucleinopathies, indicating a common neurobiological basis in their strong relationship. In view of the increasing awareness about the prevalence of mild cognitive dysfunction in multiple system atrophy, the relevance of autonomic dysfunction in demented parkinsonian patients, the critical role of non-motor symptoms in clustering Parkinson's disease patients and the shift to studying patients in the prodromal phase, we will discuss some intrinsic limitations of current clinical diagnostic criteria, even when applied by movement disorder specialists. In particular, we will focus on the early coexistence of autonomic and cognitive dysfunction in the setting of overt or latent parkinsonism as pitfalls in the differential diagnosis of α-synucleinopathies. As early and accurate diagnosis remains of outmost importance for counselling of patients and timely enrolment into disease-modifying clinical trials, a continuous effort of research community is ongoing to further improve the clinical diagnostic accuracy of α-synucleinopathies.
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25
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Costabile T, Pane C, Aurisicchio L, Salvati A, Lieto M, Peluso S, Reia A, De Lucia N, De Rosa A, Filla A, De Michele G, Saccà F. Application of the p9NORM correction method to timed neuropsychological tests in Parkinson's disease and multiple system atrophy. Neurol Sci 2020; 41:3633-3641. [PMID: 32462388 DOI: 10.1007/s10072-020-04478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Timed neuropsychological tests do not take into account physical impairment during scoring procedures. Dysarthria and upper limb impairment can be easily measured with the PATA rate test (PRT) and the nine-hole pegboard test (9HPT). We recently validated a normalization method for timed neuropsychological tests using the PRT and 9HPT (p9NORM). We now validate the p9NORM in Parkinson's disease (Yarnall et al. Neurology 82(4):308-316; 2014) and multiple system atrophy (MSA). METHODS We enrolled twenty-six patients with PD, eighteen patients with MSA, and fifteen healthy controls (HC). p9NORM was applied to patients with abnormal PRT and/or 9HPT. All subjects were tested with a comprehensive neuropsychological battery. RESULTS No differences emerged in demographics across groups: (PD: mean age ± SD 66 ± 8; education 9 ± 4 years; MSA: age 60 ± 8; education 10 ± 4 years; HC: age 61 ± 12; education 9 ± 4 years). In MSA patients, the scores on the trail making test (TMT-A p = 0.003; TMT-B p = 0.018), attentional matrices (AM; p = 0.042), and symbol digit modalities test (SDMT p = 0.027) significantly differed following application of p9NORM. In PD patients, the TMT-A (p < 0.001), TMT-B (p = 0.001), and AM (p = 0.001) differed after correction. PD and MSA showed cognitive impairment relative to HC performance. When comparing MSA with PD, the SDMT, AM, and fluencies were similar. TMT-A and -B raw scores were different between groups (p = 0.006; p = 0.034), but these differences lost significance after p9NORM corrections (p = 0.100; p = 0.186). CONCLUSIONS We confirm that the p9NORM can be successfully used in both PD and MSA patients, as it mitigates the impact of disability on timed tests, resulting in a more accurate analysis of cognitive domains.
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Affiliation(s)
- Teresa Costabile
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Chiara Pane
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy.
| | - Luisa Aurisicchio
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Adriana Salvati
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Maria Lieto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Silvio Peluso
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Antonio Reia
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Natascia De Lucia
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Alessandro Filla
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Giuseppe De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
| | - Francesco Saccà
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini, 5, 80131, Napoli, NA, Italy
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26
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Jellinger KA. Neuropathological findings in multiple system atrophy with cognitive impairment. J Neural Transm (Vienna) 2020; 127:1031-1039. [PMID: 32367182 DOI: 10.1007/s00702-020-02201-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/26/2020] [Indexed: 01/10/2023]
Abstract
Cognitive impairment (CI), previously considered an exclusion criterium for the diagnosis of multiple system atrophy (MSA) according to the second consensus criteria, is not uncommon in MSA. Mild cognitive impairment (MCI) has been reported in up to 47% of MSA patients, while severe dementia is rare. We related clinical CI with neuropathological findings in 48 autopsy-proven cases of MSA. This retrospective study included 33 parkinsonism predominant MSA (MSA-P), and 15 cerebellar ataxia-predominant MSA (MSA-C) cases (mean age at death 60.5 ± 7.8; range 46-82 years). Cognitive state was assessed from hospital charts, however, without comprehensive neuropsychological testing. Neuropathological examination, in addition to grading of the MSA pathologies, included semiquantitative assessment of Lewy and Alzheimer-related co-pathologies. Their incidence was compared with 143 age-matched controls (mean age 60.5 ± 7.6 years). MCI reported in ten cases (20.8%) was associated with moderate cortical tau pathology in only three; moderate CI in seven patients (14.5%) was associated with cortical amyloid plaques and moderate cortical tau pathology in six each, and one with probable primary age-related tauopathy (PART); a female aged 82 years with severe dementia showed fully developed Alzheimer disease. Cortical amyloid plaques, observed in eight cases, three of them without tau pathology, were associated with clinical MCI, as was cortical Lewy pathology in five. Two cases with cortical Lewy pathology and neuritic Braak stages II and III, and three with Braak stage IV, without cortical Lewy bodies, had shown moderate CI. Cortical Lewy pathology observed in four cases was not associated with clinical CI. 77.1% of the MSA cases were free of Alzheimer-type lesions, compared to 42% of controls; while Lewy pathology in the MSA cohort (22.9%) was significantly higher than in the control group (8.4%) both p < 0.001. Mild-to-moderate CI, reported in 35.3% of MSA patients, being significantly older than those without CI, were frequently associated with cortical Alzheimer (Braak stages III and IV) and Lewy pathologies, while only one with severe dementia had fully developed Alzheimer disease. In view of these findings in a limited series of MSA patients, further studies to elucidate the pathological basis of cognitive impairment in MSA are warranted.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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27
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Effects of gender on cognitive and behavioral manifestations in multiple system atrophy. J Neural Transm (Vienna) 2020; 127:925-934. [PMID: 32172473 DOI: 10.1007/s00702-020-02169-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/05/2020] [Indexed: 12/29/2022]
Abstract
Gender differences have been described in several neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease. The effects of gender on cognitive and behavioral manifestations in multiple system atrophy and the changes of cognitive functions over time according to gender have not been investigated so far. Fifty-five patients with a diagnosis of multiple system atrophy underwent a comprehensive neuropsychological and neuropsychiatric battery at baseline and 26 of them could be re-evaluated at 1-year follow-up. At baseline women with multiple system atrophy had poorer global cognitive state and visuo-spatial abilities, and a higher prevalence of depression and apathy than males. At follow-up, female patients deteriorated more than males on attention abilities and motor functions, and had a higher prevalence of depression than men. Executive functions and visuo-spatial abilities significantly worsened over time in both groups. Mild Cognitive Impairment single domain was significantly more frequent in females than males. Cognitive and behavioral differences between genders in multiple system atrophy involve global cognition, planning, attention, visual-perceptive skills, and depression, with female patients more compromised than males. Female patients deteriorated more than men over time as for motor functions and attention. Further longitudinal studies are deserved to confirm gender differences in progression of cognitive and behavioral features of multiple system atrophy.
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Eschlböck S, Delazer M, Krismer F, Bodner T, Fanciulli A, Heim B, Heras Garvin A, Kaindlstorfer C, Karner E, Mair K, Rabensteiner C, Raccagni C, Seppi K, Poewe W, Wenning GK. Cognition in multiple system atrophy: a single-center cohort study. Ann Clin Transl Neurol 2020; 7:219-228. [PMID: 32031752 PMCID: PMC7034507 DOI: 10.1002/acn3.50987] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/18/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Cognitive impairment in multiple system atrophy (MSA) is common, but remain poorly characterized. We evaluated cognitive and behavioral features in MSA patients and assessed between-group differences for MSA subtypes and the effect of orthostatic hypotension (OH) on cognition. METHODS This retrospective study included 54 patients with clinical diagnosis of possible and probable MSA referred to the Department of Neurology at Medical University of Innsbruck between 2000 and 2018. Neurological work-up included comprehensive neuropsychological testing including Consortium to Establish a Registry for Alzheimer's Disease (CERAD-plus) test battery, Frontal Assessment Battery (FAB), digit span test (DST), clock drawing task (CLOX1), and Hospital Anxiety and Depression Scale (HADS-D). RESULTS The mean MMSE score was 27.6 points. Overall, slight to moderate cognitive impairment was noted in up to 40% of patients, with predominant impairment of executive function and verbal memory. Patients with the cerebellar variant performed significantly worse than patients with the parkinsonian type (P < 0.05) in a screening of executive functions (FAB) and in phonemic verbal fluency. Depression and anxiety scores were elevated in 28% and 22% of MSA patients, respectively. Cognitive profile, depression, and anxiety levels were comparable between patients with and without OH. INTERPRETATION Cognitive deficits are relatively frequent in MSA and primarily affect executive functions and verbal memory. Future comparative studies including Parkinson dementia, Lewy body disease, and MSA cases with and without OH are required to elucidate disease-specific cognitive profiles in these synucleinopathies and to examine the influence of cardiovascular autonomic dysfunction on cognitive function in MSA.
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Affiliation(s)
- Sabine Eschlböck
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Margarete Delazer
- Division of Neuropsychology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bodner
- Division of Neuropsychology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Antonio Heras Garvin
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elfriede Karner
- Division of Neuropsychology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Katherina Mair
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Cecilia Raccagni
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Kawabata K, Hara K, Watanabe H, Bagarinao E, Ogura A, Masuda M, Yokoi T, Kato T, Ohdake R, Ito M, Katsuno M, Sobue G. Alterations in Cognition-Related Cerebello-Cerebral Networks in Multiple System Atrophy. THE CEREBELLUM 2020; 18:770-780. [PMID: 31069705 DOI: 10.1007/s12311-019-01031-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We aimed to elucidate the effect of cerebellar degeneration in relation to cognition in multiple system atrophy (MSA). Thirty-two patients diagnosed with probable MSA and 32 age- and gender-matched healthy controls (HCs) were enrolled. We conducted voxel-based morphometry (VBM) for anatomical images and independent component analysis (ICA), dual-regression analysis, and seed-based analysis for functional images with voxel-wise gray matter correction. In the MSA group, a widespread cerebellar volume loss was observed. ICA and dual-regression analysis showed lower functional connectivity (FC) in the left executive control and salience networks in regions located in the cerebellum. Seed-based analysis using the identified cerebellar regions as seeds showed extensive disruptions in cerebello-cerebral networks. Global cognitive scores correlated with the FC values between the right lobules VI/crus I and the medial prefrontal/anterior cingulate cortices and between the same region and the amygdala/parahippocampal gyrus. Our study indicates that cerebellar degeneration in MSA causes segregation of cerebellar-cerebral networks. Furthermore, the cognitive deficits in MSA may be driven by decreased cerebello-prefrontal and cerebello-amygdaloid functional connections.
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Affiliation(s)
- Kazuya Kawabata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Aya Ogura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takamasa Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiyasu Kato
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Reiko Ohdake
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan. .,Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Santangelo G, Cuoco S, Picillo M, Erro R, Squillante M, Volpe G, Cozzolino A, Cicarelli G, Barone P, Pellecchia MT. Evolution of neuropsychological profile in motor subtypes of multiple system atrophy. Parkinsonism Relat Disord 2020; 70:67-73. [DOI: 10.1016/j.parkreldis.2019.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 10/30/2019] [Accepted: 12/15/2019] [Indexed: 12/19/2022]
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Cognitive impairment and structural brain damage in multiple system atrophy-parkinsonian variant. J Neurol 2019; 267:87-94. [DOI: 10.1007/s00415-019-09555-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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Sulena, Gupta D, Sharma AK, Kumar N. Clinical Profile of Cognitive Decline in Patients with Parkinson's Disease, Progressive Supranuclear Palsy, and Multiple System Atrophy. J Neurosci Rural Pract 2019; 8:562-568. [PMID: 29204015 PMCID: PMC5709878 DOI: 10.4103/jnrp.jnrp_154_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background There are very less data on the comparison between the cognitive profile in Parkinson's disease (PD) and Parkinson's-plus groups, especially in India. Aims The aim of this study is to compare the cognitive profile across PD, progressive supranuclear palsy (PSP), and multiple system atrophy (MSA) groups and compare them using Mini-Mental State Examination (MMSE), frontal assessment battery (FAB), and verbal fluency tests. Settings and Design This was a cross-sectional study. Materials and Methods MMSE, FAB, and verbal fluency tests were administered in a total of 73 patients constituting 22 patients in MSA, 26 patients in PD, and 25 patients in PSP group, respectively. Twenty-six participants both age- and gender-matched were enrolled in control group. Statistical Analysis Statistical analysis was done using SPSS Version 20.0. Descriptive statistics were done to find out the mean and standard deviation of different variables. ANOVA was done for followed by post hoc Bonferroni test to assess the cognitive function in three groups. Results ANOVA showed that there is a significant difference for MMSE scores (P = 0.038) being worse scores for PSP and maximum for MSA. A significant difference was found for FAB scores within three groups. There is a significant difference for FAB scores (P = 0.00003) being worse scores for PSP and highest scores obtained for PD. All the subtests of FAB test differed significantly except motor programming across MSA, PSP, and PD groups. Conclusions Our data suggest that global cognitive impairment and executive dysfunction are worst in PSP among the three groups. Patients with MSA had significant cognitive decline as opposed to previous experience. FAB scores and verbal fluency tests are good tests to assess cognitive impairment in these diseases. Subsets of FAB score have significant differences but cannot help differentiating conclusively between these three diseases.
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Affiliation(s)
- Sulena
- Division of Neurology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Dipti Gupta
- Division of Neurology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Anjani Kumar Sharma
- Department of Neurology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Naveen Kumar
- Department of Medicine, Garg Hospital, Faridkot, Punjab, India
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Zhang L, Cao B, Zou Y, Wei QQ, Ou R, Zhao B, Yang J, Wu Y, Shang H. Frontal lobe function, behavioral changes and quality of life in patients with multiple system atrophy. Restor Neurol Neurosci 2019; 37:11-19. [PMID: 30741706 DOI: 10.3233/rnn-180862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive impairment is an important and common symptom in patients with multiple system atrophy (MSA). OBJECTIVE The objective of the study was to explore the potential relationships among frontal lobe function, behavioral changes and quality of life (QoL) in patients with MSA. METHODS A total of 203 MSA patients were enrolled and evaluated using the Frontal Assessment Battery (FAB), the Frontal Behavioral Inventory (FBI) and the Parkinson's disease Questionnaire-39 item version (PDQ-39). Seventy-eight age-, sex-, and education-matched healthy controls were recruited to complete the FAB. RESULTS Among MSA patients, those with frontal lobe dysfunction were older (P = 0.005), had older age of onset (P = 0.002), lower educational level (P < 0.001), higher scores in the PDQ-39 domains of mobility (P = 0.042), ADL (P = 0.020), cognition (P < 0.001) and communication compared to those with normal frontal lobe function. The most common frontal behavioral changes were logopenia followed by apathy and inflexibility. The severity of frontal behavioral changes was associated with MSA subtype (P = 0.015), disease severity (Unified Multiple System Atrophy Rating Scale-I (UMSARS-I), UMSARS-II, UMSARS-IV, and total UMSARS scores) (P < 0.001), orthostatic hypotension (P = 0.022), severity of depressive symptoms and total score on the PDQ-39 (P < 0.001). Binary logistic regression showed that the determinants of poor QoL in patients with MSA were disease severity (UMSARS-I and total UMSARS scores) (P < 0.05), depression (P = 0.013) and total FBI score (P = 0.003). CONCLUSIONS Frontal behavioral changes were potential determinants of poor QoL in MSA, in addition to the disease severity and depressive symptoms. Early discovery and management of frontal behavioral changes in addition to motor and depressive symptoms will help to improve the QoL of MSA patients.
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Affiliation(s)
- LingYu Zhang
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yutong Zou
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qian-Qian Wei
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - RuWei Ou
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Wu
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - HuiFang Shang
- Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Emerging of Explosive Speech after Olanzapine in Multiple System Atrophy Patient. Dement Neurocogn Disord 2019; 17:37-40. [PMID: 30906390 PMCID: PMC6427994 DOI: 10.12779/dnd.2018.17.1.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 11/27/2022] Open
Abstract
Background Cerebellum has an important role in sensorimotor control including speech. Multiple system atrophy (MSA) is a sporadic and rapidly progressive neurodegenerative disorder that presents with autonomic failure in combination with Parkinsonism or cerebellar ataxia. Case Report We report a case of MSA-cerebellum subtype associated with emergence of irreversible explosive speech following olanzapine therapy. Conclusions Further investigation into speech problems in MSA according to subtype and disease severity is needed, and side effects of olanzapine therapy should also be considered.
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Fabbrini G, Fabbrini A, Suppa A. Progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration. ACTA ACUST UNITED AC 2019; 165:155-177. [DOI: 10.1016/b978-0-444-64012-3.00009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Zhang L, Zhang L, Xue F, Yue K, Peng H, Wu Y, Sha O, Yang L, Ding Y. Brain morphological alteration and cognitive dysfunction in multiple system atrophy. Quant Imaging Med Surg 2018; 8:1030-1038. [PMID: 30598880 DOI: 10.21037/qims.2018.11.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease in adults, manifesting various clinical symptoms including autonomic nerve dysfunction, Parkinson's syndrome, cerebellar ataxia, and pyramidal sign. The clinical diagnosis and classification of MSA are mainly dependent on motion and non-motion symptoms, such as autonomic nerve dysfunction. In addition, an increasing amount of clinical and pathological evidence has shown that about half of the MSA patients exhibit distinct types and levels of cognitive dysfunction. However, cognitive dysfunction has not been included in the current diagnosis criteria of MSA. In most cases, it was even used as an exclusion criterion of MSA. Based on the neuroimaging, neuropathology and neuropsychology, this review summarized the morphological changes of the brain in the patients with MSA, and discussed possible brain regions that could be associated with cognitive impairment. The article may provide a theoretical basis for incorporating cognitive dysfunction into the criteria of MSA diagnosis.
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Affiliation(s)
- Lihong Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Li Zhang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Fang Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Kathy Yue
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Haixin Peng
- Department of Food Science and Nutrition, Sichuan Agricultural University, Chengdu 611130, China
| | - Ya'nan Wu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Ou Sha
- Department of Anatomy, Histology and Developmental Biology, School of Basic Medical Sciences, Shenzhen University Health Science Centre, Shenzhen 518060, China
| | - Lan Yang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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37
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Abnormal pain perception in patients with Multiple System Atrophy. Parkinsonism Relat Disord 2018; 48:28-33. [DOI: 10.1016/j.parkreldis.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/26/2017] [Accepted: 12/03/2017] [Indexed: 01/28/2023]
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Koga S, Dickson DW. Recent advances in neuropathology, biomarkers and therapeutic approach of multiple system atrophy. J Neurol Neurosurg Psychiatry 2018; 89:175-184. [PMID: 28860330 DOI: 10.1136/jnnp-2017-315813] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/07/2017] [Accepted: 08/16/2017] [Indexed: 01/20/2023]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterised by a variable combination of autonomic failure, levodopa-unresponsive parkinsonism, cerebellar ataxia and pyramidal symptoms. The pathological hallmark is the oligodendrocytic glial cytoplasmic inclusion (GCI) consisting of α-synuclein; therefore, MSA is included in the category of α-synucleinopathies. MSA has been divided into two clinicopathological subtypes: MSA with predominant parkinsonism and MSA with predominant cerebellar ataxia, which generally correlate with striatonigral degeneration and olivopontocerebellar atrophy, respectively. It is increasingly recognised, however, that clinical and pathological features of MSA are broader than previously considered.In this review, we aim to describe recent advances in neuropathology of MSA from a review of the literature and from information derived from review of nearly 200 definite MSA cases in the Mayo Clinic Brain Bank. In light of these new neuropathological findings, GCIs and neuronal cytoplasmic inclusions play an important role in clinicopathological correlates of MSA. We also focus on clinical diagnostic accuracy and differential diagnosis of MSA as well as candidate biomarkers. We also review some controversial topics in MSA. Cognitive impairment, which has been a non-supporting feature of MSA, is considered from both clinical and pathological perspectives. The cellular origin of α-synuclein in GCI and a 'prion hypothesis' are discussed. Finally, completed and ongoing clinical trials targeting disease modification, including immunotherapy, are summarised.
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Affiliation(s)
- Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
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Barcelos LB, Saad F, Giacominelli C, Saba RA, de Carvalho Aguiar PM, Silva SMA, Borges V, Bertolucci PHF, Ferraz HB. Neuropsychological and clinical heterogeneity of cognitive impairment in patients with multiple system atrophy. Clin Neurol Neurosurg 2018; 164:121-126. [DOI: 10.1016/j.clineuro.2017.10.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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Belvisi D, Berardelli I, Suppa A, Fabbrini A, Pasquini M, Pompili M, Fabbrini G. Neuropsychiatric disturbances in atypical parkinsonian disorders. Neuropsychiatr Dis Treat 2018; 14:2643-2656. [PMID: 30349262 PMCID: PMC6186304 DOI: 10.2147/ndt.s178263] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD) are the most common atypical parkinsonisms. These disorders are characterized by varying combinations of autonomic, cerebellar and pyramidal system, and cognitive dysfunctions. In this paper, we reviewed the evidence available on the presence and type of neuropsychiatric disturbances in MSA, PSP, and CBD. A MedLine, Excerpta Medica, PsycLit, PsycInfo, and Index Medicus search was performed to identify all articles published on this topic between 1965 and 2018. Neuropsychiatric disturbances including depression, anxiety, agitation, and behavioral abnormalities have been frequently described in these disorders, with depression as the most frequent disturbance. MSA patients show a higher frequency of depressive disorders when compared to healthy controls. An increased frequency of anxiety disorders has also been reported in some patients, and no studies have investigated apathy. PSP patients may have depression, apathy, disinhibition, and to a lesser extent, anxiety and agitation. In CBD, neuropsychiatric disorders are similar to those present in PSP. Hallucinations and delusions are rarely reported in these disorders. Neuropsychiatric symptoms in MSA, PSP, and CBD do not appear to be related to the severity of motor dysfunction and are one of the main factors that determine a low quality of life. The results suggest that neuropsychiatric disturbances should always be assessed in patients with atypical parkinsonisms.
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Affiliation(s)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Suppa
- IRCCS Neuromed, Pozzilli, Italy, .,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed, Pozzilli, Italy, .,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy,
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Canesi M, Rusconi ML, Cereda E, Ranghetti A, Cereda V, Moroni F, Pezzoli G. Divergent Thinking in Parkinsonism: A Case-Control Study. Front Neurol 2017; 8:534. [PMID: 29118735 PMCID: PMC5661018 DOI: 10.3389/fneur.2017.00534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Creativity is a multidimensional phenomenon and an important component of human capacities. This ability is characterized by the involvement of several cognitive functions particularly linked to the prefrontal cortex. We compared divergent thinking, a measure of creativity, in patients affected by progressive supranuclear palsy (PSP), other parkinsonian syndromes, and healthy controls (HCs). METHODS Creativity features were evaluated using the Abbreviated Torrance Test for Adults (ATTA). Consecutive PSP outpatients were screened for inclusion. Then, patients with multiple system atrophy (MSA) and Parkinson's disease (PD) and a group of HC were studied. All groups have preserved cognitive functions and were matched for gender, education, disease duration, and age at onset with exception of PD patients who were matched by disease severity rather than disease duration. RESULTS PSP patients were characterized by lower values in total ATTA and all subscales than HC and both MSA and PD patients. No differences were found comparing HC versus both MSA and PD patients. PSP patients were characterized by more impaired frontal functioning [assessed by means of Frontal Assessment Battery (FAB)] than HC and both PD and MSA patients. CONCLUSION In the present study, ATTA was significantly lower in PSP patients than in the other study groups. The worst performance in ATTA-total score and the lower score in FAB in PSP patients support the role of frontal function in creative processes.
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Affiliation(s)
- Margherita Canesi
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
| | - Maria Luisa Rusconi
- Department of Human and Social Sciences, Università degli Studi di Bergamo, Bergamo, Italy
| | - Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ranghetti
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
| | - Viviana Cereda
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
| | - Federica Moroni
- Department of Human and Social Sciences, Università degli Studi di Bergamo, Bergamo, Italy
| | - Gianni Pezzoli
- Parkinson Institute, Azienda Socio Sanitaria Territoriale Pini-CTO, Milano, Italy
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Yao Q, Zhu D, Li F, Xiao C, Lin X, Huang Q, Shi J. Altered Functional and Causal Connectivity of Cerebello-Cortical Circuits between Multiple System Atrophy (Parkinsonian Type) and Parkinson's Disease. Front Aging Neurosci 2017; 9:266. [PMID: 28848423 PMCID: PMC5554370 DOI: 10.3389/fnagi.2017.00266] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/26/2017] [Indexed: 01/28/2023] Open
Abstract
Lesions of the cerebellum lead to motor and non-motor deficits by influencing cerebral cortex activity via cerebello-cortical circuits. It remains unknown whether the cerebello-cortical “disconnection” underlies motor and non-motor impairments both in the parkinsonian variant of multiple system atrophy (MSA-P) and Parkinson’s disease (PD). In this study, we investigated both the functional and effective connectivity of the cerebello-cortical circuits from resting-state functional magnetic resonance imaging (rs-fMRI) data of three groups (26 MSA-P patients, 31 PD patients, and 30 controls). Correlation analysis was performed between the causal connectivity and clinical scores. PD patients showed a weakened cerebellar dentate nucleus (DN) functional coupling in the posterior cingulate cortex (PCC) and inferior parietal lobe compared with MSA-P or controls. MSA-P patients exhibited significantly enhanced effective connectivity from the DN to PCC compared with PD patients or controls, as well as declined causal connectivity from the left precentral gyrus to right DN compared with the controls, and this value is significantly correlated with the motor symptom scores. Our findings demonstrated a crucial role for the cerebello-cortical networks in both MSA-P and PD patients in addition to striatal-thalamo-cortical (STC) networks and indicated that different patterns of cerebello-cortical loop degeneration are involved in the development of the diseases.
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Affiliation(s)
- Qun Yao
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical UniversityNanjing, China
| | - Donglin Zhu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical UniversityNanjing, China
| | - Feng Li
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical UniversityNanjing, China
| | - Chaoyong Xiao
- Department of Radiology, Affiliated Brain Hospital of Nanjing Medical UniversityNanjing, China
| | - Xingjian Lin
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical UniversityNanjing, China
| | - Qingling Huang
- Department of Radiology, Affiliated Brain Hospital of Nanjing Medical UniversityNanjing, China
| | - Jingping Shi
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical UniversityNanjing, China
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Bhatia KP, Stamelou M. Nonmotor Features in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1285-1301. [PMID: 28805573 DOI: 10.1016/bs.irn.2017.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Atypical parkinsonism (AP) comprises mainly multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), which are distinct pathological entities, presenting with a wide phenotypic spectrum. The classic syndromes are now called MSA-parkinsonism (MSA-P), MSA-cerebellar type (MSA-C), Richardson's syndrome, and corticobasal syndrome. Nonmotor features in AP have been recognized almost since the initial description of these disorders; however, research has been limited. Autonomic dysfunction is the most prominent nonmotor feature of MSA, but also gastrointestinal symptoms, sleep dysfunction, and pain, can be a feature. In PSP and CBD, the most prominent nonmotor symptoms comprise those deriving from the cognitive/neuropsychiatric domain. Apart from assisting the clinician in the differential diagnosis with Parkinson's disease, nonmotor features in AP have a big impact on quality of life and prognosis of AP and their treatment poses a major challenge for clinicians.
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Affiliation(s)
| | - Maria Stamelou
- HYGEIA Hospital, Athens, Greece; Neurology Clinic, Philipps University Marburg, Marburg, Germany; University of Athens, Athens, Greece.
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Yildiz FG, Saka E, Elibol B, Temucin CM. Modulation of Cerebellar-Cortical Connections in Multiple System Atrophy Type C by Cerebellar Repetitive Transcranial Magnetic Stimulation. Neuromodulation 2017; 21:402-408. [PMID: 28266761 DOI: 10.1111/ner.12589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/07/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aims at modulating the altered cerebellar-cortical interactions in patients with multiple system atrophy-cerebellar subtype (MSA-C) by using cerebellar repetitive transcranial magnetic stimulation (rTMS). We hypothesized that cerebellar modulation by low-frequency rTMS can resolve the abnormal cortical excitability in multiple system atrophy cerebellar subtype. MATERIALS AND METHODS We studied detailed effects of rTMS of the cerebellum on reaction time (RT) and short-latency afferent inhibition (SAI) response in MSA-C group, Alzheimer Disease (AD) group, and a control group of healthy individuals. The RT and SAI responses were measured before and after 1 Hz cerebellar rTMS in all groups. The study was conducted in the neurophysiology laboratory in Hacettepe University Hospital. RESULTS Our results indicated that motor cortex disinhibition was predominant in patients with AD and MSA-C. In AD and control groups, there were no changes in SAI after rTMS. However, after application of rTMS over the cerebellum in MSA-C patients, the pathological disinhibition and RT results showed an improvement compared to their previous results. CONCLUSION Our study highlights that cerebellar rTMS impairs abnormal cerebellar-cortical inhibitory connections in case of MSA-C.
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Affiliation(s)
- F Gokcem Yildiz
- Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey.,Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
| | - Esen Saka
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
| | - Bulent Elibol
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
| | - Cagri Mesut Temucin
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
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Kim HW, Oh M, Oh JS, Oh SJ, Lee SJ, Chung SJ, Kim JS. Striatofrontal Deafferentiation in MSA-P: Evaluation with [18F]FDG Brain PET. PLoS One 2017; 12:e0169928. [PMID: 28085923 PMCID: PMC5234778 DOI: 10.1371/journal.pone.0169928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/22/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although cognitive impairment is not a consistent feature of multiple system atrophy (MSA), increasing evidence suggests that cognitive impairment is common in MSA with predominant parkinsonism (MSA-P). It is assumed that the cognitive impairment in MSA-P is caused by the striatal dysfunction and disruption of striatofrontal connections. The aim of this study was to evaluate the relationship between regional glucose metabolism in the frontal cortex and striatum in patients with MSA-P using [18F]FDG brain PET. Methods Twenty-nine patients with MSA-P and 28 healthy controls underwent [18F]FDG brain PET scan. The [18F]FDG brain PET images were semiquantitatively analyzed on the basis of a template in standard space. The regional glucose metabolism of the cerebral cortex and striatum were compared between MSA-P and healthy control groups. The correlations between age, symptom duration, H&Y stage, UPDRS III score, MMSE score, and glucose metabolism in the cerebellum and striatum to glucose metabolism in the frontal cortex were evaluated by multivariate analysis. Results The glucose metabolism in the frontal cortex and striatum in MSA-P patients were significantly lower than those in healthy controls. Glucose metabolism in the striatum was the most powerful determinant of glucose metabolism in the frontal cortex in MSA-P. Only age and glucose metabolism in the cerebellum were independent variables affecting the glucose metabolism in the frontal cortex in healthy controls. Conclusion The decrease in frontal glucose metabolism in MSA-P is related to the decrease in striatal glucose metabolism. This result provided evidence of striatofrontal deafferentiation in patients with MSA-P.
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Affiliation(s)
- Hae Won Kim
- Department of Nuclear Medicine, Keimyung University, School of Medicine, Daegu, Korea
| | - Minyoung Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Jun Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ju Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- * E-mail:
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46
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Stefanova N, Wenning GK. Review: Multiple system atrophy: emerging targets for interventional therapies. Neuropathol Appl Neurobiol 2016; 42:20-32. [PMID: 26785838 PMCID: PMC4788141 DOI: 10.1111/nan.12304] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/13/2016] [Accepted: 01/20/2016] [Indexed: 12/21/2022]
Abstract
Multiple system atrophy (MSA) is a fatal orphan neurodegenerative disorder that manifests with rapidly progressive autonomic and motor dysfunction. The disease is characterized by the accumulation of α-synuclein fibrils in oligodendrocytes that form glial cytoplasmic inclusions, a neuropathological hallmark and central player in the pathogenesis of MSA. Here, we summarize the current knowledge on the etiopathogenesis and neuropathology of MSA. We discuss the role of α-synuclein pathology, microglial activation, oligodendroglial dysfunction and putative cell death mechanisms as candidate therapeutic targets in MSA.
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Affiliation(s)
- N Stefanova
- Division of Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - G K Wenning
- Division of Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Koga S, Parks A, Uitti RJ, van Gerpen JA, Cheshire WP, Wszolek ZK, Dickson DW. Profile of cognitive impairment and underlying pathology in multiple system atrophy. Mov Disord 2016; 32:405-413. [PMID: 27859650 DOI: 10.1002/mds.26874] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The objectives of this study were to elucidate any potential association between α-synuclein pathology and cognitive impairment and to determine the profile of cognitive impairment in multiple system atrophy (MSA) patients. To do this, we analyzed the clinical and pathologic features in autopsy-confirmed MSA patients. METHODS We retrospectively reviewed medical records, including neuropsychological test data, in 102 patients with autopsy-confirmed MSA in the Mayo Clinic brain bank. The burden of glial cytoplasmic inclusions and neuronal cytoplasmic inclusions were semiquantitatively scored in the limbic regions and middle frontal gyrus. We also assessed concurrent pathologies potentially causing dementia including Alzheimer's disease, hippocampal sclerosis, and cerebrovascular pathology. RESULTS Of 102 patients, 33 (32%) were documented to have cognitive impairment. Those that received objective testing, deficits primarily in processing speed and attention/executive functions were identified, which suggests a frontal-subcortical pattern of dysfunction. Of these 33 patients with cognitive impairment, 8 patients had concurrent pathologies of dementia. MSA patients with cognitive impairment had a greater burden of neuronal cytoplasmic inclusions in the dentate gyrus than patients without cognitive impairment, both including and excluding patients with concurrent pathologies of dementia. CONCLUSIONS The cognitive deficits observed in this study were more evident on neuropsychological assessment than with cognitive screens. Based on these findings, we recommend that clinicians consider more in-depth neuropsychological assessments if patients with MSA present with cognitive complaints. Although we did not identify the correlation between cognitive deficits and responsible neuroanatomical regions, a greater burden of neuronal cytoplasmic inclusions in the limbic regions was associated with cognitive impairment in MSA. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shunsuke Koga
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Adam Parks
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jay A van Gerpen
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
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Fiorenzato E, Weis L, Seppi K, Onofrj M, Cortelli P, Zanigni S, Tonon C, Kaufmann H, Shepherd TM, Poewe W, Krismer F, Wenning G, Antonini A, Biundo R. Brain structural profile of multiple system atrophy patients with cognitive impairment. J Neural Transm (Vienna) 2016; 124:293-302. [PMID: 27778099 DOI: 10.1007/s00702-016-1636-0] [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: 09/25/2016] [Accepted: 10/17/2016] [Indexed: 02/03/2023]
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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Affiliation(s)
- Eleonora Fiorenzato
- Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy. .,Department of General Psychology, University of Padua, via Venezia, 8, 35131, Padua, Italy.
| | - Luca Weis
- Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, via dei Vestini, 33, 66100, Chieti, Italy
| | - Pietro Cortelli
- IRCCS Institute of Neurological Sciences of Bologna, via Altura, 3, 40139, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via Ugo Foscolo, 7, 40123, Bologna, Italy
| | - Stefano Zanigni
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via Ugo Foscolo, 7, 40123, Bologna, Italy.,Functional MR Unit, S. Orsola-Malpighi Hospital, via Massarenti, 9, 40138, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via Ugo Foscolo, 7, 40123, Bologna, Italy.,Functional MR Unit, S. Orsola-Malpighi Hospital, via Massarenti, 9, 40138, Bologna, Italy
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA
| | - Timothy Michael Shepherd
- Department of Neurology, Dysautonomia Center, New York University, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria
| | - Gregor Wenning
- Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria
| | - Angelo Antonini
- Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy
| | - Roberta Biundo
- Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy
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Robertson EE, Hall DA, McAsey AR, O'Keefe JA. Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders. Clin Neuropsychol 2016; 30:849-900. [PMID: 27414076 PMCID: PMC7336900 DOI: 10.1080/13854046.2016.1202239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this paper is to review the typical cognitive and motor impairments seen in fragile X-associated tremor/ataxia syndrome (FXTAS), essential tremor (ET), Parkinson disease (PD), spinocerebellar ataxias (SCAs), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) in order to enhance diagnosis of FXTAS patients. METHODS We compared the cognitive and motor phenotypes of FXTAS with each of these other movement disorders. Relevant neuropathological and neuroimaging findings are also reviewed. Finally, we describe the differences in age of onset, disease severity, progression rates, and average lifespan in FXTAS compared to ET, PD, SCAs, MSA, and PSP. We conclude with a flow chart algorithm to guide the clinician in the differential diagnosis of FXTAS. RESULTS By comparing the cognitive and motor phenotypes of FXTAS with the phenotypes of ET, PD, SCAs, MSA, and PSP we have clarified potential symptom overlap while elucidating factors that make these disorders unique from one another. In summary, the clinician should consider a FXTAS diagnosis and testing for the Fragile X mental retardation 1 (FMR1) gene premutation if a patient over the age of 50 (1) presents with cerebellar ataxia and/or intention tremor with mild parkinsonism, (2) has the middle cerebellar peduncle (MCP) sign, global cerebellar and cerebral atrophy, and/or subcortical white matter lesions on MRI, or (3) has a family history of fragile X related disorders, intellectual disability, autism, premature ovarian failure and has neurological signs consistent with FXTAS. Peripheral neuropathy, executive function deficits, anxiety, or depression are supportive of the diagnosis. CONCLUSIONS Distinct profiles in the cognitive and motor domains between these movement disorders may guide practitioners in the differential diagnosis process and ultimately lead to better medical management of FXTAS patients.
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Affiliation(s)
- Erin E Robertson
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Deborah A Hall
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
| | - Andrew R McAsey
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Joan A O'Keefe
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
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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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