Objective: The aim of this study was to determine the structural correlates of depressive symptoms in MSA patients.

Background: Depression is highly prevalent among patients with MSA. To date, the neuroanatomical correlates of depression in MSA remain unexplored.

Methods: Magnetic resonance imaging scans and depressive symptoms as per the Beck Depression Inventory were acquired in 27 MSA patients and 25 controls. T1 scans were analyzed using SPM8-voxel-based morphometry (VBM) to identify brain regions where gray matter volume was specifically associated with depressive symptoms.

Results: Seventy four percent of patients reported symptoms indicative of moderate to severe depression. Depressive symptoms in patients were significantly associated with bilateral insular atrophy, independently of whether or not patients were on antidepressant medication (p = 0.04, FDR-corrected).

Conclusions: Our findings suggest that depressive symptoms have distinct neurobiological substrates in MSA, over and above the established atrophy pattern typically associated with MSA. They converge with previous literature implicating the insula in the pathogenesis of depression. Our findings underline the need to pay greater attention to clinical depression in MSA and its potential treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/insular-atrophy-as-a-marker-of-depression-in-multiple-system-atrophy-a-voxel-based-morphometry-study/