Chang C C, Chang Y Y, Chang W N, Lee Y C, Wang Y L, Lui C C, Huang C W, Liu W L
Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Eur J Neurol. 2009 Oct;16(10):1144-50. doi: 10.1111/j.1468-1331.2009.02661.x. Epub 2009 May 22.
Dementia remains an exclusion criterion in diagnosing multiple system atrophy (MSA). This study aimed to determine the cognitive changes and brain atrophy patterns in the Parkinsonian (MSA-P) and cerebellar (MSA-C) variants of MSA.
Voxel-based morphometry (VBM) of magnetic resonance imaging (MRI) and neuro-psychological tests were applied to 10 MSA-C and 13 MSA-P patients, and compared to 37 age-matched controls. Correlation analyses were performed between cognitive test results and morphometric data extracted from the VBM data.
In neuro-psychological testing, the 23 MSA patients scored lower in the Stroop interference test and took longer in the trail-making test as compared with the controls, whereas MSA-C performed worse than MSA-P in the memory scores, Stroop test, and time to complete the trail-making test. MSA, as a group, showed atrophy in the cerebellum, insular cortex, fusiform gyrus, inferior orbito-frontal gyrus, superior temporal gyrus, and caudate nucleus. Memory scores correlated well with pre-frontal lobe atrophy but not in the insular area.
In conclusion, although dementia is not a typical presenting feature of MSA and is regarded as a sub-cortical movement disorder, frontal atrophy, cognitive changes, and dementia are identifiable as MSA progresses.
痴呆仍然是诊断多系统萎缩（MSA）的排除标准。本研究旨在确定MSA帕金森型（MSA-P）和小脑型（MSA-C）变体中的认知变化和脑萎缩模式。
对10例MSA-C患者和13例MSA-P患者进行磁共振成像（MRI）的基于体素的形态学测量（VBM）和神经心理学测试，并与37名年龄匹配的对照者进行比较。对认知测试结果与从VBM数据中提取的形态学数据进行相关性分析。
在神经心理学测试中，与对照组相比，23例MSA患者在Stroop干扰测试中得分较低，在连线测试中用时较长，而MSA-C在记忆得分、Stroop测试和完成连线测试的时间方面比MSA-P表现更差。MSA作为一个整体，在小脑、岛叶皮质、梭状回、眶额下回、颞上回和尾状核出现萎缩。记忆得分与额叶萎缩相关性良好，但与岛叶区域无关。
总之，虽然痴呆不是MSA的典型表现特征，且MSA被视为一种皮质下运动障碍，但随着MSA的进展，额叶萎缩、认知变化和痴呆是可以识别的。
