Magnetic Resonance T1w/T2w Ratio in the Putamen and Cerebellum as a Marker of Cognitive Impairment in MSA: a Longitudinal Study

Sofia Cuoco, Sara Ponticorvo, Rossella Bisogno, Renzo Manara, Fabrizio Esposito, Gianfranco Di Salle, Francesco Di Salle, Marianna Amboni, Roberto Erro, Marina Picillo, Paolo Barone, Maria Teresa Pellecchia

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The exact pathophysiology of cognitive impairment in multiple system atrophy (MSA) is unclear. In our longitudinal study, we aimed to analyze (I) the relationships between cognitive functions and some subcortical structures, such as putamen and cerebellum assessed by voxel-based morphometry (VBM) and T1-weighted/T2-weighted (T1w/T2w) ratio, and (II) the neuroimaging predictors of the progression of cognitive deficits. Twenty-six patients with MSA underwent a comprehensive neuropsychological battery, motor examination, and brain MRI at baseline (T0) and 1-year follow-up (T1). Patients were then divided according to cognitive status into MSA with normal cognition (MSA-NC) and MSA with mild cognitive impairment (MCI). At T1, we divided the sample according to worsening/non worsening of cognitive status compared to baseline evaluation. Logistic regression analysis showed that age (β = − 9.45, p =.02) and T1w/T2w value in the left putamen (β = 230.64, p =.01) were significant predictors of global cognitive status at T0, explaining 65% of the variance. Logistic regression analysis showed that ∆-values of WM density in the cerebellum/brainstem (β = 2188.70, p =.02) significantly predicted cognitive worsening at T1, explaining 64% of the variance. Our results suggest a role for the putamen and cerebellum in the cognitive changes of MSA, probably due to their connections with the cortex. The putaminal T1w/T2w ratio may deserve further studies as a marker of cognitive impairment in MSA.

Original languageEnglish (US)
Pages (from-to)810-817
Number of pages8
Issue number5
StatePublished - Oct 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022, The Author(s).


  • Cerebellum
  • Cognitive impairment
  • Magnetic resonance imaging
  • Multiple system atrophy
  • Putamen
  • T1w/T2w

PubMed: MeSH publication types

  • Journal Article


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