Cortical hypometabolism associated with cognitive impairment of multiple system atrophy

Kye Won Park; Ji Hyun Ko; Nari Choi; Sungyang Jo; Yun Jik Park; Eun-Jae Lee; Su Jung Kim; Sun Ju Chung; Chong S Lee

doi:10.1016/j.parkreldis.2020.10.039

Cortical hypometabolism associated with cognitive impairment of multiple system atrophy

Parkinsonism Relat Disord. 2020 Dec:81:151-156. doi: 10.1016/j.parkreldis.2020.10.039. Epub 2020 Oct 28.

Authors

Kye Won Park¹, Ji Hyun Ko², Nari Choi³, Sungyang Jo¹, Yun Jik Park¹, Eun-Jae Lee¹, Su Jung Kim¹, Sun Ju Chung¹, Chong S Lee⁴

Affiliations

¹ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
² Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
³ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology, Heavenly Hospital, Goyang, South Korea.
⁴ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: chongslee@amc.seoul.kr.

PMID: 33137618
DOI: 10.1016/j.parkreldis.2020.10.039

Abstract

Introduction: Cognitive impairment is not uncommon in patients with multiple system atrophy (MSA). This study investigated the cortical metabolic changes of MSA and the cortical structure associated with cognitive impairment.

Methods: The study included probable/definite MSA patients who underwent fluorodeoxyglucose positron emission tomography and cognitive evaluation based on mini-mental status examination (MMSE). Cerebral metabolism of the entire MSA patients (n = 88) was compared with healthy controls (n = 19) by voxel-wise statistical parametric mapping. Eight brain regions of interest (ROIs) were selected accordingly: the dorsolateral prefrontal, medial superior frontal, insular, posterior parietal, precuneus, lateral temporal, medial temporal, and posterior cingulate regions. Using validated population-based norms, MSA patients were divided by MMSE z-scores into MSA with cognitive dysfunction (MSA-D, n = 30) and without cognitive dysfunction (MSA-ND, n = 58). Regional metabolism of the selected ROIs was compared between the MSA-D and MSA-ND groups by logistic regression models. Correlations between the regional metabolism of the selected ROIs and MMSE z-scores were analyzed with a linear regression model.

Results: Voxel-wise analysis showed hypometabolism in the frontal, temporal, parietal, and limbic areas in MSA patients than in controls. ROI-based comparisons showed that metabolism in the posterior cingulate (P = 0.006) and medial temporal (P = 0.039) regions was significantly lower in the MSA-D than in the MSA-ND group. The degree of posterior cingulate metabolism correlated significantly with MMSE z-score (P = 0.023).

Conclusions: MSA shows fronto-temporo-parietal cortical involvement. Hypometabolism of the limbic regions is associated with cognitive impairment in MSA.

Keywords: Cognitive impairment; Fluorodeoxyglucose positron emission tomography imaging; Multiple system atrophy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cerebral Cortex / diagnostic imaging
Cerebral Cortex / metabolism*
Cognitive Dysfunction / diagnostic imaging
Cognitive Dysfunction / etiology
Cognitive Dysfunction / metabolism*
Female
Fluorodeoxyglucose F18
Humans
Male
Middle Aged
Multiple System Atrophy / complications
Multiple System Atrophy / diagnostic imaging
Multiple System Atrophy / metabolism*
Positron-Emission Tomography
Radiopharmaceuticals

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18