title: Brain structural profile of multiple system atrophy patients with cognitive impairment.
abstract: Current consensus diagnostic criteria for multiple system atrophy (MSA) consider dementia a non-supporting feature, although cognitive impairment and even frank dementia are reported in clinical practice. Mini-Mental State Examination (MMSE) is a commonly used global cognitive scale, and in a previous study, we established an MSA-specific screening cut-off score <27 to identify cognitive impairment. Finally, MSA neuroimaging findings suggest the presence of structural alterations in patients with cognitive deficits, although the extent of the anatomical changes is unclear. The aim of our multicenter study is to better characterize anatomical changes associated with cognitive impairment in MSA and to further investigate cortical and subcortical structural differences versus healthy controls (HC). We examined retrospectively 72 probable MSA patients [50 with normal cognition (MSA-NC) and 22 cognitively impaired (MSA-CI) based on MMSE <27] and compared them to 36 HC using gray- and white-matter voxel-based morphometry and fully automated subcortical segmentation. Compared to HC, MSA patients showed widespread cortical (bilateral frontal, occipito-temporal, and parietal areas), subcortical, and white-matter alterations. However, MSA-CI showed only focal volume reduction in the left dorsolateral prefrontal cortex compared with MSA-NC. These results suggest only a marginal contribution of cortical pathology to cognitive deficits. We believe that cognitive dysfunction is driven by focal fronto-striatal degeneration in line with the concept of "subcortical cognitive impairment".
authors: Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy. eleonora.fiorenzato@gmail.com.|Department of General Psychology, University of Padua, via Venezia, 8, 35131, Padua, Italy. eleonora.fiorenzato@gmail.com.
authors: Eleonora
authors: 0000-0001-7947-5903
authors: E
authors: Fiorenzato
authors: Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy.
authors: Luca
authors: L
authors: Weis
authors: Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria.
authors: Klaus
authors: K
authors: Seppi
authors: Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, via dei Vestini, 33, 66100, Chieti, Italy.
authors: Marco
authors: M
authors: Onofrj
authors: IRCCS Institute of Neurological Sciences of Bologna, via Altura, 3, 40139, Bologna, Italy.|Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via Ugo Foscolo, 7, 40123, Bologna, Italy.
authors: Pietro
authors: P
authors: Cortelli
authors: Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via Ugo Foscolo, 7, 40123, Bologna, Italy.|Functional MR Unit, S. Orsola-Malpighi Hospital, via Massarenti, 9, 40138, Bologna, Italy.
authors: Stefano
authors: S
authors: Zanigni
authors: Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via Ugo Foscolo, 7, 40123, Bologna, Italy.|Functional MR Unit, S. Orsola-Malpighi Hospital, via Massarenti, 9, 40138, Bologna, Italy.
authors: Caterina
authors: C
authors: Tonon
authors: Department of Neurology, Dysautonomia Center, New York University, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA.
authors: Horacio
authors: H
authors: Kaufmann
authors: Department of Neurology, Dysautonomia Center, New York University, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA.
authors: Timothy Michael
authors: TM
authors: Shepherd
authors: Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria.
authors: Werner
authors: W
authors: Poewe
authors: Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria.
authors: Florian
authors: F
authors: Krismer
authors: Department of Neurology, Medical University of Innsbruck, Anichstraße, 35, 6020, Innsbruck, Austria.
authors: Gregor
authors: G
authors: Wenning
authors: Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy.
authors: Angelo
authors: A
authors: Antonini
authors: Parkinson Disease and Movement Disorders Unit, IRCCS San Camillo Hospital Foundation, via Alberoni, 70, 30126, Venice-Lido, Italy.
authors: Roberta
authors: R
authors: Biundo
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D060825:Cognitive Dysfunction / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D000073216:Mental Status and Dementia Tests; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications* / Q000000981:diagnostic imaging* / Q000523:psychology; D059906:Neuroimaging; D009929:Organ Size; D010363:Pattern Recognition, Automated; D012189:Retrospective Studies; D066127:White Matter / Q000000981:diagnostic imaging
keywords: Cognition; Dementia; Mini-Mental State Examination (MMSE); Multiple system atrophy (MSA); Neuroimaging; Voxel-based morphometry