| Objective: Multiple System Atrophy(MSA) is an agnogenic and sporadic progressive neurodegenerative disease, proposed firstly in 1969 and characterized clinically by parkinsonism, cerebellar ataxia, pyramidal signs, and autonomic dysfunction. It has been confirmed that glial cytoplasmatic inclusions(GCIs)accepted as the hallmarks for the definite neuropathological diagnosis of MSA, which is composed of α-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 as a clinical feature of MSA, furthermore, 2008 MSA Diagnosis Expert Consensus was pointed out as an exclusion diagnostic criteria. However, in recent years, along with the growing knowledge and deep research of MSA, including quantitative assessment of the glial and neuronal cytoplasmic inclusions and semiquantitative assessment of neuronal loss in the cortical and limbic regions was performed,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. These results showed that the cognitive functions impairment of MSA may be more widespread and serious than had been thought in the early time.This study aims to access the cognitive function of MSA patients and comparative analysis towards the cognitive impairment between subtypes of MSA patients, to guide the treatment.Methods: The studies of medical records of 30 consecutive patients(18 patients with MSA-P and 12 patients with MSA-C) admitted into our neurology ward in the First Affiliated Hospital of Dalian Medical University between October 2012 and September 2014 was performed. We collected data on the epidemiological characteristics including gender, age,education and duration. Cognitive function was assessed by Mini-mental state examination(MMSE) and Montreal cognitive assessment(MoCA). Patients’ condition was assessed by Unified multiple system atrophy rating scale(UMSARS).Results: 60 cases of patients, including MSA group of 30 cases,19 case(63.3%) of men,11 cases(36.7%),were enrolled. In MSA-P group of 18 cases, 9 cases(50%) were men,and 9 cases(50%) were women.In MSA-C group of 12 cases, 10 cases(83.3%) were men, 2cases(16.7%) were women. The control group included 16 male cases(53.3%) and 14 female cases(46.7%). There was no significant difference with three groups gender composition(chi-square=3.909, P>0.05). There was no difference between the mean age [(68.4±11.2)VS.(61.1±8.33) VS.(59.5±6.0), P>0.05] among MSA-P, MSA-C and the control group.In this study, mild or moderate cognitive impairment was documented in 66.7% of MSA patients. Scores of MMSE, MoCA in the MSA group were obviously lower than those in the control group(P < 0.05). MoCA subitems such as visuospatial/executive function,nomenclature, language function, abstract thinking, delayed recall of the MSA group were significantly lower than those of the control group(P<0.05). However the comparison of orientation between the two groups had no significance(P=0.057>0.05). Except attention,the visuospatial/executive function, nomenclature, language function, abstract thinking,delayed recall and orientation scores of MSA-P group were 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 and UMSARS(r=-0.390, P=0.002<0.05).Contrarily, there was no correlation between he scores of MMSE and UMSARS(r=-0.390,P=0.103>0.05), so was the scores of MMSE with disease duration(r=0.462, P=0.10>0.05)nor the scores of MoCA with disease duration(r =-0.603, P=0.07>0.05).Conclusions:(1) MSA patients have a certain degree of cognitive impairment associated with more serious total disease severity;(2) Cognitive impairment in patients with MSA mayaffect visuospatial/executive function, nomenclature, language function, abstract thinking,delayed recall except orientational function;(3) There is not obvious difference in cognitive impairment between MSA-P and MSA-C. |
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