Objective: To evaluate the cognitive impairment and sleep disturbances in subtype MSA-P versus MSA-C.

Background: Multiple system atrophy (MSA) is a progressive neurodegenerative disorder of unknown etiology that occurs sporadically, characterized by autonomic failure, Parkinsonian feature, cerebellar and pyramidal features in various combinations. Based on the combination of symptoms, MSA is divided into MSA-P (parkinsonism) and MSA-C (cerebellar). Sleep disturbances are nonmotor features often associated, and cognitive impairment with frontal-lobe and executive deficits has been reported.

Methods: This cross-sectional study consisted 14 patients diagnosed with MSA, 4 patients with MSA-C, 10 patients with MSA-P. Sleep disturbances were evaluated by applying Restless Legs Syndrome Rating Scale (RLSRS), Parkinson’s disease Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The neuropsychological tests examined verbal and visual memory, working memory, visuospatial ability, language, and executive function. Were employed tests of Mann-Whitney, Pearson chi-squared and T-Student.

Results: The study enrolled 14 patients with MSA, 71% of patients showed a predominance of Parkinsonian signs (MSA-P), and 29% of them showed a predominance of cerebellar dysfunction (MSA-C). The mean age was 63.5 (2.4) years, and the mean disease duration was 4.4 (2.4) years. The mean Mini Mental State Examination (MMSE) was 25 (3.5) points and Mattis Dementia Rating Scale (MDRS) was 125.3 (14.5) points. Comparing continuous data between the two MSA subtypes, neuropsychological testing in patients with MSA-C did not differ significantly from MSA-P, except the Trail Making Test Part A, which showed worse results in MSA-P than in AMS-C (p < 0.05), and the MDRS in the field of attention, which showed worse performance in MSA-C (p=0.029). The comparison of patients for the presence or absence of Restless Legs Syndrome (RLS) showed a statistically significant difference in the immediate memory performed better in the group without RLS than in the group with RLS (p=0.046).

Conclusions: Comparative study of cognitive impairment in MSA- P and MSA-C produced controversial results, suggest frontal-executive and attention dysfunction in MSA-C would be more severe than MSA-P. In view of increasing awareness of cognitive impairments, we aimed to emphasize the importance of paying more attention to cognitive and behavioral features in MSA.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/multiple-system-atrophy-a-comparison-between-clinical-subtypes/