Abstract
Objective: We aimed to characterize the cognitive profiles in multiple system atrophy (MSA) and explore the cerebral metabolism related to the cognitive decline in MSA using 18F-fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET).Methods: In this study, 105 MSA patients were included for cognitive assessment and 84 of them were enrolled for 18F-FDG PET analysis. The comprehensive neuropsychological tests covered five main domains including execution, attention, memory, language, and visuospatial function. The cognitive statuses were classified to MSA with normal cognition (MSA-NC) and MSA with cognitive impairment (MSA-CI), including dementia (MSA-D), and mild cognitive impairment (MSA-MCI). With 18F-FDG PET imaging, the cerebral metabolism differences among different cognitive statuses were analyzed using statistical parametric mapping and post-hoc analysis.Results: Among 84 MSA patients, 52 patients were found with MSA-CI, including 36 patients as MSA-MCI and 16 patients as MSA-D. In detail, the cognitive impairments were observed in all the five domains, primarily in attention, executive function and memory. In 18F-FDG PET imaging, MSA-D and MSA-MCI patients exhibited hypometabolism in left middle and superior frontal lobe compared with MSA-NC (p < 0.001). The normalized regional cerebral metabolic rate of glucose (rCMRglc) in left middle frontal lobe showed relative accuracy in discriminating MSA-CI and MSA-NC [areas under the curve (AUC) = 0.750; 95%CI = 0.6391–0.8609].Conclusions: Cognitive impairments were not rare in MSA, and the hypometabolism in frontal lobe may contribute to such impairments.
Highlights
Multiple system atrophy (MSA) is a sporadic, adult-onset, progressive neurodegenerative disorder, clinically presenting with the combination of parkinsonism, cerebellar ataxia, autonomic failure, and corticospinal disorders [1, 2]
The cognition evaluation in MSA can refer to the clinical diagnostic criteria for mild cognitive impairment and dementia in Parkinson’s disease (PD-MCI, PD-D) [11, 12]
Most of the neuroimaging studies uncovering cognitive impairments in MSA focused on structural imaging [18,19,20,21], while few studies pay attention to 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) functional neuroimaging [8, 22,23,24]
Summary
Multiple system atrophy (MSA) is a sporadic, adult-onset, progressive neurodegenerative disorder, clinically presenting with the combination of parkinsonism, cerebellar ataxia, autonomic failure, and corticospinal disorders [1, 2]. The data on the prevalence or the status of cognitive impairments in MSA is greatly limited, which may be partially due to the lack of diagnostic criteria for cognition in MSA [10]. The cognition evaluation in MSA can refer to the clinical diagnostic criteria for mild cognitive impairment and dementia in Parkinson’s disease (PD-MCI, PD-D) [11, 12]. As the evidences for cognitive impairments are accumulating, the biomarker and mechanism involved are to be further explored. In some patients of autopsy-confirmed MSA, neuronal loss in the frontal cortex [15], the α-synuclein pathology in limbic regions or medial temporal lobe [16, 17] were reported to correlate with the cognitive impairments in MSA. Most of the neuroimaging studies uncovering cognitive impairments in MSA focused on structural imaging [18,19,20,21], while few studies pay attention to 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) functional neuroimaging [8, 22,23,24]
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