| Background and Purpose:Multiple system atrophy is a sporadic progressive neurodegenerative disease, characterized clinically by combinations of parkinsonism, cerebellar ataxia, pyramidal signs, and autonomic dysfunction. It has been confirmed that glial cytoplasmic inclusions (GCIs) accepted as the hallmarks for the definite neuropathological diagnosis of MSA, which is composed of a-synuclein. According to the latest the diagnosis of MSA, MSA is separated into two major clinical subtypes:MSA-P with predominant parkinsonian features and poor response of levodopa, MSA-C with predominant cerebellar ataxia, both are with autonomic nervous system involvement. Classically, cognitive impairment was not considered a clinical feature of MSA, furthermore.2008MSA Diagnosis Expert Consensus was pointed out as an exclusion diagnostic criteria. However, In recent years, along with the growing knowledge of MSA, the reports on cognitive impairment of MSA patients are gradually increasing, cognitive impairment is the primary symptom of the MSA patient, people gradually realized that the alteration of cognitive impairment appeared to the MSA patients. According to reports in the foreign literature, the morbidity of MSA cominbed with cognitive impairment is about20%-40%, the related systematic reports are rare domestically. In addition, seldom of people focus on the emotional states and the activities of daily living (ADL). This study aims to acess the cognitive function, emotional states and activities of daily living of MSA patients and comparative analysis towards the cognitive impairment between subtypes of MSA patients, to affirm the understanding of cognitive function, emotional states, activities of daily living and mutual relationships of MSA patient。Methods:Cognitive function, emotional status and activities of daily living were evaluated in32MSA patients and38healthy controls. Cognitive function was assessed by MoCA and MMSE. Emotional status was assessed by SDS and SAS. Daily living and activities were assessed by ADLResults:In this study, mild or moderate cognitive impairment was documented in71.9%of MSA patients. Scores of MoCA, MMSE in the MSA group were significantly lower than that in the control group, Scores of ADL, SDS and SAS in the MSA group were significantly higher than that in the control group (P<0.01). In the MSA-P group, the MMSE and MoCA scores are lower and the ADL, SAS and SDS scores are higher than the MSA-C group, but there is no statistic difference between the two groups (P>0.05). MoCA subitems such as space/executive function, attention, abstraction, language, delayed memory of the MSA group were significantly lower than that of the control group (P<0.05). The attention, language and nomenclature scores of MSA-C group are lower than MSA-P group, however, the visual-spatial/executive function, delay memory, directional force and abstract thinking scores of MSA-P group are lower than MSA-C group, but there was no significant difference between the two groups (P<0.05). There was significant negative correlation between the scores of MoCA, MMSE with ADL, disease duration (P<0.01). There was positive correlation between the scores of SDS, SAS with ADL, disease duration(P<0.05), and the relationship between the scores of SDS and SAS was significant (P<0.01); There was positive correlation between Scores of ADL with disease duration (P<0.05).Conclusions:MSA patients had a certain degree of cognitive impairment, emotion disorders and ADL impairment, and the cognitive impairment in patients with MSA may be more common than previously, but the difference between the two subtypes is not significant. We speculate that clinical features of cognitive impairment in these patients might have some clinical value for reference. In conclusion, cognitive impairment was not fit for exclusion criteria for the diagnosis of MSA. |
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