The characteristic of nonmotor symptoms with different phenotypes and onsets in multiple system atrophy patients

Sex-related differences in the clinical presentation of multiple system atrophy

“…The literature on sex-related differences in the clinical presentation of MSA suggested that compared to men, women more frequently have a motor symptomatic onset and a better response to L-dopa, but overall develop greater motor disability over time and more frequently suffer from pain, depression, anxiety, sarcopenia, frailty, early falls, fractures, worse cognitive performance, and lower health-related quality of life [ 10 , 11 , 22 , 25 , 31 , 48 , 50 , 51 , 59 ]. By contrast, men were more frequently reported to have an autonomic symptomatic onset and to suffer from more widespread and severe autonomic failure, except for urinary urge incontinence and constipation, which were more common in women [ 10 , 12 , 20 , 34 , 36 , 37 , 41 , 51 , 55 , 60 , 61 ]. Higher supine BP levels as well as greater orthostatic BP falls were both associated with increased mortality in men with MSA [ 54 , 57 ].…”

“…Controversial findings were found in the literature on sex-related differences in excessive daytime sleepiness and REM sleep behavior disorder [ 53 , 56 , 61 ]. The full results of the literature search on sex-related aspects in MSA are provided in ESM Table 2 .…”

“…The literature on sex-related differences in the clinical presentation of MSA primarily consisted of studies conducted following the publication of the second consensus MSA criteria [ 14 ]. Altogether, these studies indicated that women suffer from a greater motor disability and higher neuropsychiatric burden, while possibly experiencing a slight survival benefit due to initial motor onset and overall less severe autonomic failure compared to men [ 10 – 12 , 38 , 41 , 51 , 52 , 54 , 55 , 57 , 60 , 61 ]. A motor onset in MSA may positively impact women’s survival by prompting an earlier referral, diagnosis, and thus optimized care [ 10 ].…”