Non-motor symptoms in multiple system atrophy: A comparative study with Parkinson's disease and progressive supranuclear palsy

Wen-Zheng Hu; Ling-Xiao Cao; Jin-Hui Yin; Xue-Song Zhao; Ying-Shan Piao; Wei-Hong Gu; Jing-Hong Ma; Zhi-Rong Wan; Yue Huang

doi:10.3389/fneur.2022.1081219

Non-motor symptoms in multiple system atrophy: A comparative study with Parkinson's disease and progressive supranuclear palsy

Front Neurol. 2023 Jan 23:13:1081219. doi: 10.3389/fneur.2022.1081219. eCollection 2022.

Authors

Wen-Zheng Hu^{1

2}, Ling-Xiao Cao^{1

2}, Jin-Hui Yin^{1

2}, Xue-Song Zhao³, Ying-Shan Piao², Wei-Hong Gu⁴, Jing-Hong Ma⁵, Zhi-Rong Wan⁶, Yue Huang^{1

2

7}

Affiliations

¹ China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ Traditional Chinese Medical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Neurology Department, China-Japan Friendship Hospital, Beijing, China.
⁵ Neurology Department, XuanWu Hospital, Capital Medical University, Beijing, China.
⁶ Department of Neurology, Aerospace Central Hospital, Beijing, China.
⁷ Department of Pharmacology, Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.

Abstract

Background: Non-motor symptoms (NMS) are compulsory clinical features for the clinical diagnosis of multiple system atrophy (MSA), some of which precede motor symptoms onset. To date, few studies have systematically investigated NMS in MSA and the timing of presenting NMS as the disease progresses. Clinically, MSA is difficult to be differentiated from Parkinson's disease (PD) and progressive supranuclear palsy (PSP), and the differences in NMS between MSA and PD/PSP remain unclear. The aim of this study was to compare the burden of NMS between MSA and PD/PSP and to delineate the timing of NMS presentation relative to the onset of motor symptoms in MSA.

Methods: A total of 61, 87, and 30 patients with MSA, PD, and PSP, respectively, were enrolled in this study. NMS was systematically assessed in all patients using the NMS scale (NMSS), and the onset of NMS relative to the onset of motor symptoms in MSA was investigated.

Results: MSA group had higher total NMSS scores (82.15 ± 46.10) than the PD (36.14 ± 30.78) and PSP (50.30 ± 55.05) groups (p < 0.001 overall). The number distribution pattern of the NMS was significantly different among the three parkinsonian disorders (p < 0.001 overall). In total, 85.2% of patients with MSA had more than 10 NMS, which was significantly higher than PD (28.7%) and PSP (33.3%). The frequency and scores of many NMSS subdomains and symptoms were higher in MSA than in PD and PSP (all p < 0.05). Multivariate logistic regression analysis revealed that patients with fainting, lack of motivation, swallowing, and loss of sexual interest could be attributed to MSA rather than PD or PSP, while patients with loss of concentration and forgetfulness were characteristic features of PD or PSP rather than MSA. REM-sleep behavior disorder (RBD), constipation, problems having sex, and loss of sexual interest preceded the motor symptoms onset of MSA by 2.81 ± 4.51, 1.54 ± 6.32, 1.35 ± 4.70, and 0.45 ± 3.61 years, respectively.

Conclusion: The NMS spectrum in MSA differs from that of PD and PSP. Patients with MSA have a higher NMS burden than patients with PD or PSP. RBD, constipation, problems having sex, and loss of sexual interest may become early diagnostic clinical markers of MSA.

Keywords: Parkinson's disease; disease progression; multiple system atrophy; non-motor symptom; progressive supranuclear palsy.

Grants and funding

The study was funded by the National Natural Science Foundation of China (NSFC, 82071417, YH).