Depression in multiple system atrophy: Views on pathological, clinical and imaging aspects

Abstract

Multiple system atrophy (MSA) is a common atypical parkinsonism, characterized by a varying combination of autonomic, cerebellar, and pyramidal systems. It has been noticed that the patients with MSA can be accompanied by some neuropsychiatric disorders, in particular depression. However, there is limited understanding of MSA-related depression. To bridge existing gaps, we summarized research progress on this topic and provided a new perspective regarding pathological, clinical, and imaging aspects. Firstly, we synthesized corresponding studies in order to investigate the relationship between depression and MSA from a pathological perspective. And then, from a clinical perspective, we focused on the prevalence of depression in MS patients and the comparison with other populations. Furthermore, the associations between depression and some clinical characteristics, such as life quality and gender, have been reported. The available neuroimaging studies were too sparse to draw conclusions about the radiological aspect of depression in MSA patients but we still described them in the presence of paper. Finally, we discussed some limitations and shortcomings existing in the included studies, which call for more high-quality basic research and clinical research in this field.

Sex-related differences in the clinical presentation of multiple system atrophy

“…Meta-analyses and population-based studies suggest that women are diagnosed with depression about twice as often as men [81][82][83]. Frequency rates of depression in MSA are significantly higher when compared to age-and sex-matched healthy controls [84], and a preponderance of depression in women with MSA has been reported in earlier studies [11,48]. The here observed higher frequency of depression in women and its independent association with female sex thus likely reflect a sex-related female background susceptibility to developing mood disorders, amplified by the burden of a relentlessly progressing disease.…”

“…The here observed higher frequency of depression in women and its independent association with female sex thus likely reflect a sex-related female background susceptibility to developing mood disorders, amplified by the burden of a relentlessly progressing disease. In addition, gender-related differences in receiving home-care versus undergoing early institutionalization and a higher likelihood of recognizing depression in women may possibly contribute to this observation [ 84 ].…”

Multiple system atrophy: an update and emerging directions of biomarkers and clinical trials

“…The health-related quality of life (HR-QOL) of patients with MSA is significantly affected by aggressive disability due to motor and autonomic deficits and by nonmotor symptoms, especially depression. Regarding the measurement of clinical outcomes, a HR-QOL change scale could become a valuable tool and the basis for improved MSA outcome measurement associated with UMSARS, which could benefit future clinical trials of disease-modifying therapies [229][230][231].…”