Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
Brain and Mind Research Center, Nagoya University, 466-8550, Nagoya, Japan.
J Neurol. 2018 Sep;265(9):2079-2087. doi: 10.1007/s00415-018-8923-7. Epub 2018 Jul 5.
We examined the anatomical involvement related to cognitive impairment in patients with multiple system atrophy (MSA).
We examined 30 patients with probable MSA and 15 healthy controls. All MSA patients were assessed by the Unified MSA-Rating scale and Addenbrooke's Cognitive Examination-Revised (ACE-R). We classified 15 MSA patients with ACE-R scores > 88 as having normal cognition (MSA-NC) and 15 with scores ≤ 88 as having cognitive impairment (MSA-CI). All subjects underwent 3 T MRI scanning and were investigated using voxel-based morphometry and diffusion tensor imaging.
Both the MSA-NC and MSA-CI patients exhibited cerebellar but not cerebral atrophy in voxel-based morphometry compared to controls. In contrast, tract-based spatial statistics revealed widespread and significantly decreased fractional anisotropy (FA) values, as well as increased mean diffusivity, radial diffusivity, and axial diffusivity in both the cerebrum and cerebellum in MSA-CI patients compared to controls. MSA-NC patients also exhibited similar involvement of the cerebellum but less extensive involvement of the cerebrum compared with the MSA-CI patients. In particular, FA values in MSA-CI patients were significantly decreased in the anterior part of the left corpus callosum compared with those in MSA-NC patients. The mean FA values in the left anterior part of the corpus callosum were significantly correlated with total ACE-R scores and subscores (memory, fluency, and language) in MSA patients.
Decreased FA values in the anterior corpus callosum showed a significant correlation with cognitive impairment in MSA.
我们研究了与多系统萎缩（MSA）患者认知障碍相关的解剖学受累。
我们检查了 30 例可能的 MSA 患者和 15 例健康对照者。所有 MSA 患者均通过统一 MSA 评分量表和 Addenbrooke 认知评估修订版（ACE-R）进行评估。我们将 ACE-R 评分>88 的 15 例 MSA 患者分为认知正常（MSA-NC），评分≤88 的 15 例患者为认知障碍（MSA-CI）。所有受试者均接受 3T MRI 扫描，并采用基于体素的形态计量学和弥散张量成像进行研究。
与对照组相比，MSA-NC 和 MSA-CI 患者在基于体素的形态计量学上均表现出小脑而非大脑萎缩。相反，基于束的空间统计学显示，与对照组相比，MSA-CI 患者大脑和小脑的各向异性分数（FA）值明显降低，平均弥散度、径向弥散度和轴向弥散度增加。与 MSA-CI 患者相比，MSA-NC 患者也表现出类似的小脑受累，但大脑受累范围较小。特别是，与 MSA-NC 患者相比，MSA-CI 患者左侧胼胝体前部的 FA 值明显降低。MSA 患者左侧胼胝体前部的平均 FA 值与总 ACE-R 评分及其子评分（记忆、流畅性和语言）显著相关。
胼胝体前部 FA 值降低与 MSA 患者的认知障碍显著相关。
