title: Cognitive impairment before changes appear on [18F]-fluoro-D-glucose positron emission tomography images in a patient with possible early-stage cerebellar-predominant multiple system atrophy.
abstract: Multiple system atrophy (MSA) is a sporadic, rapidly progressive neurodegenerative disorder characterized by autonomic dysfunction combined with parkinsonism or cerebellar ataxia. Patients with MSA typically suffer from cognitive disorders and rapid eye movement sleep behaviour disorder.18F-fluorodeoxyglucose-positron emission tomography is used to assess MSA. However, the relationship between the clinical features and findings on18F-fluorodeoxyglucose-positron emission tomography in patients with MSA has not yet been investigated. Here we report a case of possible early-stage cerebellar-type MSA. We concluded that cerebellar-type MSA or other factors, such as rapid eye movement sleep behaviour disorder or obstructive sleep apnoea cognitive impairment, could appear before changes are visible on18F-fluorodeoxyglucose-positron emission tomography images. Additionally, we concluded that the cognitive impairment could derive from cerebellar-type MSA itself, not from other factors such as rapid eye movement sleep behaviour disorder or sleep apnoea syndrome.
authors.affiliation: Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takaya
authors.affiliation: Center for Sleep Medicine, Ueshima Clinic, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Atsumi
authors.affiliation: Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Shirakawa
keywords: FDG-PET; cognition; mild cognitive impairment; multiple system atrophy; obstructive sleep apnoea; rapid eye movement sleep behaviour disorder