Objective: This study aimed to explore the correlation between dysphagia and key clinical features in Multiple System Atrophy (MSA) patients, along with investigating the link between swallowing difficulties, disease progression, and MRI features of MSA.

Background: Multiple System Atrophy (MSA) is a rare neurodegenerative disorder marked by autonomic dysfunction, parkinsonism, and cerebellar ataxia. Dysphagia is related to increased aspiration, pneumonia leading to poor survival. Some patients with MSA experience dysphagia in the early stage. Yet, its correlation with other MSA symptoms remains unclear. We aimed to explore this relationship, alongside common clinical features such as autonomic symptoms, parkinsonism, and cerebellar symptoms. Additionally, we investigate the link between swallowing difficulties, disease progression, and Magnetic Resonance Imaging (MRI) features of MSA.

Method: We investigated 44 MSA patients who visited Asan Medical Center’s movement clinic from 2018 and 2022. Disease severity was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), Unified Multiple System Atrophy Rating Scale (UMSAR), and Scale for the Assessment and Rating of Ataxia (SARA). MRI features including olivopontocerebellar atrophy (OPCA) and putaminal rim sign were assessed. 10 Patients with incomplete records were excluded. Rapid eye movement sleep behavior disorders (RBD) were retrieved from electronic medical records. Dysphagia was evaluated with dysphagia score in UMSARS part 1. We compared the clinical features between patients with dysphagia (dysphagia score ≥2) and those without dysphagia (dysphagia score <2).

Results: Total study population was 34 patients with MSA. Patients with dysphagia had a higher age at diagnosis compared with those without dysphagia (mean 62.9 vs. 57.5, p=0.056). However, MRI findings were not significantly different between two groups. Patients with dysphagia had higher UPDRS part 3 score than those without dysphagia (median 32.8 vs. 21.9, p=0.01), and UMSARS part 1 and part2 (mean 16.9 vs 16.8, p 0.001 vs 0.039) score. In UMSARS, orthostatic dizziness was related to dysphagia in MSA patients (p=0.043). SARA showed a partial correlation with dysphagia (p=0.062).

Conclusion: We found that older age at onset, higher disease severity of parkinsonism and ataxia, is related to dysphagia in patients with MSA. The result might enhance our understanding and management of MSA patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-clinical-implication-of-dysphagia-in-patients-with-multiple-system-atrophy/