{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T21:09:46Z","timestamp":1785186586733,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Multiple system atrophy (MSA) clinically manifests with either predominant nigrostriatal or cerebellopontine degeneration. This corresponds to two different phenotypes, one with predominant Parkinson's symptoms (MSA\u2010P [multiple system atrophy\u2010parkinsonian subtype]) and one with predominant cerebellar deficits (MSA\u2010C [multiple system atrophy\u2010cerebellar subtype]). Both nigrostriatal and cerebellar degeneration can lead to impaired dexterity, which is a frequent cause of disability in MSA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim was to disentangle the contribution of nigrostriatal and cerebellar degeneration to impaired dexterity in both subtypes of MSA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We thus investigated nigrostriatal and cerebellopontine integrity using diffusion microstructure imaging in 47 patients with MSA\u2010P and 17 patients with MSA\u2010C compared to 31 healthy controls (HC). Dexterity was assessed using the 9\u2010Hole Peg Board (9HPB) performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nigrostriatal degeneration, represented by the loss of cells and neurites, leading to a larger free\u2010fluid compartment, was present in MSA\u2010P and MSA\u2010C when compared to HCs. Whereas no intergroup differences were observed between the MSAs in the substantia nigra, MSA\u2010P showed more pronounced putaminal degeneration than MSA\u2010C. In contrast, a cerebellopontine axonal degeneration was observed in MSA\u2010P and MSA\u2010C, with stronger effects in MSA\u2010C. Interestingly, the degeneration of cerebellopontine fibers is associated with impaired dexterity in both subtypes, whereas no association was observed with nigrostriatal degeneration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cerebellar dysfunction contributes to impaired dexterity not only in MSA\u2010C but also in MSA\u2010P and may be a promising biomarker for disease staging. In contrast, no significant association was observed with nigrostriatal dysfunction. \u00a9 2023 The Authors. <jats:italic>Movement Disorders<\/jats:italic> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.29661","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T01:56:59Z","timestamp":1701136619000},"page":"130-140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Cerebellar, Not Nigrostriatal Degeneration Impairs Dexterity in Multiple System Atrophy"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5881-6043","authenticated-orcid":false,"given":"Alexander","family":"Rau","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, Medical Center\u2014University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg 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