As the disease progresses one of three groups of symptoms predominate. These are:
1）Parkinsonism (slow, stiff movement, writing becomes small and spidery)
2）Cerebellar dysfunction (difficulty coordinating movement and balance)
3）Autonomic nervous system dysfunction (impaired automatic body functions) including: postural or orthostatic hypotension, resulting in dizziness or fainting upon standing up；urinary incontinence or urinary retention；impotence；constipation；vocal cord paralysis；dry mouth and skin；trouble regulating body temperature due to sweating deficiency in all parts of the body；loud snoring, abnormal breathing or inspiratory stridor during sleep; other sleep disorders including sleep apnea, REM behavior disorder
Other symptoms such as double vision can occur. Not all patients experience all of these symptoms.
Some patients (20% in one study) experience significant cognitive impairment as a result of MSA.
Multiple system atrophy score
It mainly includes four items: history review, exercise examination, autonomic function test and overall disability score. The scores of the first and second items range from 0 (normal) to 4 (severe abnormal).
The average remaining lifespan after the onset of symptoms in patients with MSA is 6-10 years. Approximately 60% of patients require a wheelchair within five years of onset of the motor symptoms, and few patients survive beyond 12 years. The disease progresses without remission at a variable rate - those who present at an older age, those with parkinsonian features, and those with severe autonomic dysfunction have a poorer prognosis. Those with predominantly cerebellar features and those who display autonomic dysfunction later have a better prognosis.