Objective: To investigate associations between swallowing-related symptoms and disease severity, quality of life, and caregiver burden in patients with MSA in a large UK-based cohort.

Background: Multiple System Atrophy (MSA) is a progressive neurodegenerative disorder associated with impaired quality of life and caregiver burden. Swallowing impairment is a recognised feature.

Method: Cross-sectional baseline data for Unified MSA Rating Scale (UMSARS), MSA-QoL scores, and Zarit Burden Interview (ZBI) scores were collected from the PROSPECT-M-UK MSA cohort. MSA-QoL items 6, 7, 9, and 10 were categorised as the oropharyngeal domain. Clinical and demographic characteristics were summarized using descriptive statistics. Spearman’s rank correlation with Benjamini-Hochberg correction was used to assess associations.

Results: A total of 164 MSA cases were included (44% female, 48% MSA-C). Matched UMSARS and MSA-QoL data were available for 66 participants, and 151 ZBI scores were obtained.

UMSARS Part I scores correlated with MSA-QoL difficulty swallowing food (ρ=0.336, p=0.0014) and difficulty feeding oneself (ρ=0.434, p=0.0014). UMSARS Part II scores correlated with difficulty feeding oneself (ρ=0.309, p=0.017) and difficulty drinking fluids (ρ=0.330, p=0.007). Total UMSARS correlated with difficulty feeding oneself (ρ=0.392, p=0.0022) and difficulty drinking fluids (ρ=0.394, p=0.0022), while the global disability score correlated with difficulty swallowing food (ρ=0.295, p=0.0226) and difficulty feeding oneself (ρ=0.362, p=0.0058). Drooling was not associated with UMSARS scores.

At the domain level, UMSARS scores correlated with the MSA-QoL oropharyngeal impairment domain for Part I (ρ=0.441, p=0.0014), Part II (ρ=0.310, p=0.0162), total UMSARS (ρ=0.425, p=0.0014), and global disability score (ρ=0.290, p=0.0244).

Higher MSA-QoL total scores were associated with greater difficulty cutting food on UMSARS Part I (ρ=0.365, p=0.0058), while poorer life satisfaction correlated negatively with this item (ρ=−0.259, p=0.0479).

ZBI scores correlated with difficulty swallowing food (ρ=0.259, p=0.0014), difficulty drinking fluids (ρ=0.175, p=0.0349), and the MSA-QoL oropharyngeal impairment domain (ρ=0.260, p=0.0024).

Conclusion: Swallowing dysfunction in MSA is associated with greater disease severity on clinical scales, poorer quality of life, and increased caregiver burden.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-swallowing-dysfunction-quality-of-life-and-caregiver-burden-in-multiple-system-atrophy/