多系统萎缩和帕金森病患者执行功能障碍研究

目的探讨多系统萎缩和帕金森病患者执行功能障碍特点。方法采用简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(Mo CA),以及Stroop色词测验(SCWT)、数字符号转换测验(DSST)/图形符号转换测验(GSST)、画钟测验(CDT)和连线测验(TMT)评价34例多系统萎缩患者[以小脑共济失调为主要表现型(MSA-C型)21例、以帕金森病综合征为主要表现型(MSA-P型)13例]和18例原发性帕金森病患者的整体认知功能和执行功能。结果各组受试者Mo CA评分差异有统计学意义(P=0.019),其中PD组和MSA-C型组患者评分低于对照组(P=0.015,0.002)。各组受试者SCWT测验各部分评分(P=0.035,0.013,0.012,0.037)、DSST评分(P=0.000)、GSST评分(P=0.000)、TMT评分(P=0.035)差异均有统计学意义,其中,MSA-C型组和MSA-P型组患者SCWT-A(P=0.004,0.045)、SCWT-B(P=0.001,0.036)和SCWT-D(P=0.023,0.010)评分均高于对照组,PD组、MSA-C型组和MSA-P型组患者SCWT-C评分(P=0.005,0.014,0.003)、DSST评分(P=0.003,0.000,0.000)和GSST评分(P=0.001,0.000,0.000)均高于对照组,仅MSA-P型组患者TMT评分高于对照组(P=0.006)。结论多系统萎缩和帕金森病患者均存在不同程度的执行功能障碍,SCWT和DSST/GSST测验有助于评价此类患者的执行功能障碍。     

多系统萎缩患者血清尿酸水平分析

目的探讨多系统萎缩患者血清尿酸水平及其与病情严重程度的相关性。方法连续选取2012-06—2016-12在北京大学深圳医院神经内科就诊的多系统萎缩患者32例,详细进行病史采集及体格检查,并进行统一多系统萎缩评估量表(UMSARS)评估。另选择同期健康体检者50例为健康对照组,2组均测定空腹血清尿酸水平。结果 MSA-P组及MSA-C组的尿酸水平均低于对照组,差异有统计学意义(P0.05);MSA-P组血清尿酸水平与MSA-C组比较,差异无统计学意义(P0.05);MSA患者尿酸水平与UMSARS评分呈负相关(Pearson r=-0.389,P0.05),但与病程年限无相关性(P0.05)。结论MSA患者血清尿酸水平降低,低尿酸可能与MSA发病有关;尿酸与MSA病情严重程度呈负相关。     

MMSE和MoCA在不同类型轻度认知障碍筛查中的应用

目的探讨简易精神状态量表(MMSE)和蒙特利尔认知评估量表(Mo CA)在遗忘型轻度认知障碍(a MCI)和轻度血管性认知障碍(m VCI)患者中的应用。方法从2012年3月至2015年3月本科收治的年龄60~80岁近200例患者中筛选出a MCI组42例,m VCI组50例,采用分组对照研究,所有患者经过临床痴呆评定量表(CDR)和日常生活能力量表(ADL)评估与接受Mo CA量表中文版和MMSE量表进行认知功能评估。Mo CA与MMSE的评估间隔1h以上,在同一天进行。结果两组患者性别构成比、年龄及受教育程度间差异均无统计学意义(P>0.05)。MMSE量表测评两组间差异无统计学意义(P>0.05)。两组间MMSE分项比较,除a MCI组延迟回忆得分低于m VCI组(P<0.05)外,其余各分项得分无显著性差异(P>0.05)。m VCI组患者Mo CA总分较a MCI组水平低,差异有统计学意义(P<0.05)。两组间Mo CA分项比较,m VCI组视空间执行功能、注意力与计算各项得分低于a MCI组,差异有统计学意义(P<0.05)。a MCI组延迟回忆得分低于m VCI组,差异有统计学意义(P<0.05)。余各分项得分两组间无显著性差异(P>0.05)。m VCI组患者在交替连线、立方体画图及指针得分均低于a MCI组,差异有统计学意义(P<0.05)。相关性分析显示MMSE与Mo CA评分呈正相关关系,a MCI患者中相关系数为0.861,m VCI患者中相关系数为0.762,差异均有统计学意义(P<0.05)。结论 m VCI患者存在包括视空间执行功能、注意力及计算力等多个领域认知功能的损害,与a MCI患者相比,执行功能受损更明显。Mo CA是筛查a MCI及m VCI的一个简便、有效的工具,敏感性高于MMSE,尤其适于对m VCI患者的早期筛查。     

成年起病的癫痫患者认知损害的影响因素研究

目的评估患者性别、教育水平、发作频率、持续时间、抗癫痫药物和视频脑电图(VEEG)尖波出现对成年起病的癫痫患者认知能力的影响。方法 50例成年起病的癫痫患者接受VEEG检查后行简易精神状态量表(MMSE)和蒙特利尔认知评估量表(Mo CA)检查获得认知分数,按照上述6种因素分别分组,应用SPSS16.0软件进行差异统计学分析。结果 VEEG尖波出现明显降低癫痫患者两种量表得分(MMSE P0.01;Mo CA P0.05),而性别、发作频率和持续时间均不影响两种量表的得分(均P0.05)。丙戊酸钠治疗组两种量表的得分低于非丙戊酸钠(拉莫三嗪、奥卡西平、卡马西平和苯妥英钠)治疗组(MMSE P=0.097;Mo CA P=0.061)。研究还发现,较高教育程度癫痫人群Mo CA得分明显高于较低教育水平患者,Mo CA量表评分P0.05,而MMSE量表评分P0.05,提示Mo CA量表对于认知能力影响的评估更加敏感。结论 VEEG尖波出现提示成年发病癫痫患者的认知损害,丙戊酸钠治疗也可能损害癫痫患者的认知水平。另外,教育程度较高的成年发病癫痫患者认知能力较高。而癫痫发作频率、持续时间和患者性别不影响成年发病癫痫患者的认知水平。     

认知障碍患者颅内动脉狭窄与脑白质胆碱能通路病变的关系

目的探讨认知功能障碍患者中颅内动脉狭窄与脑白质胆碱能通路病变的相关性。方法连续收集符合入组标准的病例118例。对入组患者行蒙特利尔认知量表(Mo CA)评估认知功能、头颅CT血管成像采集颅内血管信息、头颅磁共振采集脑白质病变情况,按认知功能水平,分为认知功能障碍组(研究组,85例)和认知功能正常组(对照组,33例)。结果相较于对照组,研究组颅内血管狭窄比例较高,差异有统计学意义(P=0.042)。研究组Mo CA总分及其分项均低于对照组,差异有统计学意义(P0.01);研究组CHIPS得分高于对照组,差异有统计学意义(P=0.047)。CHIPS得分与Mo CA评分及其部分分项呈负相关(均P0.05)。颅内动脉狭窄与Mo CA评分及其分项(除抽象功能)呈负相关(均P0.05);CHIPS得分与颅内动脉狭窄呈正相关(P=0.001)。结论颅内动脉狭窄在脑白质胆碱能通路病变致使多领域认知功能障碍过程中起到一定作用。     

重复经颅磁刺激治疗老年性痴呆的效果及安全性

目的探讨重复经颅磁刺激(r TMS)对老年性痴呆(AD)患者认知功能的效果及安全性。方法以2015年1月-2016年10月在黑龙江省大庆市第三医院和大庆市龙南医院神经内科就诊,符合《国际疾病分类(第10版)》(ICD-10)诊断标准的60例AD患者为研究对象,采用最小不平衡指数法分为研究组和对照组各30例;研究组给予20 Hz r TMS治疗;对照组给予r TMS假刺激治疗。每周5次,共8周。治疗前后分别进行简易精神状态评价量表(MMSE)、蒙特利尔认知评价量表(Mo CA)、阿尔茨海默病评定量表认知分量表(ADAS-cog)评定。结果治疗前两组一般资料和MMSE、Mo CA、ADAS-cog评分比较差异均无统计学意义(P均0.05);治疗8周后,两组MMSE、Mo CA、ADAS-cog评分比较差异有统计学意义(P0.05)。结论高频(20 Hz)r TMS可能有助于改善AD患者认知功能,且安全性较好。     

首次脑梗死后血管性认知功能损害的神经心理学研究

目的探讨首次脑梗死后血管性认知功能损害(CVI)的神经心理学特点。方法以蒙特利尔认知评估量表(Montreal Cognitive Assessment,Mo CA)和日常生活活动能力量表(activity of daily living scale,ADL)修订版为神经心理学检测量表,评估70例首次脑梗死患者起病后3个月(病例组)和50例正常者(对照组)的认知功能状态和日常生活能力,并分析不同梗死部位的Mo CA和ADL得分。结果病例组Mo CA、ADL分值较对照组明显下降,差异有统计学意义(P0.05),病例组中43例(61.4%)Mo CA23分;病例组与对照组比较,视空间与执行、注意力、抽象思维能力有显著差异(均P0.05);皮质脑梗死组ADL得分较基底核内囊区脑梗死组低,差异有显著性(P0.05);Mo CA得分无明显差异。结论脑梗死后血管性认知功能减退及日常生活能力下降发生率较高,认知功能减退主要表现为执行功能﹑注意力及抽象思维能力的损害,基底核内囊区与皮质梗死CVA发生率较其他部位高,皮质梗死患者日常生活能力受损较基底核内囊区梗死患者突出。     

多系统萎缩患者认知功能评估及影响因素分析

目的采用蒙特利尔认知评估量表(MoCA)评估多系统萎缩(MSA)患者认知功能情况,并探讨其影响因素。方法收集2014年9月至2018年6月在北京中医药大学东方医院脑一科就诊的MSA患者199例,采集患者年龄、性别、教育水平、起病年龄及起病症状、病程等一般临床资料;应用统一多系统萎缩量表(UMSARS)及MoCA评价患者的病情严重程度及认知功能。比较不同性别、诊断分型患者的MoCA得分的差异,并分析MoCA得分与年龄、病程、教育水平、UMSARS得分的相关性。结果 199例MSA患者中MoCA评分26分者占60. 3%,其中失分最多的亚项是视空间与执行和延迟回忆。不同性别患者以及很可能的MSA患者与可能的MSA患者间MoCA总评分比较均无统计学差异(均P0. 05)。MSA-C患者MoCA评分及定向评分高于MSA-P患者(均P0.05),余各亚项得分比较无统计学差异(均P0.05)。单因素相关性分析显示MoCA总评分与教育水平呈正相关(r=0.309,P0.05),与UMSARS-Ⅰ、Ⅱ、Ⅳ评分及发病年龄、就诊年龄呈负相关(r=-0. 267、r=-0. 372、r=-0. 292、r=-0. 175、r=-0. 185,均P0. 05),而与病程无相关性(P0. 05);进一步行多元线性回归分析显示MoCA总评分与教育水平以及UMSARS-Ⅰ、Ⅱ、Ⅳ得分具有相关性(分别β=0.317、-0.213、-0.307、-0.192,均P0.05)。结论 MSA患者存在一定程度的认知功能障碍,以视空间与执行功能障碍及记忆力障碍最为明显;P型患者较C型患者更重;MSA患者的认知损害严重程度与病情严重程度相关,而与年龄及病程不相关。     

2型糖尿病患者轻度认知功能障碍的临床分析

目的探讨2型糖尿病患者轻度认知功能障碍的特点。方法将122例2型糖尿病患者分为伴2型糖尿病轻度认知功能障碍组(45例)、不伴2型糖尿病轻度认知功能障碍组(41例)和对照组(36例),使用蒙特利尔认知评估量表(montreal cognitive assessme,MoCA)对患者的命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆进行评分评估。结果与对照组比较,伴2型糖尿病轻度认知功能障碍组在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等评分比较差异具有统计学意义(P0.01)。与不伴2型糖尿病MCI组比较,伴2型糖尿病MCI组在总分、视空间/执行功能、注意、持续注意、延迟回忆等评分2组间差异有统计学意义(P0.05)。结论伴2型糖尿病的MCI患者在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等方面有不同程度的损害;其总体认知功能损害较不伴2型糖尿病者严重,尤其在视空间/执行能力、注意、持续注意及记忆方面。     

早期帕金森病、多系统萎缩及进行性核上性麻痹理查森型工作记忆损害的比较

目的比较早期帕金森病(PD)、多系统萎缩(MSA)及进行性核上性麻痹理查森型(PSP-RS)的工作记忆损害。方法对早期PD患者55例、MSA患者16例和PSP-RS型患者13例进行数字广度(DST)、改良版数字序背测验(DOT-A)及蒙特利尔认知评估(MoCA)测试。结果 PD组、MSA组及PSP-RS组Hoehn-Yahr(H-Y)分级差异有统计学意义(F=15.356,P=0.000),其中PSP-RS组H-Y分级显著高于PD组及MSA组(均P0.01)。PD组、MSA组及PSP-RS组DST顺背测验评分差异有统计学意义(F=7.392,P=0.001);PD组与MSA组评分均显著高于PSP-RS组(均P0.01)。PD组、MSA组及PSP-RS组DST倒背测验评分差异有统计学意义(F=3.684,P=0.030);MSA组与PSP-RS组评分均显著低于PD组(均P0.05)。PD组、MSA组、PSP-RS组DOT-A评分差异有统计学意义(F=4.201,P=0.019);PSP-RS组评分显著低于PD组(P=0.009)。PD组、MSA组和PSP-RS组MoCA评分差异有统计学意义(F=4.594,P=0.014);PSP-RS组评分显著低于PD组(P=0.006)。结论在早期PD、MSA和PSP-RS型中,PSP-RS型工作记忆和整体认知损害最明显,PD相对最轻。MSA在早期也有明显的工作记忆和整体认知损害。     

短暂性脑缺血发作患者认知功能特点及动态观察

目的观察前循环短暂性脑缺血发作(TIA)后认知功能障碍的特点及动态变化。方法纳入2017年8月至2018年8月于河南省人民医院神经内科住院的前循环TIA病人82例(TIA组),均行头颅磁共振灌注成像(PWI)检查。采用蒙特利尔认知评估量表(Mo CA)对其分别在发病后的第7天、第1个月±3天、第3个月±5天、第6个月±7天进行认知及运动功能评估,并与90例正常体检者(正常对照组)对照。结果发病后4个时间点分别有46例(60. 5%)、48例(63. 1. 0%)、60例(78. 9%)和65例(85. 5%) TIA患者存在认知功能损害。TIA组发病后第1个月、第3个月、第6个月,Mo CA总分逐渐下降(P 0. 05),且各时间点Mo CA总分均较正常对照组低,差异具有统计学意义(P 0. 05); MoCA各因子中,视空间与执行能力、延迟回忆、语言重复、语言流畅性等分项评分明显下降,差异有统计学意义(P 0. 05)。结论 TIA发病早期即可出现认知障碍,且持续存在,发病3个月后认知功能明显下降。     

Cognitive profiling in relation to short latency afferent inhibition of frontal cortex in multiple system atrophy

BackgroundCognitive dysfunction occurs in multiple system atrophy (MSA) more frequently than previously known. As a type of synucleinopathy, pathology spreads widely in cortical and subcortical areas as the disease advances. The exact anatomical and imaging substrates, and electrophysiological or biochemical indicators of cognitive impairment in MSA are not yet clear. Diminished short-latency afferent inhibition (SAI) of motor cortex was shown to be an electrophysiological correlate of dementia and mild cognitive impairment associated to Parkinson's disease (PD). We hypothesize that it can also be electrophysiological correlate of cognitive impairment in MSA.MethodsWe studied SAI and a neuropsychological test battery in 19 non-demented MSA patients (11 MSA-P and 8 MSA-C), 10 non-demented PD patients and 10 healthy controls. Neuropsychological test scores were grouped in four main cognitive domains (attention, memory, executive and visuo-spatial functions) and were analyzed by factor analysis.ResultsAll subject groups were matched for age. Moreover, the MSA-P, MSA-C, and PD groups were matched for disease duration. Scores of cognitive domains were similar in MSA and PD cases, while scores in attention, executive and visuo-spatial domains were worse in MSA than controls (p < 0.05). SAI was normal in PD but decreased in MSA patients by reaching statistical significance in MSA-C subtype. SAI response was correlated with cognitive performances measured by factor scores of neuropsychological test battery in all study subjects.ConclusionsThese results show that cognitive functions are impaired in MSA patients compared to controls as well as a parallel reduction in SAI response.     

颞叶癫痫患者情绪及认知功能研究

目的调查颞叶癫痫(TLE)患者情绪及认知功能状况,分析相关的临床影响因素。方法对30例颞叶癫痫患者以及30例年龄、性别和受教育程度无差异的健康对照进行信息采集、神经心理学量表调查和统计学分析。结果与对照组相比,TLE组中出现焦虑情绪个体比例更高(P0.01);MoCA、WAIS-RC知识、TMT_B以及BDST评分较低,差异具有统计学意义(P0.05)。病程、癫痫家族史与MoCA评分及起病年龄与WAIS-RC知识评分之间均具有线性回归关系(决定系数分别为R~2=0.325和R~2=0.137,P0.05)。结论 TLE患者群体相较于正常人群更容易出现焦虑情绪,并且可出现整体智能、短时记忆、远期记忆能力、注意力和执行控制能力下降。对TLE患者,尤其对病程长、起病早和有家族史的患者,早期进行神经心理学评估将有利于及早发现认知功能损伤,实行有效干预。     

线性法测量皮质下缺血性血管病患者脑萎缩及其与认知损害的相关性分析

目的通过线性法测量皮质下缺血性血管病(SIVD)患者脑萎缩,分析其与认知功能损害的相关性。方法共纳入SIVD组50例,健康对照组50例。所有入组对象均完成一般情况评定、Mo CA量表评估认知功能、头颅MRI检查,线性法进行脑萎缩测量。结果 SIVD组代表脑室系统横径的测量值及脑沟测量值,除桥池宽度外,均较对照组显著增大(P 0. 05)。SIVD组的脑萎缩测量相对值除脑干指数外,均显著高于对照组(P 0. 05)。SIVD组双侧侧脑室两额角间最宽距离、双侧侧脑室额角两侧尾状核头间最小距离、第三脑室宽度、双侧侧脑室腰部外侧壁最小距离与Mo CA评分呈显著负相关(P 0. 05)。SIVD组脑萎缩测量相对值中的额角指数、尾状核指数、哈氏值、第三脑室宽度与视空间能力、计算力、延迟记忆和定向力均呈负相关(P 0. 05)。结论 SIVD患者存在明显的皮质和皮质下萎缩,并与认知功能损害相关。哈氏值、额角指数、尾状核指数、第三脑室宽度可作为SIVD患者脑萎缩的预测指标,提示执行功能/视空间及计算力、记忆力的损害。     

Cognitive function in multiple system atrophy of the cerebellar type.

Dementia represents an exclusion criterion for the diagnosis of multiple system atrophy (MSA), but there have been reports of fronto-executive dysfunction in patients with MSA of the striatonigral type (MSA-P). To study the cognitive profile of MSA, 20 patients with MSA of the cerebellar type (MSA-C) were subjected to an extensive neuropsychological test battery comprising tests for IQ, attention, verbal and visuospatial memory, as well as executive function. There was evidence for impaired verbal memory and verbal fluency. Test performance was not related to the severity of motor disability. Regarding the similar cognitive syndrome of MSA-P, the otherwise subclinical problems in MSA-C result from subcortical rather than from cerebellar dysfunction.     

影响老年额叶胶质瘤认知功能的因素及手术治疗对认知功能的影响

目的探讨手术干预是否影响老年额叶胶质瘤患者认知功能。方法前瞻性分析于首都医科大学附属北京天坛医院行手术治疗的33例老年额叶胶质瘤患者的临床资料。在术前、术后1周、术后3月指导患者完成Mo CA、MMSE认知评估量表。采用独立样本t检验、成对样本t检验及多因素回归分析认知功能变化。结果入组患者的Mo CA、MMSE评分与术前相比,在术后1周及术后3月的下降无统计学意义(P 0. 05)。在术前,高级别胶质瘤组的Mo CA、MMSE评分(15. 33±5. 723)、(20. 444±5. 0028)低于低级别胶质瘤组(21. 58±6. 178)、(25. 167±4. 8245)(P 0. 05)。复发胶质瘤组(13. 14±4. 259)、(19. 000±4. 0415)低于首发胶质瘤组(21. 69±5. 945)、(25. 192±4. 7835)(P 0. 05)。在术后1周,延迟回忆能力较术前下降(P 0. 05)。术后3月,延迟回忆能力较术前及术后1周明显改善,计算力较术后1周改善(P 0. 05)。结论手术治疗后患者总体认知功能未出现恶化。复发和高级别胶质瘤导致更严重的认知功能障碍。在术后3月,延迟回忆能力及计算力较术前改善。     

Cognition in multiple system atrophy: neuropsychological profile and interaction with mood

We evaluated cognitive functions and mood in two groups of patients with multiple system atrophy (MSA) in order to determine the influence of mood on cognitive performance. Our aim was to differentiate between parkinsonism-predominant (MSA-P) and cerebellar-predominant (MSA-C) MSA based on those parameters. Fifteen MSA-P and 10 MSA-C patients underwent neuropsychological tests that examined executive functions (working memory, response inhibition, and verbal reproduction), verbal learning and memory, verbal and visual reasoning, and processing speed. Anxiety and depression were also assessed. The findings on their cognitive performance and mood were compared to those of healthy controls and also discussed in relation to a group of Parkinson’s disease (PD) patients. The results showed that cognitive and mood characteristics could distinguish MSA-P from MSA-C and that anxiety and depression are related to cognitive decline. Compared with healthy controls, MSA-P patients showed reduced verbal retrieval (immediate, P < 0.019; long-term, P < 0.018) while MSA-C patients had difficulties in learning new verbal information (P < 0.022) and in controlling attention (P < 0.023). These data indicate that MSA-P and MSA-C appear to have, at least in part, different cognitive and mood profiles. The neuropsychological assessments of MSA patients should test for and then take into account their level of anxiety and depression, insofar as it might have an adverse effect on their cognitive performance.     

Visual event-related potential changes in two subtypes of multiple system atrophy,MSA-C and MSA-P

We investigated the visual event-related potentials (ERPs) in two subtypes of multisystem atrophy (MSA) in 15 MSA-C patients, 12 MSA-P patients, and 21 normal control (NC) subjects. We used a visual oddball task to elicit ERPs. No significant changes were seen in N1 or N2 latency, in either MSA-C or MSA-P, compared with the NC group. An early stage of visual information process related to N1 and a visual discrimination process related to N2 might be preserved in both MSA-C and MSA-P. The P3a peak was more frequently undetectable in MSA than in the NC group. Significant P3a amplitude reduction in both MSA-C and MSA-P suggests impairment of the automatic cognitive processing in both MSA-C and MSA-P. Significant difference was found in P3b latency and P3b amplitude only in MSA-C, compared with the NC group. The result suggests the impairment of the controlled cognitive processing after the visual discrimination process in the MSA-C group. We further investigated the correlation between visual ERP changes and magnetic resonance imaging (MRI) data. Quantitative MRI measurements showed reduced size of the pons, cerebellum, perisylvian cerebral area, and deep cerebral gray matter in both MSA-C and MSA-P, and of the corpus callosum only in MSA-P, as compared to NC group. In both MSA-C and MSA-P, P3b latency was significantly correlated with the size on MRI of the pons and the cerebellum. P3b latency in the whole MSA group was also significantly correlated with the size of the pons and the cerebellum. These results indicate that P3b latency changes in parallel with the volume of the pons and the cerebellum in both MSA-C and MSA-P. Received: 28 August 2001 Received in revised form: 22 January 2002 Accepted: 25 January 2002     

Cognitive deficits in multiple system atrophy correlate with frontal atrophy and disease duration

Background and purpose:  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.
Methods:  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.
Results:  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.
Conclusion:  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.