BackgroundFunctional Motor Disorders (FMDs) represent a diagnostic and therapeutic challenge in pediatric neurology, particularly among adolescents. Their clinical presentation is common but often nonspecific, leading to frequent misdiagnoses and diagnostic delays. We aimed to characterize FMDs in adolescents and to examine the frequency of isolated and combined phenotypes and their associations with demographic and clinical variables.MethodsIn this observational study, data were obtained from the Italian Registry of FMDs, including patients with a clinically definite diagnosis of FMD consecutively enrolled at 25 Italian tertiary movement disorders centers.ResultsAmong 847 patients, 93 (10.9%) had adolescent-onset FMDs. Motor phenotypes did not differ significantly between adolescent- and adult-onset FMDs, with the exception of parkinsonism, which was observed only in the latter. Compared with adult-onset FMDs, adolescent-onset FMDs were associated with a longer disease duration, a higher number of medical consultations before diagnosis, and a higher frequency of functional seizures and infections, but with lower rates of insomnia, fatigue, and antipsychotic use. In multivariable analysis, adolescent-onset FMDs remained independently associated with a greater number of medical consultations (adjusted OR 1.07; 95% CI 1.02-1.13), the presence of functional seizures (adjusted OR 2.06; 95% CI 1.09-3.8), and with lower occurrence of insomnia (adjusted OR 0.49; 95% CI 0.27-0.92) and fatigue (adjusted OR 0.51; 95% CI 0.30-0.86). Pain was more likely to be associated with the combined FMDs phenotype.ConclusionsAdolescent-onset FMDs are common and are associated with several non-motor symptoms in tertiary movement disorders centers. Early and accurate diagnosis may help to reduce unnecessary investigations and inappropriate treatments.

Lewy body disease (LBD) and Alzheimer’s disease (AD) are the most common causes of cognitive decline and dementia and are associated with characteristic alterations in resting-state electroencephalographic (rsEEG) activity. This multicenter exploratory study investigated periodic and aperiodic rsEEG features in patients with cognitive decline due to Lewy body disease (LBCD) and Alzheimer’s disease (ADCD), compared with cognitively unimpaired older adults (Nold), and examined the clinical relevance of these markers in LBCD. A total of 140 LBCD, 135 ADCD, and 118 Nold datasets from the PDWAVES archive underwent spectral parameterization to decompose rsEEG power spectra (1–30 Hz) into periodic peaks and aperiodic background activity. Both clinical groups showed a significant slowing of the individual alpha frequency (IAF), more pronounced in LBCD, along with reduced periodic alpha and beta power reflected in a lower vigilance index. The aperiodic exponent was elevated in both groups, and the aperiodic offset was also higher in LBCD, suggesting steeper spectral profiles consistent with increased inhibitory cortical tone. Within the LBCD group, poorer cognition was associated with higher low-frequency alpha power, whereas better cognition was predicted by higher high-frequency alpha power. A reduced vigilance index was associated with the presence of visual hallucinations, while no associations emerged for other symptoms. These findings suggest that combined periodic and aperiodic rsEEG features may provide relevant markers of altered vigilance regulation in LBCD. Future studies should evaluate whether these EEG markers can inform targeted interventions, such as neuromodulatory or audiovisual stimulation, to stabilize quiet-vigilance states and improve clinical outcomes. Panel A shows the spectral parameterization of rsEEG activity into periodic and aperiodic components. Panel B summarizes the main group differences in key rsEEG markers across LBCD, ADCD, and Nold participants. Panel C shows the topographical associations between the vigilance index and cognition and visual hallucinations in LBCD; colors reflect the direction and strength of the associations. For the visual hallucinations map, negative log-odds indicate lower odds of hallucinations for higher vigilance index values, whereas positive log-odds indicate higher odds; values around ± 1.5 correspond approximately to odds ratios of 0.22 and 4.5, respectively. Abbreviations: rsEEG, resting-state electroencephalography; LBCD, cognitive decline due to Lewy body disease; ADCD, cognitive decline due to Alzheimer’s disease; Nold, cognitively unimpaired older adults; IAF, individual alpha frequency; MMSE, Mini-Mental State Examination; p, standardized regression coefficient; log-odds, logistic regression coefficient.

Non-motor symptoms (NMSs) are highly prevalent in Parkinson’s disease (PD) and affect patients’ quality of life. Data on gender differences in NMSs are largely cross-sectional and derived from chronically treated populations. Longitudinal evidence in early, levodopa-naïve PD patients remains limited. This study aims to longitudinally investigate gender differences in a wide range of NMSs in early-stage levodopa-naïve PD patients during the first 2 years following levodopa initiation. This multicenter, prospective study enrolled 216 levodopa-naïve PD patients (139 men, 77 women) from 17 Italian movement disorder centers. Patients were evaluated at baseline and after 24 months (24 M) using validated scales. Baseline gender differences were explored using group comparisons. Gender effects at 24 M were examined using ANCOVA models adjusted for baseline values and levodopa dose at follow-up. At baseline, women showed greater cardiovascular and thermoregulatory autonomic dysfunction, higher anxiety, pain, fatigue, and worse quality of life, whereas men exhibited greater sexual dysfunction, daytime sleepiness, and better attentional performance. At the 24 M, gender differences persisted only for anxiety, pain, mobility, and emotional well-being, while additional significant differences emerged, including hypersexuality, visuo- spatial domain, and orthostatic-hypotension. Women exhibited greater symptom severity than men across all aforementioned variables, with the exception of hypersexuality. Gender significantly influences the expression and early evolution of NMSs in PD, independently of levodopa exposure. Gender-specific NMSs profiles are already evident in the first two years of treatment. These findings highlight the importance of integrating gender considerations into early assessment and personalized management of NMSs in PD.

INTRODUCTION:We evaluated whether the brain glymphatic drainage function estimated by the diffusion tensor imaging along the perivascular space (DTI-ALPS) index relates to white matter (WM) integrity, Alzheimer's disease (AD) neuropathology, resting-state electroencephalogram (rsEEG) alpha rhythms underpinning quiet vigilance, and cognitive decline in mild cognitive impairment (MCI). METHODS:Clinical, neuroimaging, and rsEEG data were analyzed in matched mild cognitive impairment due to AD (ADMCI) and MCI not due to AD (noADMCI) participants. DTI-ALPS index and aperiodic and periodic components of the rsEEG power spectra were calculated following standard pipelines. RESULTS:Lower DTI-ALPS index was associated with higher AD neuropathology and WM lesions, lower periodic rsEEG alpha rhythms, and worse cognition in patients with ADMCI and noADMCI as a whole population, with the ADMCI (over noADMCI) group showing lower DTI-ALPS index, greater AD neuropathology, and lower periodic rsEEG alpha rhythms. CONCLUSIONS:The DTI-ALPS index may capture glymphatic system impairment linked to AD neuropathology, vigilance dysfunction, and cognitive decline in MCI.

Functional motor disorders (FMD) are a common yet often misunderstood group of neurological conditions characterized by abnormal movements, including limb weakness, tremor, dystonia, and gait disturbances. These disorders involve disrupted sensory processing mechanism. Previous studies have shown abnormal prepulse inhibition of the blink reflex (BR) in FMD, but the baseline R2-area, reflecting brainstem excitability and cortical modulation, has not been characterized. This study investigated baseline BR R2-area in patients with FMD compared with healthy controls (HC), its associations with affective and interoceptive factors, and its diagnostic potential when combined with laser-evoked potentials (LEPs). BR responses were recorded in clinically definite patients with FMD (n = 75) and matched HC (n = 75). The R2-component was elicited by supraorbital stimulation and quantified as the area under the curve across ipsilateral, contralateral, and average responses. Associations with with behavioural and interoceptive measures were investigated. LEPs were incorporated into multivariate logistic regression models to assess diagnostic potential. Compared with HC, FMD-patients exhibited a consistent reduction in baseline R2 area. Worst depressive symptoms were associated with larger R2 areas, whereas reduced body awareness was associated with smaller responses, indicating affective and interoceptive influences on brainstem excitability. Baseline R2-metrics, particularly the ipsilateral area, contributed substantially to group discrimination, achieving 71.1

OBJECTIVES:This exploratory study tested the hypothesis that Huntington's disease (HD) is characterized by distinct abnormalities in resting-state electroencephalographic (rsEEG) rhythms compared to Alzheimer's disease (AD). METHODS:Clinical and rsEEG data were collected from 35 patients with HD, 81 patients with AD, and 102 healthy controls (HC). The rsEEG cortical source activations from 30 electrodes were estimated using eLORETA and were harmonized across clinical sites. RESULTS:Compared to the HC group, both the HD and AD groups showed widespread increases in rsEEG delta source activation and decreases in alpha source activation, with the HD patients exhibiting the most pronounced frontal effects. In patients with HD, those abnormal rsEEG source activations were associated with cognitive, motor, and functional deficits. CONCLUSIONS:Patients with HD were characterized by a particular slowing of frontal rsEEG rhythms associated with clinically relevant variables. SIGNIFICANCE:A topographically widespread slowing of cortical oscillatory activity was observed in both HD and AD groups, with a particularly pronounced frontal effect in HD, which may predict a greater impact on the sleep-wake cycle. These observations should be considered exploratory and need validation in future studies with enhanced vigilance monitoring during longer rsEEG recordings.

Functional motor disorders (FMD) are common and disabling conditions, but objective biomarker changes following multidisciplinary management remain limited. Our objective was to investigate changes and responsiveness of multimodal biomarkers in individuals with FMD undergoing multidisciplinary management. 34 patients with clinically definite FMD (mean age 42.76 ± 11.01 years; 85.7

Functional motor disorders (FMDs) represent a frequent and disabling neurological condition. The lack of reliable diagnostic biomarkers and their heterogeneity might affect diagnosis. We identified multimodal biomarkers distinguishing FMDs from healthy controls (HCs) using machine-learning approaches. In this multicenter cross-sectional study, consecutive adults with a clinically established FMDs diagnosis (n = 75, 74.7

Alzheimer's disease (AD) dementia is associated with marked disruptions in resting-state eyes-closed electroencephalographic (rsEEG) rhythms, particularly in the periodic alpha band (8-12 Hz), suggesting impaired vigilance regulation. In contrast, the aperiodic rsEEG component, reflecting global cortical arousal, has been reported to remain unchanged. This exploratory study examined periodic and aperiodic EEG activity in patients with mild cognitive impairment due to AD (ADMCI) during transitions from quiet wakefulness to light sleep. EEG datasets (∼30 min) from 19 ADMCI patients and 18 matched cognitively unimpaired older adults (control) were analyzed. Vigilance stages were scored using a reduced version of Hori's system, distinguishing the alpha-dominant wakefulness stage and the theta-dominant light sleep (ripples) stage. EEG spectra were parameterized using the specparam algorithm. ADMCI participants showed reduced reactivity of individual alpha power between the wakefulness and ripples stages compared to the control group. Conversely, both groups exhibited comparable increases in fronto-central theta power and steepening of the aperiodic slope and offset. No group differences emerged in aperiodic exponent and offset, although statistical power was limited by modest sample size. Overall, EEG alpha rhythms reflecting vigilance regulation are disrupted in prodromal AD, while periodic and aperiodic signatures of sleep onset are relatively preserved, suggesting selective vulnerability of attentional thalamocortical systems.

Subtle gait and cognitive dysfunction are common in Parkinson’s disease (PD), even before most evident clinical manifestations. Such alterations can be assumed as hypothetical phenotypical and prognostic/progression markers. To compare spatiotemporal gait parameters in PD patients with three cognitive status: cognitively intact (PD-noCI), with subjective cognitive impairment (PD-SCI) and with mild cognitive impairment (PD-MCI) in order to detect subclinical gait differences. One hundred PD patients were consecutively enrolled and divided in three groups based on both the first item od MDS-UPDRS part I and an extensive neuropsychological evaluation: 41 PD-noCI, 15 PD-SCI and 44 PD-MCI. They were evaluated with gait analysis acquired in three different conditions (normal gait, motor and cognitive dual task). Spatiotemporal variables were extracted. A univariate statistical analysis (parametric ANOVA test or non-parametric Kruskal–Wallis test, as appropriate) with post-hoc analysis was carried out in order to evaluate the significant differences among the groups. In normal gait task, the three groups showed several differences, all due to the comparison between PD-MCI and PD-noCI, as disclosed by post-hoc analysis. In dual task conditions, mostly in the cognitive dual task, the three groups showed increased gait alterations that, at post-hoc analysis, mirrored the magnitude of cognitive dysfunction (PD-noCI < PD-SCI < PD-MCI). Peculiar prodromal gait patterns—especially those highlighted by cognitive dual task—could be considered possible markers to objectify self-reported symptoms-based construct, like SCI, and to early intercept subjects with different clinical evolutions and prognoses, even representing an innovative clustering/phenotyping tool for PD subtypes.

The Scales for Outcomes in Parkinson's disease-Psychiatric Complications (SCOPA-PC) is a validated tool to score psychotic and compulsive symptoms in Parkinson's disease (PD). We translated into Italian the SCOPA-PC and evaluated its psychometric properties and clinical correlates in different subgroups of PD patients. The scale underwent translation, back-translation, and cognitive pretesting before being administered to a calculated sample of 135 PD patients. All patients underwent a clinical interview, motor evaluation, cognitive screening test, behavioral and functional scales. We explored SCOPA-PC feasibility, acceptability, internal consistency, convergent validity, known-groups validity, and test-retest reliability. The mean SCOPA-PC score was 1.99 ± 2.09. The internal consistency was acceptable (α = 0.631); corrected item-total correlation was > 0.45 for most items. The significant and moderate correlation of the SCOPA-PC with other tools evaluating psychiatric symptoms indicated adequate convergent validity of the scale. The factor analysis disclosed two factors, with total variance equal to 50.19%. The reliability of SCOPA-PC was high especially in cognitively preserved patients not on medications for dementia, depression, psychosis and anxiety. The SCOPA-PC is a rapid and reliable screening tool for assessing psychotic and compulsive symptoms in PD. Our data support a role for the SCOPA-PC as a screening scale in early, non-demented PD.

Background/Aims Eosinophilic esophagitis (EoE) is a chronic type 2-mediated disease that impairs Quality of Life (QoL). Our aim was the transcultural adaptation and validation of the Adult Eosinophilic Esophagitis Quality of Life Questionnaire (EoE-QoL-A) for the Italian population. Methods Seventy participants (53 males, >18 years), completed the Italian version translated from the original EoE-QoL-A and validated scales to measure depression, anxiety and QoL. The reliability of total and sub-dimensions’ scores, internal consistency, construct validity and test-retest reliability were assessed. The socio-demographic subgroups differences, mood and EoE-QoL-A correlations and the impact of sub-dimensions of EoE-QoL-A on mental and physical QoL were analyzed. Results The Italian EoE-QoL-A demonstrated excellent internal consistency (α=0.966), with all sub-dimensions had α-values>0.826 and test-retest reliability (ICC=0.982). Specifically, the Cronbach’s α was 0.936 for Eating/diet impact, 0.826 for Social impact, 0.938 for Emotional impact, 0.852 for Disease anxiety, and 0.879 for Choking anxiety. Female patients reported significantly higher EoE-QoL-A than males (p < 0.05). Younger patients showed a higher score in the Social Impact dimension than older patients (p = 0.006). High scores on EoE-QoL-A were linked with high mood symptoms. The Emotional Impact domain was a significant predictor of mental health status (R2=0.418). Conclusions The Italian EoE-QoL-A is a valid, reliable and responsive tool for assessing QoL in adults with EoE. Emotional impact was the most affected dimension in the health-related QoL, highlighting the necessity for clinical strategies.

Here, we investigated whether educational attainment influences the neurophysiological mechanisms underlying vigilance regulation, as reflected in resting-state eyes-closed electroencephalographic (rsEEG) rhythms, in patients with dementia due to Parkinson's (PDD) and Lewy body disease (DLB). Clinical, demographic, and rsEEG data were obtained from an international database, including PDD patients (N = 75), DLB patients (N = 50), and cognitively unimpaired older controls (Healthy; N = 54). Each group was partitioned into low (Edu-) and high (Edu+) educational attainment subgroups, matched for age, sex, and cognitive-motor status. We analyzed rsEEG rhythms across the individual delta, theta, and alpha frequency bands. Cortical rsEEG source topography was estimated using eLORETA freeware. In the Healthy group, Edu+ participants exhibited significantly greater widespread rsEEG alpha source activities compared to Edu- participants, possibly reflecting neuroprotective neurophysiological mechanisms. Conversely, in the PDD group, Edu+ patients showed lower widespread rsEEG alpha source activities than Edu- patients, possibly indicating compensatory mechanisms. No significant differences in rsEEG source activities were observed between DLB-Edu+ and DLB-Edu- patients. Educational attainment may be associated with compensatory mechanisms that counteract the abnormal neurophysiological processes underlying rsEEG alpha rhythms and vigilance regulation in PDD patients, but not in DLB patients. Future studies combining rsEEG and neuroimaging techniques should investigate the metabolic and functional connectivity correlates of these putative compensatory mechanisms in the PDD brain. Early education may be a key investment for national governments, especially in low-income countries, to prevent the cognitive deficits of Parkinson's disease along aging, thereby reducing the unbearable social and economic burden.

OBJECTIVE:Although psychological issues are not diagnostic criteria for functional neurological disorder (FND), they often occur among individuals with FND, especially among those with functional seizures. However, corresponding findings for individuals with functional motor disorder (FMD) are inconclusive. METHODS:Thirty individuals with FMD and 30 age-, education-, and sex-matched healthy control (HC) individuals completed the Minnesota Multiphasic Personality Inventory-2. The authors used the test's 10 basic clinical scales and its 15 content scales along with their subscales to explore the participants' personality profiles. After logarithmic data transformation, parametric tests were performed to compare the two groups. RESULTS:Individuals with FMD had significantly higher scores than those in the HC group on the following basic clinical scales: hypochondriasis, depression, hysteria, psychopathic deviance, paranoia, psychasthenia, and schizophrenia (p<0.005). Compared with participants in the HC group, a higher proportion of those with FMD surpassed the cutoff score for the hypochondriasis, depression, hysteria, paranoia, and schizophrenia scales. Individuals with FMD showed a specific personality pattern, the "passive-aggressive valley," characterized by high scores on the psychopathic deviance and paranoia scales and low scores on the masculinity-femininity scale. Individuals with FMD had higher scores than those in the HC group on anxiety, obsessiveness, depression, health concerns, low self-esteem, and work interference scales (p<0.003). CONCLUSIONS:Individuals with FMD had significantly higher impairments in emotional-cognitive functioning compared with HC individuals, characterized by excessive attention to somatic sensations, poor emotional insight, and cognitive inflexibility, associated with personality features of susceptibility, misperception of threats, unexpressed anger, and behaviors indicating unmet emotional needs.

BACKGROUND:Mild cognitive impairment (MCI) and freezing of gait (FOG) are two common symptoms in Parkinson's disease (PD). OBJECTIVES:The objectives were to test the strength of association of fist-palm test (FiPaT), a nonverbal motor test, with both MCI and FOG in PD and investigate the predictive ability of FiPaT in the identification of PD patients with MCI or FOG. METHODS:We enrolled 74 PD patients: 47 of 74 patients had MCI (PD + MCI), 27 of 74 were cognitively unimpaired (PD-NC), 29 of 74 presented FOG (PD + FOG), and 45 of 74 were without FOG (PD-FOG). We performed univariate statistical analysis, including binary logistic regressions, to determine the variables that distinguish PD + MCI from PD-NC and PD + FOG from PD-FOG. We implemented machine learning algorithms with feature selection, using clinical-demographic features and FiPaT scores as input variables, and the presence of MCI or FOG as features to predict. RESULTS:FiPaT total error and topography errors (P = 0.049 and P = 0.026) significantly discriminated PD + MCI and PD-NC, whereas disease duration (P = 0.039), FiPaT total error (P = 0.026), and attention errors (P = 0.046) significantly discriminated PD + FOG and PD-FOG. Applying machine learning analysis, the models reached an accuracy of 87.4% for MCI and 78.2% for FOG. CONCLUSIONS:A worse performance on FiPaT and its subscores is closely related to MCI and FOG in PD. The early identification of MCI and FOG is of particular interest as both are important risk factors for PD dementia. Moreover, the association between FiPaT and FOG strengthens the close relationship between motor system, namely gait, and higher-order cognitive functions.

BACKGROUND:There is increasing recognition Functional Neurological disorder (FND) is comorbid with other neurological conditions, but little is known about patients with Multiple Sclerosis (MS). We therefore systematically evaluated the presence of FND in consecutive patients with MS and its clinical correlates. METHODS:Three-hundred and ten consecutive MS patients, seen at our center on either elective or emergent basis, underwent a structured protocol to gather demographics and data about clinical features, previous and current treatments and presence of mood disorders and were additionally assessed by an expert in FND. Patients with and without FND were then compared to identify clinical correlates with the functional comorbidity. RESULTS:Overall, we found that 5.8 % of patients with MS had comorbid FND. Of note, 22.6 % (7/31) of MS patients admitted on an emergent basis for a suspected relapse were found to have incident FND. Patients with comorbid FND had higher rates of clinically significant mood disturbances and a higher number of previous therapeutic switches due to treatment failure or to side effects than patients without FND. Depression, relapsing remitting MS and disability were found to independently predict the presence of FND. CONCLUSIONS:FND is relatively frequent in patients with MS. As the two conditions might have similar phenomenological presentations, it is important to properly screen and recognize FND because of crucial treatment implications.

White matter hyperintensities (WMH), traditionally linked to cerebral small vessel disease, are frequent in Progressive Supranuclear Palsy (PSP). This study assessed their prognostic value in disease progression. Sixty PSP patients underwent 3 Tesla Magnetic Resonance Imaging (MRI) at baseline and then were followed for of 48.62 ± 25.11 (mean ± standard deviation) months with extensive neurological evaluations. WMH were rated with the age-related white matter changes (ARWMC) scale (total and lobar), classifying patients into two groups: ARWMC = 0 (without WMH) and ARWMC >0 (with WMH). Outcomes included time to disease milestones (unintelligible speech, wheelchair dependency, PEG placement, death). Kaplan–Meier, Cox regression, and linear mixed models were applied, adjusting for age, sex, and vascular risk factors. Baseline WMH were present in 65

Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB) are more prevalent in males than females. Furthermore, they typically showed abnormally high delta (< 4 Hz) and low alpha (8-10 Hz) rhythms from resting-state electroencephalographic (rsEEG) activity. Here, we hypothesized that those abnormalities may depend on the patient's sex. An international database provided clinical-demographic-rsEEG datasets for cognitively unimpaired older (Healthy; N = 49; 24 females), PDD (N = 39; 13 females), and DLB (N = 38; 15 females) participants. Each group was stratified into matched female and male subgroups. The rsEEG rhythms were investigated across the individual rsEEG delta, theta, and alpha frequency bands based on the individual alpha frequency peak. The eLORETA freeware was used to estimate cortical rsEEG sources. In the Healthy group, widespread rsEEG alpha source activities were greater in the females than in the males. In the PDD group, widespread rsEEG delta source activities were lower and widespread rsEEG alpha source activities were greater in the females than in the males. In the DLB group, central-parietal rsEEG delta source activities were lower, and posterior rsEEG alpha source activities were greater in the females than in the males. These results suggest sex-dependent hormonal modulation of neuroprotective-compensatory neurophysiological mechanisms in PDD and DLB patients underlying the generation of rsEEG delta and alpha rhythms, which should be considered in the treatment of vigilance dysregulation in those patients.

BACKGROUND:Mild cognitive impairment (MCI) and dementia are reported in up to 44 % and 7 % of patients with Multiple system atrophy (MSA), respectively. The sensitivity and discriminative power of brief cognitive screening tools such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) for detecting MCI and dementia in MSA has not yet been evaluated. OBJECTIVE:The aim of this study was to determine the optimal cut-off scores of the MMSE and MoCA for accurately differentiating MSA patients with MCI and dementia from those with normal cognition. The fluency item of MoCA was also assessed separately for the same purpose. METHODS:Sixty-two MSA patients underwent a comprehensive II level neuropsychological evaluation, in order to diagnose dementia or MCI. ROC analyses were used to establish the optimal cut-off scores for MCI and dementia, respectively. RESULTS:According to the II level neuropsychological evaluation, 4.8 % of MSA patients met criteria for dementia and 53,2 % for MCI. The optimal MMSE cut-off scores were 20.5 for dementia (AUC = 0.915) and 26.5 for MCI (AUC = 0.698). For MoCA, the most accurate cut-offs were 14.0 to detect dementia (AUC = 0.919) and 19.5 to detect MCI (AUC = 0.702).ROC analysis suggested that both tests were more accurate to identify MCI than dementia. The optimal cut-off for MoCA fluency item to identify MCI was 8.5 words (AUC = 0.717). CONCLUSION:Our findings support MMSE and MoCA as effective and accessible tools to detect MCI and dementia in MSA. MoCA fluency item emerged as a reliable tool to detect MCI.