Search

Several MRI techniques have become available to support the early diagnosis of multiple system atrophy (MSA), but few longitudinal studies on both MSA variants have been performed, and there are no established MRI markers of disease progression. We aimed to characterize longitudinal brain changes in 26 patients with MSA (14 MSA-P and 12 MSA-C) over a 1-year follow-up period in terms of local tissue density and T1w/T2w ratio in a-priori regions, namely, bilateral putamen, cerebellar gray matter (GM), white matter (WM), and substantia nigra (SN). A significant GM density decrease was found in cerebellum and left putamen in the entire group (10.7 and 33.1% variation, respectively) and both MSA subtypes (MSA-C: 15.4 and 33.0% variation; MSA-P: 7.7 and 33.2%) and in right putamen in the entire group (19.8% variation) and patients with MSA-C (20.9% variation). A WM density decrease was found in the entire group (9.3% variation) and both subtypes in cerebellum-brainstem (MSA-C: 18.0% variation; MSA-P: 5% variation). The T1w/T2w ratio increase was found in the cerebellar and left putamen GM (6.6 and 24.9% variation), while a significant T1w/T2w ratio decrease was detected in SN in the entire MSA group (31% variation). We found a more progressive atrophy of the cerebellum in MSA-C with a similar progression of putaminal atrophy in the two variants. T1w/T2w ratio can be further studied as a potential marker of disease progression, possibly reflecting decreased neuronal density or iron accumulation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ponticorvo, Manara, Russillo, Andreozzi, Forino, Erro, Picillo, Amboni, Cuoco, Di Salle, Di Salle, Barone, Esposito and Pellecchia.)

Background: There is increasing evidence of gender differences in the epidemiology and clinical manifestation of both motor and non-motor symptoms of Parkinson's disease (PD). Nevertheless, few data are available on gender differences in the response to antiparkinsonian drugs. Safinamide is a multimodal drug with positive effects on motor and non-motor fluctuations that might improve patients' care and quality of life. Objective: To analyze gender differences on clinical effects of safinamide in PD patients treated in real-life conditions during the SYNAPSES trial. Methods: SYNAPSES was a multinational, multicenter, observational study. At baseline, patients with PD diagnosis received safinamide as an add-on to levodopa and were followed up for 12 months, with visits performed every 4 months. A new statistical analysis was performed to describe the efficacy of safinamide in men and women on motor complications, motor symptoms, and adverse events. Results: Six hundred and sixteen (38%) out of 1,610 patients enrolled in the SYNAPSES study were women and 994 (62%) men. Safinamide improved motor symptoms and motor complications (fluctuations and dyskinesia) in both genders, with a good safety profile and without requiring any change in the concomitant dopaminergic therapy. Clinically significant improvements, according to the criteria developed by Shulman et al., were seen in 46% of male and female patients for the UPDRS motor score and 43.5% of men vs. 39.1% of women for the UPDRS total score. Conclusions: Safinamide was effective in improving motor fluctuations and dyskinesia and proved to be safe in both male and female patients with PD. Further prospective studies, specifically addressing potential gender differences in response to PD therapies, are needed to develop tailored management strategies., Competing Interests: MTP, MP, MR, and MD are members of the Scientific Advisory Board of Zambon S.p.A. CC and IM are employees at Zambon S.p.A. EB is a statistical consultant for Zambon S.p.A. Zambon S.p.A. was involved in the study design and collection of data for the original study. Zambon S.p.A funded the original study. CC requested approval for publication from Zambon S.p.A as an employee but Zambon S.p.A was not involved in the analysis, interpretation of data, writing of this article, or the decision to submit it for publication., (Copyright © 2021 Pellecchia, Picillo, Russillo, De Pandis, Bonizzoni, Marjanovic and Cattaneo.)

Introduction: The aim of this study is to investigate the impact of orthostatic hypotension (OH) on cognitive functions in patients with multiple system atrophy (MSA) followed over time. Methods: Thirty-two MSA patients were enrolled and underwent a comprehensive neuropsychological battery; at baseline (T 0 ) 15 out of 32 patients presented OH, assessed by means of orthostatic standing test. All patients underwent a follow-up (T 1 ) evaluation 12 months after baseline. Thirteen out of 32 patients also underwent a second follow-up (T 2 ) evaluation at 24 months. Changes over time on different neuropsychological tasks were compared between patients with and without OH by means of Mann-Whitney's U -test. Moreover, clinical categories of normal cognition, mild cognitive impairment, and dementia were determined, and changes at T 1 and T 2 in global cognitive status were compared between patients with and without OH. Results: At T 0 , patients with OH had better performance on words/non-words repetition task ( p = 0.02) compared to patients without OH. Compared to patients without OH, patients with OH performed worse on semantic association task ( p < 0.01) at T 1 and on Stroop test-error effect ( p = 0.04) at T 2 . The percentage of patients with worsened cognitive status at T 1 was higher among patients with OH than among patients without OH (93 vs. 59%, p = 0.03). OH (β = -4.67, p = 0.01), education (β = 0.45, p = 0.02), age (β = 0.19, p = 0.03), and Montreal Cognitive Assessment battery (MOCA) score at T 0 (β = -0.26, p = 0.04) were significant predictors of global cognitive status worsening at T 1 . Discussion: We found that global cognitive status worsened at 1-year follow-up in 93% of patients with OH, and OH, along with age, education, and MOCA score, predicted cognitive worsening over time. To clarify the relationship between OH and cognitive dysfunction in MSA, we suggest the use of clinical categories of normal cognition, mild cognitive impairment, and dementia in further longitudinal studies on MSA patients with and without OH., Competing Interests: Unrelated to this study, PB received consultancies as a member of the advisory board for Zambon, Lundbeck, UCB, Chiesi, Abbvie, and Acorda. RE received consultancies from Zambon and honoraria from TEVA. The other authors report no financial disclosures. The other authors report no financial disclosures. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Cuoco, Carotenuto, Cappiello, Scannapieco, Russillo, Andreozzi, Forino, Amboni, Picillo, Erro, Barone and Pellecchia.)