The prevalence of APOE ɛ4 carriers in our total MSA cohort was 42.1% (8/19), which appears higher than previous reports of 22%.5,75 The APOE ɛ4 allele is strongly associated with the typical constellation ADNC (i.e. plaques and tangles),5,44 and CAA is also an independent contributor to cognitive impairment.76 Although it is plausible that the APOE ɛ4 allele may influence the distribution and severity of Aβ plaques and CAA pathology in Aβ-predominant ADNC-MSA, however, we demonstrated that APOE ɛ4 alone might not account for the discrepancy between Aβ Thal phases and Braak NFT stages. Here, APOE is linked to Cognitive impairment.