European journal of neurology
October 1, 2026 · via Europe PMC
Neural Correlates of Apathy in Multiple System Atrophy: A Clinical and Perfusion Imaging Study.
Nakagawa Y, Sugiyama A, Nakano Y, +6 more, Mori M.
AI summary — for doctors, generated from the abstract only
Apathy affected over half of cognitively preserved MSA patients and was associated with reduced medial prefrontal perfusion.
What was studied
A retrospective cross-sectional study of 76 MSA patients with apathy assessment, MRI and perfusion SPECT.
Key findings
- Apathy in 55.3%, similar across motor subtypes
- Distinct from depression scores
- Reduced medial prefrontal perfusion independently associated with apathy
- Exploratory reduced prefrontal-cerebellar covariance
Clinical relevance
Suggests apathy should be assessed in MSA; cross-sectional data.
Who should care
Limitations
Retrospective single-center design.
Medial prefrontal dysfunction may underlie apathy in MSA.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Apathy is a frequent nonmotor symptom of multiple system atrophy (MSA) that worsens quality of life. Although frontostriatal dysfunction has been implicated in apathy, its neural basis in MSA remains insufficiently characterized.
Objectives
To identify the neural substrates of apathy associated with MSA-specific neurodegenerative processes.
Methods
This retrospective cross-sectional study included 76 patients with cognitively preserved clinically established/probable MSA who underwent clinical and neuropsychological assessments, including the Apathy Scale and a separate depression measure, magnetic resonance imaging, and cerebral blood flow single-photon emission computed tomography. Clinical variables, gray matter volume, and voxel-wise perfusion were compared between apathy and non-apathy groups. Multivariate logistic regression was used to analyze the independent association of the significant perfusion cluster with apathy, and seed-based covariance analysis was used to explore network alterations.
Results
Apathy was present in 55.3% of patients and did not differ between motor subtypes. Compared with the non-apathy group, the apathy group showed lower visuospatial scores and frequency of neurogenic orthostatic hypotension, similar depression scores and gray matter volume, and reduced perfusion in the medial prefrontal cortex on voxel-wise perfusion analysis. These findings remained independently associated with apathy after adjustment for clinical variables. Seed-based covariance analysis suggested reduced positive covariance between the medial prefrontal cortex and cerebellar regions, predominantly in the posterior lobe.
Conclusions
Apathy was common in MSA even with relatively preserved global cognition and distinct from depression. In addition to medial frontostriatal dysfunction, exploratory findings suggested that mechanisms related to cerebellar cognitive affective syndrome may contribute to its pathophysiology.
DOI
10.1111/ene.70766
PMID
42798249
PMCID
PMC13615368
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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