Distinct patterns of cognitive impairment in multiple system atrophy patients of cerebellar and parkinsonian predominance

To delineate possibly distinct cognitive impairment in patients with multiple system atrophy (MSA) of cerebellar (MSA-C) and striatonigral (MSA-P) predominance, we employed two experimental tasks sensitive to striatal lesions: the Weather-Prediction Task (WPT) and the Object Alternation Task (OAT). Only MSA-P (n = 10) patients showed reduced learning in the WPT and were impaired at maintaining the alternation rule in the OAT, compared to MSA-C (n = 10) and matched controls (n = 26). Both MSA-groups were impaired regarding digit span and verbal fluency.This distinct pattern of cognitive impairment reflects the prevailing involvement of striato-thalamo-cortical circuits in MSA-P patients and of cerebellar-prefrontal circuits in MSA-C patients. The specific cognitive impairments correspond to the type of motor predominance in MSA.

► We compared subtypes of patients with Multiple System atrophy (MSA-P vs MSA-C vs. Controls). ► We used different task of reinforcement learning and executive function. ► Reinforcement learning was impaired only in the parkinsonian subtype of MSA. ► Specific cognitive impairments correspond to the underling neuropathology in MSA subtypes.