Objective: To evaluate sociodemographic and clinical predictors of diagnostic delay in multiple system atrophy (MSA) at a single tertiary referral center.

Background: MSA is a rare neurodegenerative disorder characterized by autonomic dysfunction, parkinsonism (MSA-P), and cerebellar features (MSA-C). Postmortem diagnostic accuracy rates as low as 62% have been reported, and delayed diagnosis (mean 3.8 years) and misdiagnosis of MSA is common [1,2]. There is limited research on healthcare access and demographic factors which may contribute to diagnostic delay.

Method: We conducted a retrospective chart review of all patients meeting the 2022 MDS criteria for diagnosis of MSA at The Queen’s Medical Center (QMC) in Honolulu, Hawaii (2006–2025) [3]. Diagnostic delay was defined as the difference between age at symptom onset and confirmed diagnosis. Geographic distance from patient residence to QMC was estimated using the National Bureau of Economic Research Zip Code Distance Database. Associations between diagnostic delay and demographic variables, insurance, distance, and MSA subtype were assessed using Wilcoxon Rank Sum and Kruskal-Wallis tests and multivariable regression.

Results: A total of 51 patients with MSA were identified; MSA-P accounted for 37% of cases (n=19) and MSA-C for 63% (n=32). Mean age at symptom onset was 63.6±8.6 years and diagnosis 66.2±8.1 years. Mean diagnostic delay was 2.6±2.4 years, with a maximum delay of 15 years. Median geographic distance to QMC was 6.7 miles (IQR=9.65). No significant differences in diagnostic delay were observed across sex, race (White=5, Asian American=37, Native Hawaiian or Pacific Islander [NHPI]=5, Other=4), insurance category (Medicare=36, other government=3, private=11), MSA subtype, or geographic distance (p>0.05). Subtype distribution by race was similar (p=0.30) but trended toward higher frequencies of MSA-P in White populations (n=3; 60%) and MSA-C in Asian American (n=22; 59%) and NHPI (n=4; 80%) populations.

Conclusion: Diagnostic delay in MSA was not significantly associated with sociodemographic factors or clinical subtype. Barriers to timely diagnosis may instead reflect disease-specific processes, highlighting a need for larger multi-center studies for further characterization.

References: [1] Nandanwar D, Truong DD. Multiple system atrophy: Diagnostic challenges and a proposed diagnostic algorithm. Clin Park Relat Disord. 2024;11:100271. doi:10.1016/j.prdoa.2024.100271.
[2] Goh YY, Saunders E, Pavey S, et al. Multiple system atrophy. Pract Neurol. 2023;23(3):208-221. doi:10.1136/pn-2020-002797.
[3] Wenning GK, Stankovic I, Vignatelli L, et al. The Movement Disorder Society criteria for the diagnosis of multiple system atrophy. Mov Disord. 2022;37(6):1131-1148. doi:10.1002/mds.29005.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-delay-in-multiple-system-atrophy-sociodemographic-and-clinical-predictors-in-a-single-center-cohort/