Yes, cognitive decline is common in Multiple System Atrophy (MSA), often appearing as executive dysfunction (planning, multitasking) or processing speed issues, though severe dementia is less typical than in other conditions like Lewy Body Dementia. While historically excluded, recent evidence shows cognitive impairment (CI) affects many MSA patients, ranging from mild deficits to moderate impairment, sometimes even preceding motor symptoms, and affects both MSA-P (parkinsonian) and MSA-C (cerebellar) types.
Mild cognitive impairment has been reported in up to 40 % of MSA patients6, 14 and can also occur in early stage of disease. Nonetheless, severe cognitive decline that significantly disrupts daily living is uncommon in MSA.
Signs of MCI include losing things often, forgetting to go to important events or appointments, and having more trouble coming up with words than other people of the same age. It's common for family and friends to notice these changes.
In people with MSA, nerves in the area of the brain that controls things like balance and movement become damaged and lost over time. It's not known why this happens. There's no evidence that it can be passed on to children by their parents (inherited).
Appetite reduces and weight loss is apparent. Communication becomes too effortful and breathing more bubbly or shallow. Dying is a natural process where our bodily functions all slow down and ultimately stop. This will be a very emotional time for everyone close to the dying person.
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 trouble breathing, infections or blood clots in the lungs.
About 60% of people with MSA need to use a wheelchair about five years after the onset of MSA. Within six to eight years, at least half of those with this condition are bedridden.
Multiple system atrophy- parkinsonian type (MSA-P) is a rare condition that causes symptoms similar to Parkinson disease. However, people with MSA-P have more widespread damage to the part of the nervous system that regulates important functions such as heart rate, blood pressure, and sweating.
Symptoms tend to appear in a person's 50s and advance rapidly over the course of five to 10 years. A person with MSA will have increased difficulty with movement and eventually become bedridden. People with MSA often develop swallowing problems that can lead to pneumonia in the later stages of the disease.
MRI is useful and indispensable in the diagnosis of MSA and also possibly for monitoring disease progression. In this regard, well‐designed, long‐term, prospective studies on large numbers of patients are needed.
Memory loss that disrupts daily life
Others include forgetting important dates or events, asking the same questions over and over, and increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
The "2-finger test" for dementia involves an examiner showing a hand gesture (like interlocking index and middle fingers) and asking the patient to copy it, testing motor skills, visual memory, and coordination, as difficulties can signal early cognitive decline, but it's a screening tool, not a definitive diagnosis, prompting further medical evaluation. Other related tests include finger-tapping and finger-to-nose, looking for hesitation or misjudgment in movement.
Anxiety, agitation, apathy, impulse control disorders, and REM sleep behavioral disorder (RBD) are the most common behavioral changes in MSA [13,14,15]. Obsessive compulsive disorders (OCD) may also occur, but these are less common [16].
Cognitive changes
Memory loss, which is usually noticed by someone else. Problems communicating or finding words. Trouble with visual and spatial abilities, such as getting lost while driving. Problems with reasoning or problem-solving.
MSA tends to progress rapidly, though there are exceptions. After the onset of motor symptoms and diagnosis, the condition typically worsens over five to ten years.
Increasing evidence suggests that cognitive impairment is common in both MSA subtypes. However, cognitive deficits in MSA remain poorly characterized and are still considered non-supporting diagnostic features by current consensus diagnostic criteria.
Multiple system atrophy (MSA) is a rare and aggressive neurodegenerative disease that typically leads to death 6 to 10 years after symptom onset.
Those people with MSA-C present with balance, co-ordination and speech problems. Both men and women often experience problems with their bladders including urgency, frequency, nocturia, incomplete bladder emptying, or retention. Erectile dysfunction is an early symptom in male patients and is almost always present.
Medicines that treat Parkinson's disease, such as combined levodopa and carbidopa (Sinemet, Duopa, others), can help some people with MSA. The medicine can treat stiffness, trouble with balance and slow movements.
Comparing to other synucleinopathies such as Parkinson's disease (PD) or Dementia with Lewy body (DLB), MSA has not been characterized by dementia. However, recent studies reported that various types of cognitive impairments could be presented in MSA.
The approximate rate of effectiveness of levodopa in multiple system atrophy (MSA) has been reported as 30-65% in both clinical and pathological cases (1-3). The pathological background in which levodopa is effective has mainly been studied with a focus on putaminal lesions (4,5).
Symptoms of MSA-C result from lack of control of motor movement:
Most commonly people with MSA experience increasing sluggishness of the bowel and risk a build-up of chronic constipation. You should aim to keep your bowel movements at least as regular as they were before you had MSA.
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.