Among 48 autopsy-proven cases of MSA (mean age at death 60.5 ± 7.8, range 46–82 years), mild to moderate cognitive impairment in 35.3% was associated with a moderate cortical tau pathology (Braak NFT stages II-IV) and cortical Lewy pathologies, while one had a probable primary age-related tauopathy (PART). Here, MAPT is linked to Cognitive impairment.