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Cognitive impairment before changes appear on [18F]‐fluoro‐D‐glucose positron emission tomography images in a patient with possible early‐stage cerebellar‐predominant multiple system atrophy

Multiple system atrophy (MSA) is a sporadic, rapidly progressive neurodegenerative disorder characterized by autonomic dysfunction combined with parkinsonism or cerebellar ataxia. Patients with MSA typically suffer from cognitive disorders and rapid eye movement sleep behaviour disorder. 18F‐fluorodeoxyglucose‐positron emission tomography is used to assess MSA. However, the relationship between the clinical features and findings on 18F‐fluorodeoxyglucose‐positron emission tomography in patients with MSA has not yet been investigated. Here we report a case of possible early‐stage cerebellar‐type MSA. We concluded that cerebellar‐type MSA or other factors, such as rapid eye movement sleep behaviour disorder or obstructive sleep apnoea cognitive impairment, could appear before changes are visible on 18F‐fluorodeoxyglucose‐positron emission tomography images. Additionally, we concluded that the cognitive impairment could derive from cerebellar‐type MSA itself, not from other factors such as rapid eye movement sleep behaviour disorder or sleep apnoea syndrome.