Abstract

Background:

Cerebral small vessel disease (CSVD) has not been systematically studied in patients with multiple system atrophy (MSA).

Objective:

We sought to explore whether MSA patients suffer from a heavier CSVD burden relative to healthy individuals and whether CSVD has a relationship with motor, cognitive, and emotional dysfunction in patients with MSA.

Methods:

This study consecutively recruited 190 MSA patients and 190 matched healthy controls whose overall CSVD burden and single CSVD imaging markers (including white matter hyperintensity (WMH), microbleeds, lacunes, and enlarged perivascular spaces (EPVS)) were measured. Of the MSA patients, 118 completed multi-dimensional outcome assessments. Spearman’s correlations and multivariable linear regressions were performed.

Results:

We observed a greater burden of overall CSVD, WMH, and EPVS in MSA patients compared with controls, but not for microbleeds and lacunes. Motor dysfunction and cognitive impairment were significantly worse in subjects with severe CSVD than those with none-to-mild CSVD. In patients with MSA, the severity of CSVD burden was positively associated with motor impairments as measured by the Unified Multiple System Atrophy Rating Scale-II (β= 2.430, p = 0.039) and Scale for the Assessment and Rating of Ataxia (β= 1.882, p = 0.015). Of CSVD imaging markers, different associations with MSA outcomes were displayed. WMH was associated with motor, cognitive, and emotional deficits, while the EPVS in the centrum semiovale, basal ganglia, and hippocampus regions was correlated only with motor severity, anxiety, and cognition, respectively. Similar findings were noted in MSA-C and MSA-P patients.

Conclusions:

Concomitant CSVD may be correlated with worse multi-dimensional dysfunction in patients with MSA.

中文翻译：

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脑小血管疾病与多系统萎缩中的运动、认知和情绪功能障碍有关

摘要

背景：

尚未对多系统萎缩 (MSA) 患者的脑小血管疾病 (CSVD) 进行系统研究。

客观的：

我们试图探讨 MSA 患者相对于健康个体是否患有更重的 CSVD 负担，以及 CSVD 是否与 MSA 患者的运动、认知和情绪功能障碍有关。

方法：

该研究连续招募了 190 名 MSA 患者和 190 名匹配的健康对照者，测量了他们的总体 CSVD 负荷和单一 CSVD 成像标志物（包括白质高信号（WMH）、微出血、腔隙和血管周围间隙扩大（EPVS））。在 MSA 患者中，118 名完成了多维结果评估。进行了 Spearman 相关性和多变量线性回归。

结果：

我们观察到，与对照组相比，MSA 患者的整体 CSVD、WMH 和 EPVS 负担更大，但微出血和腔隙则不然。严重脑小血管病患者的运动功能障碍和认知障碍明显比非轻度脑小血管病患者更严重。在 MSA 患者中，脑小血管病负担的严重程度与运动障碍呈正相关，根据统一多系统萎缩评定量表 II（β= 2.430，p  = 0.039）和共济失调评估和评定量表（β= 1.882）测量，p  = 0.015）。CSVD 成像标记物与 MSA 结果显示出不同的关联。WMH 与运动、认知和情绪缺陷相关，而半卵圆中心、基底神经节和海马区域的 EPVS 分别仅与运动严重程度、焦虑和认知相关。在 MSA-C 和 MSA-P 患者中也发现了类似的结果。

结论：

并发脑小血管病可能与 MSA 患者更严重的多维功能障碍相关。