Cerebral Metabolism Related to Cognitive Impairments in Multiple System Atrophy

Cong Shen; Li Chen; Jing-Jie Ge; Jia-Ying Lu; Qi-Si Chen; Shu-Jin He; Xin-Yi Li; Jue Zhao; Yi-Min Sun; Ping Wu; Jian-Jun Wu; Feng-Tao Liu; Jian Wang

doi:10.3389/fneur.2021.652059

Cerebral Metabolism Related to Cognitive Impairments in Multiple System Atrophy

Front Neurol. 2021 Apr 1:12:652059. doi: 10.3389/fneur.2021.652059. eCollection 2021.

Authors

Cong Shen¹, Li Chen², Jing-Jie Ge³, Jia-Ying Lu³, Qi-Si Chen¹, Shu-Jin He¹, Xin-Yi Li¹, Jue Zhao¹, Yi-Min Sun¹, Ping Wu³, Jian-Jun Wu¹, Feng-Tao Liu¹, Jian Wang¹

Affiliations

¹ Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China.
³ Positron emission tomography (PET) Center at Huashan Hospital, Institute of Functional and Molecular Medical Imaging, Human Phenome Institute, Fudan University, Shanghai, China.

Abstract

Objective: We aimed to characterize the cognitive profiles in multiple system atrophy (MSA) and explore the cerebral metabolism related to the cognitive decline in MSA using ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) Positron Emission Tomography (PET). Methods: In this study, 105 MSA patients were included for cognitive assessment and 84 of them were enrolled for ¹⁸F-FDG PET analysis. The comprehensive neuropsychological tests covered five main domains including execution, attention, memory, language, and visuospatial function. The cognitive statuses were classified to MSA with normal cognition (MSA-NC) and MSA with cognitive impairment (MSA-CI), including dementia (MSA-D), and mild cognitive impairment (MSA-MCI). With ¹⁸F-FDG PET imaging, the cerebral metabolism differences among different cognitive statuses were analyzed using statistical parametric mapping and post-hoc analysis. Results: Among 84 MSA patients, 52 patients were found with MSA-CI, including 36 patients as MSA-MCI and 16 patients as MSA-D. In detail, the cognitive impairments were observed in all the five domains, primarily in attention, executive function and memory. In ¹⁸F-FDG PET imaging, MSA-D and MSA-MCI patients exhibited hypometabolism in left middle and superior frontal lobe compared with MSA-NC (p < 0.001). The normalized regional cerebral metabolic rate of glucose (rCMRglc) in left middle frontal lobe showed relative accuracy in discriminating MSA-CI and MSA-NC [areas under the curve (AUC) = 0.750; 95%CI = 0.6391-0.8609]. Conclusions: Cognitive impairments were not rare in MSA, and the hypometabolism in frontal lobe may contribute to such impairments.

Keywords: 18 F-fluorodeoxyglucose; cerebral metabolism; cognitive impairment; multiple system atrophy; positron emission tomography.