Many people affected by MSA experience dysfunction of the autonomic nervous system, which commonly manifests as orthostatic hypotension, impotence, loss of sweating, dry mouth and urinary retention and incontinence. Palsy of the vocal cords is an important and sometimes initial clinical manifestation of the disorder.
A person with MSA has much slower movements than normal (bradykinesia). This can make it difficult to carry out everyday tasks. Movement is hard to initiate, and the person will often have a distinctive slow, shuffling walk with very small steps. Some people may also have stiff and tense muscles.
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.
In a person with MSA, the propulsion of the bolus is likely to be delayed and extremely effortful; resulting in a significantly prolonged oral stage of the swallow (Fernagut et al, 2011). This puts them at higher risk of aspiration as the reduced co- ordination may lead to a premature spillage of bolus.
Sleep and breathing problems are very common in MSA patients. Sleep apnea (momentary lapses in breathing), respiratory stridor (noisy breathing), REM behavior disorder (shouting and acting out dreams) and excessive daytime sleepiness can be among the earliest symptoms of MSA.
What bowel problems can occur when you have MSA? Constipation is the most common bowel problem experienced by people with MSA. However, a number of people with MSA will experience diarrhoea and some people have fluctuation between constipation and diarrhoea (see points 5, 7 and 9 below).
People typically live about 7 to 10 years after multiple system atrophy symptoms first appear. However, the survival rate with MSA varies widely. Death is often due to respiratory problems, infections or blood clots in the lungs (pulmonary embolus).
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.
Malnutrition is associated with higher mortality in the elderly population19 and MSA patients are frequently associated with weight loss20 and a malnutritional state8.
All people with MSA have autonomic dysfunction, but it varies in severity from person to person. Symptoms can include: Cold hands or feet and heat intolerance, because control of body temperature is impaired.
When you feel safer, because the 'danger' has passed or because you no longer fear it, your body returns to a more relaxed state. This explains why some symptoms of MSA such as a tremor or speech difficulty can seem temporarily worse in stressful situations.
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.
PD and MSA patients are prone to pain with insufficient treatment.
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.
MSA affects men and women equally, with an average age of onset of approximately 55 years [2, 3].
MRI is useful and indispensable in the diagnosis of MSA and also possibly for monitoring disease progression.
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.
An additional manifestation of MSA is sudden death, in which patients die of no apparent reason 24 h after the onset of symptoms . Sudden death in MSA usually occurs during sleep  and may occur at an early disease stage .
Multiple system atrophy (MSA) is a rare neurological disease that causes certain brain areas to deteriorate. Over time, this disrupts abilities and functions handled by those brain areas. This disease is ultimately fatal.
There are three levels of certainty: Possible, probable and definate.
Based on comprehensive neuropsychological assessment, cognitive impairment was found to be a frequent feature in MSA, and clinically-defined dementia is now reported in 14-16% of cases.
MSA entails variable degrees of olfactory dysfunction, and at least some patients have a normal ability to distinguish among odors . Whether olfactory dysfunction in the three synucleinopathies is related to cardiac noradrenergic or nigrostriatal dopaminergic denervation has not been assessed in the same study.