Objective: This study aimed to clarify the characteristics of communication impairment, its influencing factors, and availability of communication tools in patients with multiple system atrophy (MSA).

Background: Patients with MSA have progressive motor impairment, which results in impaired communication. In patients with MSA, communication impairment remains a major problem in self-decision-making for therapeutic intervention. Compared to communication impairment experienced by patients with amyotrophic lateral sclerosis, that in patients with MSA is poorly documented.

Method: We assessed the severity of communication impairment, motor symptoms (parkinsonism and cerebellar ataxia), and cognitive function of patients with probable MSA, according to the Gilman criteria, who were admitted to our hospital or home-support clinic between 2017 and 2019. We also examined the availability of communication tools, including communication boards and voice output communication aids.

Results: We examined 6 patients with MSA who had communication impairment (MSA-C, 2 patients; MSA-P, 4 patients; mean age, 65.6 [50–75] years; disease duration, 6.2 [2–9] years; 3 patients underwent tracheostomy). Three patients with MSA-P presumably developed communication impairment because of motor symptom; however, their communication improved by using communication tools. In contrast, one patient with MSA-C experienced difficulty in operating the communication tools because of severe kinetic tremor. Two patients with MSA-C or MSA-P presumably developed impaired communication due to cognitive dysfunction, and therefore, could not use the communication tools.

Conclusion: The severity of disturbance of motor and cognitive function is the primary factor influencing communication impairment in patients with MSA. To improve communication impairment in MSA, different approaches are needed for specific types of motor dysfunction. In cases with primarily extrapyramidal motor dysfunction, step-by-step intervention is possible. Contrarily, in cerebellar ataxia, a major motor dysfunction, detailed examination on switch selection and operability improvement is needed. In patients with cognitive impairment, use of alternative communication devices is difficult. Moreover, regular assessment of cognitive function is required.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-features-of-impaired-communication-in-patients-with-multiple-system-atrophy/