Multiple system atrophy: Prognostic indicators of survival

Juan J. Figueroa, Wolfgang Singer, Ajay Parsaik, Eduardo E. Benarroch, J. Eric Ahlskog, Robert D. Fealey, Joseph E. Parisi, Paola Sandroni, Jay Mandrekar, Valeria Iodice, Phillip A. Low, James H. Bower

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Neurological and autonomic presentation in multiple system atrophy (MSA) may predict early mortality. Quantification of early autonomic failure as a mortality predictor is lacking. Early neurological and autonomic clinical features were retrospectively reviewed in 49 MSA cases (median age at onset, 56.1 years; 16 women) confirmed by autopsy at Mayo Clinic. When available, the 10-point composite autonomic severity score derived from the autonomic reflex screen provided quantification of the degree of autonomic failure and thermoregulatory sweat test quantitated body surface anhidrosis. Symptoms at onset were autonomic in 50%, parkinsonian in 30%, and cerebellar in 20% of cases. Survival (median [95% confidence interval]) was 8.6 [6.7-10.2] years. Survival was shorter in patients with early laboratory evidence of generalized (composite autonomic severity score≥6) autonomic failure (7.0 [3.9-9.8] vs. 9.8 [4.6-13.8] years; P=0.036), and early requirement of bladder catheterization (7.3 [3.1-10.2] vs. 13.7 [8.5-14.9] years; P=0.003) compared with those without these clinical features. On Cox proportional analysis, prognostic indicators of shorter survival were older age at onset (hazard ratio [95% confidence interval], 1.04 [1.01-1.08]; P=0.03), early requirement of bladder catheterization (7.9 [1.88-38.63]; P=0.004), and early generalized (composite autonomic severity score≥6) autonomic failure (2.8 [1.01-9.26]; P=0.047). Gender, phenotype, and early development of gait instability, aid-requiring ambulation, orthostatic symptoms, neurogenic bladder, or significant anhidrosis (thermoregulatory sweat test≥40%) were not indicators of shorter survival. Our data suggest that early development of severe generalized autonomic failure more than triples the risk of shorter survival in patients with MSA.

Original languageEnglish (US)
Pages (from-to)1151-1157
Number of pages7
JournalMovement Disorders
Issue number9
StatePublished - Aug 2014


  • Autonomic failure
  • MSA
  • Mortality
  • Survival

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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