Objective: We aim to ascertain the association between serum cholesterol and multiple system atrophy (MSA).

Background: MSA, a common form of atypical parkinsonism, is a rapidly progressive neurodegenerative disease characterized by a combination of symptoms that affect both the autonomic nervous system and movement. The hallmark of MSA is the glial cytoplasmic inclusion (GCI) with aggregation and deposition of α-synuclein. Deranged cholesterol metabolism have been found in many neurodegenerative disorders such as Alzheimer’s disease and Parkinson’s disease.

Methods: This is a cohort study for investigation of lipid metabolism in MSA in a Taiwanese population. The patients fulfilled with the criteria of possible and probable diagnosis of MSA were enrolled in the special clinics of Movement disorders in one medical center of Taiwan. The functional scores (UMSARS, MDS-UPDRS), epidemiological questionnaire and BMI were evaluated. Serum total cholesterol (T-CHO) and triglyceride (TG) were examined. Healthy controls are obtained from Taiwan Biobank. Subjects in Taiwan Biobank less than 60 years old or with major diseases will be excluded. In the end, 234 subjects were included as healthy controls for analyses.

Results: 100 MSA patients participated in this study. The demographic data of the MSA group are 53 men, 47 women; 73 MSA-P, 27 MSA-C; mean age of onset, 63.4 years; median of disease duration, 4.7 years. In particular, the T-CHO levels are significantly lower in 100 MSA patients compared with 234 healthy controls (176.4 ± 40.4 vs. 200.4 ± 35.8, p<0.0001). The T-CHO levels are even lower in MSA-P (171.6 ± 40.4) compared with MSA-C (189.8 ± 41.0). Nevertheless, the TG levels had no difference among patients and control (116.7 ± 67.3 vs. 115.5 ± 61.1, p=0.931). We performed a stepwise multiple logistic regression analysis and discovered that lower cholesterol level was significantly correlated with risk of developing MSA (p<0.0001, adjusted odds ratio = 0.975, 95% CI = 0.966 - 0.985).

Conclusions: The T-CHO level is negatively correlated with MSA risk. Whether systemic lipid metabolism is connected with myelin degradation and α-synucleinopathy in MSA deserves further investigation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/serum-cholesterol-level-is-associated-with-risk-of-msa/