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[19]
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.