Cerebral cortical cholinergic activity is decreased to a similar level in Parkinson disease (PD), parkinsonian syndromes of multiple system atrophy (MSA-P), and progressive supranuclear palsy (PSP) as compared to normal controls. Subcortical cholinergic activity is significantly more decreased in MSA-P and PSP than in PD. The more substantial decrease reflects greater impairment in the pontine cholinergic group, which is important in motor activity, particularly gait. These differences may account for the greater gait disturbances in the early stages of MSA-P and PSP than in PD.

Objectivey Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia frequently affecting patients with synucleinopathies but its exact prevalence in multiple system atrophy (MSA) is unclear. Whether questionnaires alone are sufficient to diagnose RBD is also unknown. Methods Cross-sectional study of patients with probable MSA from six academic centers in the US and Europe. RBD was ascertained clinically and with polysomnography; and meta-analysis according to PRISMA guidelines for studies published before September 2014 that reported the prevalence of RBD in MSA. A random-effects model was constructed using weighted prevalence proportions. Only articles in English were included. Studies were classified into those that ascertained the presence of RBD in MSA clinically and with polysomnography. Case reports or case series (≤5 patients) were not included. Results Forty-two patients completed questionnaires and underwent polysomnography. Of those, 32 (76.1%) had clinically-suspected RBD and 34 (81%) had polysomnography-confirmed RBD. Two patients reported no symptoms of RBD but had polysomnography-confirmed RBD. The primary search strategy yielded 374 articles of which 12 met the inclusion criteria The summary prevalence of clinically suspected RBD was 73% (95% CI, 62%-84%) in a combined sample of 324 MSA patients. The summary prevalence of polysomnography-confirmed RBD was 88% (95% CI, 79%-94%) in a combined sample of 217 MSA patients. Interpretation Polysomnography-confirmed RBD is present in up to 88% of patients with MSA. RBD was present in some patients that reported no symptoms. More than half of MSA patients report symptoms of RBD before the onset of motor deficits.

Little is known about the service needs for persons caring for individuals with Mild Cognitive Impairment (MCI). In this study, the level of support service need for caregivers of individuals diagnosed with Alzheimer's Disease (AD; N=55) and MCI (N=25) was compared to normal controls (NC; N=44). Study partners (i.e., caregivers) completed questionnaires about their service needs and participants' neurobehavioral symptoms, functional abilities, and frailty. Total, social, and mental health service needs were significantly different among the three groups (p<.0001), with MCI and AD caregivers reporting more need for services as compared to the NC group. There was no significant difference between MCI and AD groups for total and social service need. In the MCI group, caregiver's service need was related to neurobehavioral symptoms and frailty, whereas service need among the AD caregivers was related to functional disability and frailty. Caregivers of individuals with MCI are already experiencing a need for increased services comparable to that of individuals caring for AD patients, though the pattern of patient-related factors is different between the two patient groups. These findings suggest possible areas of intervention that could be considered at the earliest stages of memory loss. Key words/phrasesmild cognitive impairment; Alzheimer's disease; service need; support services; caregiver The term Mild Cognitive Impairment (MCI) has been used to describe the transitional phase between normal functioning and Alzheimer's disease (AD) 1 . According to Petersen and colleagues'1 original criterion, amnestic MCI is diagnosed when there is a subjective memory complaint as well as evidence of objective memory impairment in the context of intact activities of daily living and general intellectual abilities. Peterson2 later broadened the criterion to include two primary subtypes of MCI: amnestic and nonamnestic MCI. The broader definition of MCI acknowledges the possibility of other cognitive complaints or deficits in other areas besides memory. Many studies indicate that MCI progresses to AD at a relatively high rate, from 13-48% over 12-60 months 3 -5 . The cognitive and functional changes associated with the progression to AD as well as the potential for a longer disease course among individuals with MCI likely pose a unique set of challenges for caregivers or family members who provide assistance to or care for these patients. There is extensive literature on care burden by family Although no research exists on what formal support services family members of patients with MCI use, there is some evidence to suggest that spouses of patients with MCI are experiencing increased caregiver burden [13][14] . Garand and her colleagues 14 reported that MCI spouses/ caregivers endorsed an increase in caregiving responsibilities such as greater frequency of errands, more coordination of transportation, and greater management of business affairs and medications. Lifestyle constraints and increase in household responsibilit...

Given greater diagnostic specificity and internal consistency of informant report, clinicians should weigh this information more heavily than self-report in the diagnostic process.

NeuroQuant (NQ) is a fully-automated program that overcomes several existing limitations in the clinical translation of MRI-derived volumetry. The current study characterized differences between the original (NQ1) and an updated NQ version (NQ2) by (i) replicating previously identified relationships between neuropsychological test performance and medial temporal lobe volumes, (ii) evaluating the level of agreement between NQ versions, and (iii) determining if the addition of NQ2 age-/sex-based z-scores hold greater clinical utility for prediction of memory impairment than standard percent of intracranial volume (%ICV) values. Sixty-seven healthy older adults and 65 MCI patients underwent structural MRI and completed cognitive testing, including the Immediate and Delayed Memory indices from the RBANS. Results generally replicated previous relationships between key medial temporal lobe regions and memory test performance, though comparison of NQ regions revealed statistically different values that were biased toward one version or the other depending on the region. NQ2 hippocampal z-scores explained additional variance in memory performance relative to %ICV values. Findings indicate that NQ1/2 medial temporal lobe volumes, especially age- and sex-based z-scores, hold clinical value, though caution is warranted when directly comparing volumes across NQ versions.