Role of neuropsychological tests and diffusion tensor imaging in the differential diagnosis of multiple system atrophy and Parkinson’s disease

Abstract

Objective To investigate the role of the neuropsychological tests and functional imaging in differentiation between multiple system atrophy parkinsonism-predominant (MSA-P) and multiple system atrophy predominant cerebellar ataxia (MSA-C) or idiopathic Parkinson’s disease (PD). Methods We collected three groups of patients including MSA-P (n=8), MSA-C (n=13), idiopathic PD (n=13), and control group (n=13) between December 2012 and November 2013 in General Hospital of People’s Liberation Army. We then compared the scores of neuropsychological assessment and parameters obtained from diffusion tensor imaging (DTI) examination among the four groups. Results (1) MSA-P group had longer time-consuming of trail-making test（(103.7±25.9) s）and lower graphic symbol test scores (20.9±6.1) than that of the MSA-P group ((80.9±29.1) s; 28.1±7.4) and PD group ((72.0±19.6) s; 29.0±9.4; all P<0.05). (2) Mean diffusivity (MD) in both putamen (8.01±0.76, 7.91±0.74) and the left substantia nigra (8.31±0.43), thalamus (8.30±0.69), external capsule (8.12±0.32) of MSA-P group was significantly different from that of MSA-C group (7.27±0.42, 7.34±0.31, 7.58±0.81, 7.81±0.34, 7.70±0.44) and PD group (7.35±0.43, 7.45±0.43, 7.66±0.45, 7.72±0.40, 7.56±0.37); Significantly higher MD in both middle cerebellar peduncle (8.54±0.74, 8.28±0.71), medulla oblongata (8.32±0.61) was demonstrated in MSA-C group than that of MSA-P group (8.54±0.74, 8.28±0.71, 8.32±0.61), PD group (7.25±0.70, 7.30±0.66, 7.65±0.50) and control group (6.94±0.39, 7.08±0.32, 7.44±0.41; all P<0.01). (3) Fractional anisotropy (FA) in the left external capsule (0.45±0.35) and right thalamus (0.28±0.27), occipital lobe (0.47±0.87) in MSA-P group was significantly different from that in MSA-C group (0.48±0.36, 0.23±0.24, 0.49±0.49; P<0.05); FA in the left occipital lobe (0.46±0.10) in PD group was significantly different from that in MSA-P group (0.56±0.82; P<0.01). Conclusion Trail-making test, graphic symbol test and DTI can be used to differentiate MSA-P type from MSA-C type or PD. Key words: Multiple system atrophy; Parkinson disease; Neuropsychological tests; Magnetic resonance imaging; Diagnosis, differential