Objective: To assess the cognitive function and its demographic and clinical correlates in MSA patients included in the Catalan Multiple System Atrophy-Registry (CMSAR).

Background: Cognitive impairment has been reported in MSA and related to disease duration. Published figures range from 22% of mild cognitive impairment to up to 14% of patients meeting the dementia definition in the last year prior to death.

Methods: In this cross-sectional assessment of the first 36 MSA patients included in the ongoing longitudinal CMSAR, we analysed their baseline demographic and clinical data relating them to cognition. Specifically, Hoehn & Yahr stages and the Unified MSA rating scale (UMSARS) were applied to assess motor involvement, whereas depressive symptoms were assessed by means of the Beck depression inventory (BDI), neuropsychiatric disturbances with the Neuropsychiatric inventory (NPI) and cognitive performance with frontal assessment battery (FAB), mini mental state examination (MMSE) and Mattis dementia-rating scale (MDRS-2). The study received approval from the respective review boards of all the participating centres, and all subjects provided their written informed consent. The CMSAR project is funded by “Fundació La Marató de TV3”.

Results: Over one and half year, we have included 36 MSA patients (17 women), with a mean age at onset of disease of 57.8 years and a mean disease duration of 57.6 months, including 44.4% MSA-P and 55.6% MSA-C, 58.3% of them with a probable diagnosis and 41.7% with possible MSA. Hoehn & Yahr stage was III or IV in 75% of the participants. Mean UMSARS score was of 53.78, with higher scores in MSA-P vs. MSA-C (63.19 vs. 46.25, p=0.002). The MMSE was impaired only in 5.6% showing a significant (but weak) correlation with older age (r=-0.352; p=0.035). The FAB was impaired in 55.6% and significantly associated with higher UMSARS scores without differences in sex, MSA subtype or MDRS-2 scores. However, worse attention/initiation MDRS-2 scores were related to higher UMSARS (r=-0.571; p=0.001). Mean BDI score was 7.53 without differences between groups.

Conclusions: Dementia is infrequent in our MSA population, with cognitive impairment being mostly dysexecutive and related to older age and severity of motor impairment. The longitudinal monitoring shall enable us to further characterize cognitive impairment in MSA throughout disease evolution.

References:

1. R. G. Brown et al.  Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy.  Brain 2010: 33; 2382–2393  doi:10.1093/brain/awq158
2. Stankovic et al. Cognitive impairment in multiple system atrophy: A position statement by the Neuropsychology Task Force of the MDS multiple system atrophy (MODIMSA) Study Group. Mov Disord. 2014 June; 29(7): 857–867. doi:10.1002/mds.25880

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-impairment-in-msa-patients-from-the-catalan-multiple-system-atrophy-registry-cmsar/