Objective: To describe the clinical phenotypes of Multiple System Atrophy (MSA) in a Sri Lankan cohort and evaluate the relationship between disease severity and functional status.

Background: MSA is a rapidly progressive neurodegenerative disorder characterized by autonomic failure, parkinsonism, and cerebellar ataxia. While phenotypic distribution is known to vary globally, data from South Asian populations remain sparse. This study aims to characterize the clinical profile and functional burden of MSA in Sri Lanka

Method: As part of the GP2, this multicenter cross-sectional study (November 2025–February 2026) evaluated patients meeting the MDS diagnostic criteria for MSA. Clinical phenotypes were characterized using MDS-MSA criteria. Disease severity was quantified via the Unified Multiple System Atrophy Rating Scale (UMSARS), while cognitive status and functional independence were assessed using the Montreal Cognitive Assessment (MoCA) and Barthel Index (BI), respectively. Statistical associations were determined using Spearman’s correlation (⍴)

Results:

The cohort (n=15) had a median age of 65.0 years (IQR 54.5–74.0) and onset of 62.0 years (IQR 52.5–72.5), with a marked female predominance (M:F 1:4). Classification per MDS criteria identified MSA-C as the dominant subtype (66.7%, n=10), followed by MSA-P (20%, n=3) and clinically probable MSA (13.3%, n=2). Cerebellar syndrome was the most prevalent core feature (93.3%, n=14). Autonomic symptoms were frequent, specifically urinary urge incontinence (80.0%, n=12) and neurogenic orthostatic hypotension (33.3%, n=5). Median MoCA was 17.5 (IQR 16.2–23.5).

Significant inverse correlations were observed between functional status (BI) and both UMSARS Part I score: Historical review (⍴= -0.864, p < 0.001) and Part II score: Motor examination (⍴= -0.767, p < 0.001). No significant correlation was observed between UMSARS and MoCA scores

Conclusion: In this Sri Lankan cohort, the cerebellar phenotype (MSA-C) was the most common clinical presentation, occurring alongside a high burden of autonomic dysfunction. The strong correlation between UMSARS scores and the Barthel Index underscores the functional disability associated with MSA. These findings provide essential baseline phenotypic data for MSA in the South Asian region

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characterization-and-functional-correlates-of-multiple-system-atrophy-in-sri-lanka-preliminary-results-from-a-cross-sectional-collaborative-study-with-global-parkinsons-genetic-prog/