Objective: Objective: To determine the frequency and gender differences of non-motor symptoms (NMS) in patients with multiple system atrophy (MSA). 

Background: Background: NMS are a core feature in MSA and may precede onset of motor symptoms. Although NMS are gaining awareness as significant cause of morbidity, the frequency of symptoms among MSA subtypes and gender differences remain to be thoroughly characterized.

Methods: Methods: The clinical features of patients diagnosed clinically as probable or possible MSA who were treated at the movement disorder unit of Innsbruck, Austria between 2000-2016 were analysed. NMS covering autonomic, neuropsychiatric, sleep and olfactory domains were evaluated based on a review of medical records. Descriptive statistics of nominal and ordinal variables were performed and appropriate parametric or non-parametric tests were applied.

Results: Results: Data from 175 MSA patients (51.4 % men) were included in the analysis. Early autonomic dysfunction as defined by occurrence of at least one symptom within 1 year of motor onset was recorded in 49.1 % of the patients. Overall the most frequent NMS reported by patients at any time throughout the disease course were bladder symptoms (94.8 % of cases), depression (80.7 %) and symptoms of REM sleep behavior disorder (78.8 %) followed by postural dizziness/ syncope (77.8 %) and constipation (75.2 %). Sleep-related breathing disturbance occurred in 66.1 % of patients. Up to 82.9 % of patients experienced at least three symptoms of the non-motor complex. Constipation and sudomotor symptoms were more prevalent in MSA-P (parkinsonian variant) patients compared to MSA-C (cerebellar variant) patients (p < 0.05). The most frequent NMS in men was impotence (96.6 %), and in women urinary urgency (95.8 %). Except for depression which occurred more frequently in women than in men (p = 0.04), the frequency of NMS during the entire disease course was comparable between male and female patients. In contrast early autonomic failure was more prevalent in male patients (58.9 % in male vs. 38.8 % in female, p = 0.008). 

Conclusions: Conclusion: Our data show that NMS are prominent in MSA likely affecting quality of life. Gender differences were apparent for depression (women > men) and early autonomic failure (men > women). Further prospective studies are required to confirm our results. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-and-gender-differences-in-multiple-system-atrophy/