RBD affects most people with MSA. Mood changes are common and may include depression, anxiety and mood swings. Changes to thought processes, known as cognitive changes, also occur with MSA.
In MSA, a part of the brain called the cerebellum is damaged. This can make the person clumsy and unsteady when walking, and can also cause slurred speech. These problems are collectively known as cerebellar ataxia.
Attention, execution, verbal and visual memory, verbal fluency, and new learning were impaired in patients with MSA. MSA-P had more impairment in motor and mental speed, working memory, executive functions, and focused attention compared to MSA-C.
Neuropsychiatric symptoms have been reported in MSA however their extent and nature has not been investigated. In this study, we showed that these symptoms affect almost 90% of MSA patients, the most frequent being depression, apathy, anxiety, and agitation.
MSA is one of a family of neurological disorders known as an atypical parkinsonian disorder. The initial symptoms can be difficult to distinguish from those of Parkinson's disease, and can include: Slowness of movement, tremor, or stiffness. Clumsiness or lack of coordination.
Brain imaging scans, such as an MRI , can show signs that may suggest MSA and also help determine if there are other causes that may be contributing to your symptoms. You may receive a referral to a neurologist or other specialist for specific evaluations that can help in making the diagnosis.
Though dementia is not considered a common characteristic of MSA, cognitive impairment occurs in some patients in the form of loss of verbal memory and verbal fluency1.
Sleep disorders in patients with MSA include rapid eye movement sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), and nocturnal sleep disturbances.
Several MRI abnormalities on conventional MRI already are included in the current diagnostic criteria for MSA along with abnormalities of functional neuroimaging, including 18F‐flurodeoxyglucose positron‐emission tomography (FDG‐PET) and presynaptic dopaminergic imaging.
MSA damages the nervous system. The disease tends to progress rapidly. About one half of people with MSA-P have lost most of their motor skills within 5 years of onset of the disease.
Cognitive disturbances in multiple system atrophy occur across a wide spectrum from mild single domain deficits to impairments in multiple domains and even to frank dementia in some cases. Frontal-executive dysfunction is the most common presentation, while memory and visuospatial functions may also be impaired.
Deconditioning – having MSA means a greater effort is needed to be mobile, this can lead to deconditioning of the muscles and the cardiovascular system, which in turn can lead to fatigue.
This explains why some symptoms of MSA such as a tremor or speech difficulty can seem temporarily worse in stressful situations. Feeling anxious and worried is a familiar feeling for many people affected by MSA and it can easily become an unhelpful cycle.
However, in the last few years, cognitive impairment was found to be a frequent feature in MSA based on evidence from qualitative neuropsychological assessment. Dementia in MSA is now reported in 14-16% of cases.
In MSA there may be several stages -- alpha-synuclein accumulates in the oligodendroglial cells, then there is failure of mitochondrial function as well as loss of trophic factor support. Then the oligodendroglia degenerate, followed by microglia and astroglial activation.
Red flags supporting the diagnosis of MSA include the following: Orofacial dystonia. Disproportionate antecollis. Severe anterior flexion of the spine (camptocormia)
The disease was first known as Shy-Drager Syndrome. Currently, it is believed that MSA is “sporadic,” meaning that there are no established genetic or environmental factors that cause the disease. A few reports have described families with MSA, but this finding is probably very rare.
We found that 30 MSA patients (46.15%) suffered from pain. There was a trend towards a higher prevalence in MSA-P compared to MSA-C patients although the difference was not significant, which might be due to the small sample size. Few studies have investigated the pain mechanism in MSA patients.
Hallucinations have been reported to occur in 5–9% of patients with MSA but rarely in CBD.
Appetite reduces and weight loss is apparent. Communication becomes too effortful and breathing more bubbly or shallow. Dying is very rarely a dramatic event. In the majority of cases it is an increasing winding down of all bodily functions and everything stopping, death occurring in a peaceful and dignified manner.
Listen, listen, listen: Living with MSA can be very isolating. The family may be eager to talk about what they are going through so listening and showing empathy can be one of the most helpful things you can do. Or they may just want a light, fun evening with laughter. Pay attention to their cues and follow their lead.
Alongside the bladder difficulties, people with MSA also experience bowel difficulties.
A person with MSA experiences increasing difficulties with word finding and speech initiation, due to progressive neurological deterioration (Lieberman et al, 1992; Walsh & Smith, 2011). The rate of speech may also be slower compared to someone with Parkinson's disease (Huh et al, 2015).
Typical ocular features of MSA include blepharospasm, excessive square-wave jerks, mild to moderate hypometria of saccades, impaired vestibular-ocular reflex (VOR), nystagmus and impaired event-related evoked potentials.
Upper airway dysfunction associated with autonomic failure and dysfunction of the medullary serotonergic system, which regulates the cardiovascular and respiratory systems, could also be responsible for sudden death in patients with MSA [24, 25] since sudden death also occurred during the daytime.