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Depression and Cognitive Impairment in MSA

Though dementia is not considered a common characteristic of MSA, cognitive impairment occurs in some patients in the form of loss of verbal memory and verbal fluency1. There is considerable lack of consensus among researchers at this time regarding rate of occurrence of cognitive impairment in MSA, with results varying widely between studies and depending upon which method of evaluation is used. In one study, a test for mental status, the Mini-Mental State Examination, or MMSE, yielded 3% of participants showing signs of cognitive decline while a test called the Frontal Assessment Battery categorized 41% of participants as being cognitively impaired2. Another study concluded that 72% of participants showed mild or moderate cognitive impairment, including shortened attention span, abstract thought, and delayed memory3. Differences in patterns of cognitive loss between MSA-P and MSA-C patients have also been observed, with MSA-P patients tending to lose verbal memory while MSA-C patients showing difficulty in acquiring new verbal information and maintaining attention.

Anxiety, depression and emotional instability also enter the picture for MSA patients, in part due to cognitive impairment4 and in part from the mental and emotional stresses associated with this complex disease. MSA patients often show high scores on self-rating depression questionnaires3.


Non-Pharmacological Treatment Options


Cognitive Training

Keeping the brain active through mental exercise, such as memory games or mental arithmetic sharpens memory, decision-making ability, and brain processing speed, and can help slow age-related cognitive decline5. Parkinson’s patients who practice mental processing exercises have been shown to improve processing speed and remain independent in activities of daily living for longer periods6. Physical exercise, such as walking or a home-based exercise routine including balance training, also improves cognitive function and mental processing speed in Parkinson’s patients7,8.

Animal studies have demonstrated that exercise strengthens cell-to-cell connections within the brain and improves adaptability of brain cells in Parkinson’s disease9.


Repetitive Transcranial Magnetic Stimulation for Depression

A technique called repetitive transcranial magnetic stimulation (rTMS) offers non-drug, noninvasive relief for symptoms of depression that do not respond to counseling or medication. A device, about the size of a hand, is placed on the top of the left side of the patient’s head, directly over the frontal lobe of the brain. It emits a magnetic field that stimulates areas of the brain that produce positive mood. A series of treatments consists of daily 37-minute sessions for 4 to 6 weeks10. rTMS is considered safe and effective, with minor side effects such as scalp discomfort10.

For all references listed in the About MSA section please download the MSA Coalition's "MSA - What You Need to Know"

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