title: Cognitive deficits in multiple system atrophy correlate with frontal atrophy and disease duration.
abstract: OBJECTIVE
  Dementia remains an exclusion criterion in diagnosing multiple system atrophy (MSA). This study aimed to determine the cognitive changes and brain atrophy patterns in the Parkinsonian (MSA-P) and cerebellar (MSA-C) variants of MSA.
  
  
  METHODS
  Voxel-based morphometry (VBM) of magnetic resonance imaging (MRI) and neuro-psychological tests were applied to 10 MSA-C and 13 MSA-P patients, and compared to 37 age-matched controls. Correlation analyses were performed between cognitive test results and morphometric data extracted from the VBM data.
  
  
  RESULTS
  In neuro-psychological testing, the 23 MSA patients scored lower in the Stroop interference test and took longer in the trail-making test as compared with the controls, whereas MSA-C performed worse than MSA-P in the memory scores, Stroop test, and time to complete the trail-making test. MSA, as a group, showed atrophy in the cerebellum, insular cortex, fusiform gyrus, inferior orbito-frontal gyrus, superior temporal gyrus, and caudate nucleus. Memory scores correlated well with pre-frontal lobe atrophy but not in the insular area.
  
  
  CONCLUSIONS
  In conclusion, although dementia is not a typical presenting feature of MSA and is regarded as a sub-cortical movement disorder, frontal atrophy, cognitive changes, and dementia are identifiable as MSA progresses.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. neur099@adm.cgmh.org.tw
authors.forename: C C
authors.initials: CC
authors.lastname: Chang
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chang
authors.forename: W N
authors.initials: WN
authors.lastname: Chang
authors.forename: Y C
authors.initials: YC
authors.lastname: Lee
authors.forename: Y L
authors.initials: YL
authors.lastname: Wang
authors.forename: C C
authors.initials: CC
authors.lastname: Lui
authors.forename: C W
authors.initials: CW
authors.lastname: Huang
authors.forename: W L
authors.initials: WL
authors.lastname: Liu
mesh_terms: D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D003072:Cognition Disorders / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications / Q000473:pathology*; D019578:Multiple System Atrophy / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D009483:Neuropsychological Tests; D012044:Regression Analysis