title: Cognitive and sleep features of multiple system atrophy: review and prospective study.
abstract: BACKGROUND
  The profile and degree of cognitive impairment in Multiple System Atrophy (MSA) and the impact of sleep disorders, REM sleep behavior disorder (RBD) in particular, in parkinsonism-related cognitive deficits are currently being debated.
  
  
  CONCLUSIONS
  We reviewed the cognitive, affective and sleep findings in MSA and also carried out a longitudinal investigation of 10 MSA patients. At the first evaluation, 3 patients showed isolated cognitive deficits. After a mean of 16 months, these patients remained unchanged, while 1 patient worsened from a normal condition. No significant differences emerged when the cognitive, affective and video-polysomnographic findings of MSA-P and MSA-C were compared. Depression was present in half of the patients, although it did not influence their cognitive performance. Comparisons between the first and second evaluation data showed significant worsening in visual attention and in ADL/IADL and UMSARS.
  
  
  CONCLUSIONS
  Isolated cognitive deficits are evidenced in a minority of MSA patients with the absence of a clear-cut diagnosis of dementia in the early stages of the disease. Attention and executive functions are often impaired. This study with a short follow-up period showed that RBD, although present in almost all patients affected by MSA, does not appear a clear early marker of cognitive impairment. Future longer-term studies with a larger patient sample are thus encouraged.
authors.affiliation: IRCCS Istituto delle Scienze Neurologiche di Bologna, Università di Bologna, Bologna, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Stanzani-Maserati
authors.forename: Roberto
authors.initials: R
authors.lastname: Gallassi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Calandra-Buonaura
authors.forename: Maria
authors.initials: M
authors.lastname: Alessandria
authors.forename: Federico
authors.initials: F
authors.lastname: Oppi
authors.forename: Roberto
authors.initials: R
authors.lastname: Poda
authors.forename: Luisa
authors.initials: L
authors.lastname: Sambati
authors.forename: Federica
authors.initials: F
authors.lastname: Provini
authors.forename: Pietro
authors.initials: P
authors.lastname: Cortelli
mesh_terms: D003071:Cognition; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000503:physiopathology* / Q000523:psychology*; D011446:Prospective Studies; D012890:Sleep