Several subtypes do not fit into the current classification of MSA [42]: (1) MSA groups with different ages at onset and disease duration; (2) a “minimal change” or “preclinical” MSA as early pathological forms; (3) rare familial forms; (4) pathological variants, like MSA with Lewy body disease and with severe hippocampal atrophy or those with unusual tau pathology; (5) MSA with cognitive impairment/dementia; (6) MSA with dystonia and spinal myoclonus; (7) MSA-C with questionable conjugal MSA. The gene discussed is MAPT; the disease is Cognitive impairment.