Date: Monday, June 20, 2016
Session Title: Parkinsonism, MSA, PSP (secondary and parkinsonism-plus)
Session Time: 12:30pm-2:00pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To investigate the cerebral anatomical changes associated with cognitive impairment (CI) in multiple system atrophy (MSA).
Background: Mild cognitive deficits are frequently reported in MSA. However, the underlying anatomical defects are unclear.
Methods: A multicenter cohort of 72 probable MSA patients was retrospectively collected from 5 international centers. Clinical, cognitive and MRI data were compared with a cohort of 36 healthy controls (HC). Cognitive impairment was defined as a Mini-Mental State Examination score <27; we identified 22 MSA with CI (MSA-CI) and 50 MSA without CI (MSA-CNT) (Auzou et al., 2015). We analyzed structural changes using gray matter (GM) and white matter (WM) voxel-based morphometry (VBM), and subcortical volumes segmentations. WM and GM VBM was run using FSL-VBM tool. Subcortical brain volumes were calculated from MR T13D using the software package FreeSurfer. Moreover, a new Bayesian based brainstem segmentation method was used to obtain volumes of superior cerebellum pedunculus, pons, midbrain and medulla.
Results: The subcortical volumetric and cortical GM VBM analysis revealed a pattern of widespread cortical and subcortical brain alterations in MSA patients when compared to HC. Namely, we found bilateral subcortical atrophies in the cerebellum, putamen, middle cingulum, pallidum, accumbens, thalamus and brainstem; and cortical atrophies in the bilateral temporo-occipital, parietal and frontal areas. Moreover, GM volume increases were observed in the bilateral thalamus, periaqueductal gray (PAG), right calcarine and amigdala areas. The reduction of the brainstem volume observed in medulla, pons and midbrain, was associated with WM atrophy (anterior thalamic radiation and corticospinal tract). The direct MSA-CNT vs. MSA-CI group comparison revealed only focal brain atrophy in the left dorsolateral prefrontal cortex (lDLPFC) in MSA patients with cognitive impairment. No alterations in the WM and subcortical areas were showed to be related with cognitive decline.
Conclusions: Our results highlight a complex neuroanatomical profile, with a crucial involvement of WM in patients with MSA. CI in MSA seems to be associated with a focal atrophy in the lDLPFC possibly secondary to the predominantly fronto-striatal neurodegenerative process.
To cite this abstract in AMA style:E. Fiorenzato, R. Biundo, L. Weis, K. Seppi, M. Onofrj, P. Cortelli, H. Kaufmann, W. Poewe, F. Krismer, G. Wenning, A. Antonini. Brain structural abnormalities in multiple system atrophy patients with cognitive impairment [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/brain-structural-abnormalities-in-multiple-system-atrophy-patients-with-cognitive-impairment/. Accessed December 7, 2023.
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