Diagnosing dementia in multiple system atrophy by applying Movement Disorder Society diagnostic criteria for Parkinson's disease dementia

Auzou, Nicolas; Dujardin, Kathy; Biundo, Roberta; Foubert‐Samier, Alexandra; Barth, Caroline; Duval, Fanny; Tison, François; Defebvre, Luc; Antonini, Angelo; Meissner, Wassilios G.

doi:10.1016/j.parkreldis.2015.08.013

Cited by 25 publications

(18 citation statements)

References 15 publications

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“…This is confirmed by our study, where the executive and attentive-working memory domains were the most commonly affected cognitive functions (Auzou et al 2015). Based on the MoCA subitems analysis, we observed a trend for PSP patients to have worse performance than MSA and PD, in the executive (in particular in: ''clock drawing'', ''letter fluency'', and ''abstraction'' tasks), attentive and working memory domains (namely in: ''sustained attention'', ''digit forward'', and ''calculation'' tasks).…”

Section: Discussionsupporting

confidence: 89%

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Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy

et al. 2016

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To determine if Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting cognitive abnormalities in patients with probable progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) compared with Parkinson's disease (PD). In this multicenter observational study, MMSE and MoCA were administered in a random order to 130 patients: 35 MSA, 30 PSP and 65 age, and education and gender matched-PD. We assessed between-group differences for MMSE, MoCA, and their subitems. Receiver-operating characteristic (ROC) curves were calculated. The mean MMSE was higher than the mean MoCA score in each MSA (27.7 ± 2.4 vs. 22.9 ± 3.0, p < 0.0001), PSP (26.0 ± 2.9 vs. 18.2 ± 3.9, p < 0.0001), and PD (27.3 ± 2.0 vs. 22.3 ± 3.5, p < 0.0001). MoCA total score as well as its letter fluency subitem differentiated PSP from MSA and PD with high specificity and moderate sensitivity. More specifically, a cut-off score of 7 F-words or less per minute would support a diagnosis of PSP (PSP vs. PD: 86 % specificity, 70 % sensitivity; PSP vs. MSA: 71 % specificity, 70 % sensitivity). By contrast, MMSE presented an overall ceiling effect for most subitems, except for the pentagon scores, where PSP did less well than MSA or PD patients. These preliminary results suggest that PSP and MSA, similar to PD patients, may present normal MMSE and reduced MoCA performance. Overall, MoCA is more sensitive than MMSE in detecting cognitive impairment in atypical parkinsonism and together with verbal fluency would be a useful test to support PSP diagnosis.

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Section: Discussionsupporting

confidence: 89%

“…Executive dysfunction is the most frequent cognitive abnormality in MSA and PSP (Auzou et al 2015;Dujardin et al 2003;Lange et al 2003). This is confirmed by our study, where the executive and attentive-working memory domains were the most commonly affected cognitive functions (Auzou et al 2015).…”

Section: Discussionsupporting

confidence: 88%

Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy

et al. 2016

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“…2 In contrast, the Stroop Test Color Naming trial (i.e., quickly naming the color of items on a page) requires very little motor involvement. 3 From our study, 9 MSA patients with CI underwent neuropsychological evaluation, with 8 patients demonstrating impairment in processing speed. Data for these patients, including the presence of motor signs and qualitative indicators for processing speed impairment, are presented in Table 1.…”

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confidence: 95%

“…Although attention/executive deficits were highly prevalent also in our cohort, we choose to not consider processing speed because motor disability in advanced MSA could interfere with the evaluation of this cognitive domain. 3,4 Indeed, the assessment of cognition is challenging because motor impairment could hamper cognitive evaluation, especially tasks based on reaction time. In this regard, listing cognitive tests used would facilitate outcome comparisons from different studies.…”

Section: E T T E R S : P U B L I S H E D a R T I C L Ementioning

confidence: 99%

“…We recently reported the results of MRI volumetric, clinical, and cognitive assessments in 72 probable MSA enrolled in 5 institutions as part of the Movement Disorder Society MSA study group. 2 We used an MSA-specific MMSE screening cut-off score to define CI, 3 which was associated with focal volume reduction in the left dorsolateral prefrontal cortex. Our interpretation was that CI in MSA is underlined by disruption of the striato-pallido-thalamo-cortical circuits and that cortical defects are secondary to subcortical alterations.…”

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confidence: 99%

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Cognitive impairment in multiple system atrophy

et al. 2017

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The extent and the underlying anatomical signature of cognitive impairment (CI) in patients with multiple system atrophy (MSA) is still debated. We read with interest the study by Koga and colleagues, 1 who reported CI in 32% of 102 autopsy-confirmed MSA patients. However, MSA-CI brains did not show significant cortical atrophy but, rather, neuronal cytoplasmic inclusions in the dentate gyrus although CI primarily affected processing speed and attention/executive functions, which are typically fronto-striatal.However, not all had structured cognitive evaluation cognitive testing (48%) that had been performed at variable intervals before death. The remaining subjects (52%) were assessed only by subjective indicators, which may have altered the proportion of patients with CI.We recently reported the results of MRI volumetric, clinical, and cognitive assessments in 72 probable MSA enrolled in 5 institutions as part of the Movement Disorder Society MSA study group. 2 We used an MSA-specific MMSE screening cut-off score to define CI, 3 which was associated with focal volume reduction in the left dorsolateral prefrontal cortex. Our interpretation was that CI in MSA is underlined by disruption of the striato-pallido-thalamo-cortical circuits and that cortical defects are secondary to subcortical alterations. Koga and colleagues 1 reported CI predominantly in

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Laboratory‐Supported Multiple System Atrophy beyond Autonomic Function Testing and Imaging: A Systematic Review by the MoDiMSA Study Group

Stanković

Fanciulli

Kostić

et al. 2021

Movement Disord Clin Pract

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Background Neuroimaging has been used to support a diagnosis of possible multiple system atrophy (MSA). Only blood pressure changes upon standing are included in the second consensus criteria but other autonomic function tests (AFT) are also useful to diagnose widespread and progressive autonomic failure typical of MSA. Additional diagnostic tools are of interest to improve accuracy of MSA diagnosis. Objectives To assess the utility of diagnostic tools beyond brain imaging and AFT in enhancing a laboratory‐supported diagnosis of MSA to support the upcoming revision of the consensus criteria. Methods The International Parkinson and Movement Disorders Society MSA Study Group (MoDiMSA) performed a systematic review of original papers on biomarkers, sleep studies, genetic, neuroendocrine, neurophysiological, neuropsychological and other tests including olfactory testing and acute levodopa challenge test published before August 2019. Results Evaluation of history of levodopa responsiveness and olfaction is useful in patients in whom MSA‐parkinsonian subtype is suspected. Neuropsychological testing is useful to exclude dementia at time of diagnosis. Applicability of sphincter EMG is limited. When MSA‐cerebellar subtype is suspected, a screening for the common causes of adult‐onset progressive ataxia is useful, including spinocerebellar ataxias in selected patients. Diagnosing stridor and REM sleep behavior disorder is useful in both MSA subtypes. However, none of these tools are validated in large longitudinal cohorts of postmortem confirmed MSA cases. Conclusions Despite limited evidence, additional laboratory work‐up of patients with possible MSA beyond imaging and AFT should be considered to optimize the clinical diagnostic accuracy.

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Diagnosing dementia in multiple system atrophy by applying Movement Disorder Society diagnostic criteria for Parkinson's disease dementia

Cited by 25 publications

References 15 publications

Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy

Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy

Cognitive impairment in multiple system atrophy

Laboratory‐Supported Multiple System Atrophy beyond Autonomic Function Testing and Imaging: A Systematic Review by the MoDiMSA Study Group

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