Schrag, Anette; Bohlken, Jens; Kostev, Karel; (2022) Pre-diagnostic presentations of Multiple System Atrophy case control study in a primary care dataset. Parkinsonism and Related Disorders 10.1016/j.parkreldis.2022.02.003. (In press).

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Abstract

Background: We here report the pre-diagnostic clinical presentations of patients with Multiple System Atrophy (MSA) from analysis of a large routine clinical care database. Methods: Data were extracted from a primary care database in the German healthcare system for the period between January 2000 and December 2020. We identified 250 patients with new diagnosis of MSA and 250 controls matched for age, sex, and index year. Logistic regression analyses were conducted to assess association between MSA and predefined diagnoses. Results: The greatest rate increase in the 2 years preceding diagnosis of MSA was seen for hypotension and balance impairment but rates of memory problems, urinary dysfunction, dizziness and depression rates were also markedly increased, and ataxia was solely identified in those with a later diagnosis of MSA. Up to 5 years before diagnosis similar patterns were seen, but >5 years before diagnosis only depression rates were increased with a trend for increase in constipation. Conclusions: Presentations that were significantly more common in patients with MSA in the pre-diagnostic phase than in controls were autonomic complaints such as postural hypotension, urinary and bowel dysfunction, and early balance impairment. However, the study also highlights that memory complaints and depression may be early features of MSA years before diagnosis.

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