Lower Vitamin B12 Level at Multiple System Atrophy Diagnosis Is Associated With Shorter Survival

Stuart J. McCarter, Elizabeth A. Coon, Rodolfo Savica, Erik K. St Louis, James H. Bower, Eduardo E. Benarroch, Paola Sandroni, Phillip Low, Wolfgang Singer

Research output: Contribution to journalArticlepeer-review


Background: Multiple system atrophy (MSA) is a neurodegenerative disorder from α-synuclein aggregation. in vitro studies suggest vitamin B12 may interrupt α-synuclein-mediated neurodegeneration. The objective of this study was to determine whether serum vitamin B12 level at MSA diagnosis is associated with survival. Methods: One hundred eighty-two MSA patients evaluated at Mayo Clinic with vitamin B12 testing were studied. We determined the risk of death in relationship to serum vitamin B12 levels at MSA diagnosis, adjusting for predictors of poor survival. Results: Predictors of shorter survival included vitamin B12 < 367 ng/L (HR, 1.8; 95% CI, 1.3–2.7), falls within 3 years of MSA diagnosis (HR, 1.6; 95% CI, 1.1–2.3), bladder symptoms (HR, 1.6; 95% CI, 1.0–2.6), urinary catheter requirement (HR, 1.7; 95% CI, 1.0–2.8), male sex (HR, 1.4; 95% CI, 1.0–2.0), and MSA-P subtype (HR, 1.5; 95% CI, 1.0–2.0). Conclusions: Low vitamin B12 levels are associated with shorter survival in MSA. Additional studies to explore this observation and assess the potential role of vitamin B12 as a modifiable survival factor are needed.

Original languageEnglish (US)
Pages (from-to)1462-1466
Number of pages5
JournalMovement Disorders
Issue number8
StatePublished - Aug 1 2020


  • autonomic
  • cyanocobalamin
  • multiple system atrophy
  • survival
  • vitamin B12

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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