Highlights
- •In MSA autonomic dysfunction within the first 3 years from the disease onset is associated with rapid progression to death.
- •In MSA urinary impairment at baseline may help to select ‘fast progressors’ in terms of neuronal loss.
- •Urinary impairment should be recognized as a key target for disease modifying therapeutic interventions in MSA.
Abstract
Introduction
MSA is an adult-onset, sporadic, progressive parkinsonian syndrome characterised by
the presence of akinesia, cerebellar dysfunction, autonomic failure and pyramidal
signs. Annualized-whole-brain atrophy rate (a-WBAR) is an informative way to quantify
disease progression. In this longitudinal work we investigate the correlations of
a-WBAR with clinical scales for motor impairment, autonomic disability and cognitive
decline in MSA and explore how atrophy progresses within the brain.
Method
Fourty-one MSA patients were studied using Structural Imaging Evaluation with Normalization
of Atrophy (SIENA). SIENA is an MRI-based algorithm that quantifies brain tissue volume.
Clinical parameters were explored using the 18-item Movement Disorder Society-sponsored
revision of the Unified Parkinson's Disease Rating Scale, the Hoehn and Yahr Scale,
the Frontal Assessment Battery and the Natural History and Neuroprotection in Parkinson
Plus Syndromes scale (sub-items for orthostatic and urinary functions).
Results
The mean (±SD) age was 60.4 years ± 7.7 and a-WBAR was 1.65% ± 0.9. Demographics and
clinical ratings at the time of the first scan were non-significantly associated with
a-WBAR. The only exception was the baseline urinary score with a weak but significant
association (R2 = 0.15, p = 0.04). Progression of grey matter atrophy was detected in the left superior temporal
gyrus, right middle frontal gyrus, right frontopolar region and midbrain.
Conclusion
Urinary impairment at baseline may help to identify ‘fast progressors’ in terms of
neuronal loss, particularly in the frontal and temporal lobes. Thus, urinary impairment
should be recognized as a key target for disease modifying therapeutic interventions
in MSA.
Keywords
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References
- Proton magnetic resonance spectroscopy of patients with parkinsonism.Brain Res. Bull. 2000; 52: 589-595
- Manifestations of early brain recovery associated with abstinence from alcoholism.Brain J. Neurol. 2007; 130: 36-47
- The standardization of terminology of lower urinary tract function.J. Urol. 1979; 121: 551-554
- Involvement of medullary serotonergic groups in multiple system atrophy.Ann. Neurol. 2004; 55: 418-422
- Involvement of vagal autonomic nuclei in multiple system atrophy and Lewy body disease.Neurology. 2006; 66: 378-383
- Differential involvement of the periaqueductal gray in multiple system atrophy.Auton. Neurosci. 2010; 158: 111-117
- Incidence of progressive supranuclear palsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990.Neurology. 1997; 49: 1284-1288
- Voxel-based morphometry detects cortical atrophy in the Parkinson variant of multiple system atrophy.Mov. Disord. 2003; 18: 1132-1138
- The Talairach coordinate of a point in the MNI space: how to interpret it.NeuroImage. 2005; 25: 408-416
- Neuropathology of autonomic dysfunction in synucleinopathies.Mov. Disord. 2018; 33: 349-358
- The FAB: a frontal assessment battery at bedside.Neurology. 2000; 55: 1621-1626
- Brain atrophy progression measured from registered serial MRI: validation and application to Alzheimer's disease.J. Magn. Reson. Imaging. 1997; 7: 1069-1075
- Second consensus statement on the diagnosis of multiple system atrophy.Neurology. 2008; 71: 670-676
- Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan.Mov. Disord. 2007; 22: 41-47
- Measuring disease progression in frontotemporal lobar degeneration: a clinical and MRI study.Neurology. 2010; 74: 666-673
- Orthostatic hypotension and nicotine sensitivity in a case of multiple system atrophy.J. Neurol. Neurosurg. Psychiatry. 1969; 32: 28-34
- Onset and progression of pathologic atrophy in Huntington disease: a longitudinal MR imaging study.AJNR Am. J. Neuroradiol. 2010; 31: 1036-1041
- Parkinsonism: onset, progression, and mortality. 1967.Neurology. 2001; 57: S11-S26
- Longitudinal MRI study of multiple system atrophy - when do the findings appear, and what is the course?.J. Neurol. 2002; 249: 847-854
- The distribution and dynamic density of oligodendroglial cytoplasmic inclusions (GCIs) in multiple system atrophy: a correlation between the density of GCIs and the degree of involvement of striatonigral and olivopontocerebellar systems.Acta Neuropathol. 1997; 93: 585-591
- Cognitive impairments in multiple system atrophy: MSA-C vs MSA-P.Neurology. 2008; 70: 1390-1396
- A preliminary report on the use of functional magnetic resonance imaging with simultaneous urodynamics to record brain activity during micturition.J. Urol. 2012; 188: 474-479
- Large neurons in the tuberomammillary nucleus in patients with Parkinson's disease and multiple system atrophy.Neurology. 1996; 46: 1693-1696
- Examining mechanisms of brain control of bladder function with resting state functional connectivity MRI.Neurourol. Urodyn. 2014; 33: 493-501
- Effect of chemical stimulation of the medial frontal lobe on the micturition reflex in rats.J. Urol. 2012; 187: 1116-1120
- Glial cytoplasmic inclusions in the CNS of patients with multiple system atrophy (striatonigral degeneration, olivopontocerebellar atrophy and Shy-Drager syndrome).J. Neurol. Sci. 1989; 94: 79-100
- MRI derived brain atrophy in PSP and MSA-P. Determining sample size to detect treatment effects.J. Neurol. 2007; 254: 478-481
- Disease severity and progression in progressive supranuclear palsy and multiple system atrophy: validation of the NNIPPS—Parkinson Plus Scale.PLoS One. 2011; 6e22293
- Neuroimaging in Parkinson disease: from research setting to clinical practice.Nat. Rev. Neurol. 2014; 10: 708-722
- Bladder dysfunction as the initial presentation of multiple system atrophy: a prospective cohort study.Clin. Auton. Res. 2018; (Epub ahead of print)https://doi.org/10.1007/s10286-018-0550-y
- Measuring atrophy in Alzheimer disease: a serial MRI study over 6 and 12 months.Neurology. 2005; 65: 119-124
- Prevalence of progressive supranuclear palsy and multiple system atrophy: a cross-sectional study.Lancet. 1999; 354: 1771-1775
- Whole-brain atrophy rate and cognitive decline: longitudinal MR study of memory clinic patients.Radiology. 2008; 248: 590-598
- Normalized accurate measurement of longitudinal brain change.J. Comput. Assist. Tomogr. 2001; 25: 466-475
- Advances in functional and structural MR image analysis and implementation as FSL.NeuroImage. 2004; 23: S208-S219
- Multiple system atrophy with severe involvement of the motor cortical areas and cerebral white matter.J. Neurol. Sci. 1998; 156: 114-117
- Progression and prognosis in multiple system atrophy: an analysis of 230 Japanese patients.Brain J. Neurol. 2002; 125: 1070-1083
- Multiple system atrophy: a review of 203 pathologically proven cases.Mov. Disord. 1997; 12: 133-147
- Serial volumetric MRI in Parkinsonian disorders.Mov. Disord. 2009; 24: S691-S698
Article Info
Publication History
Published online: December 13, 2018
Accepted:
December 13,
2018
Received in revised form:
November 11,
2018
Received:
June 4,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
