Neuropsychiatric symptoms and their impact on quality of life in multiple system atrophy

Background: Multiple system atrophy (MSA) is a sporadic neurodegenerative disorder characterized by severe dysautonomia and atypical Parkinsonism or cerebellar dysfunction. Disease-modifying treatment is not available and the mainstream of care is supportive. Neuropsychiatric symptoms are frequent in MSA and their successful management can improve patients’ quality of life (QOL). This study aimed to define a comprehensive neuropsychiatric profile in MSA patients in relation to QOL. Methods: In 48 MSA patients and 40 controls neuropsychiatric symptoms were assessed using Neuropsychiatric Inventory. MSA patients completed Beck Depression Inventory and QOL questionnaire (SF12), including Mental and Physical subscales. Results: Eighty-seven percent of MSA patients had neuropsychiatric symptoms as compared with 10.4% of controls. Depression (56%), apathy (48%), anxiety (27%), and agitation (27%) predominated. The Physical SF-12 scores were lower in the patients as compared with the controls. Neuropsychiatric Inventory (NPI) scores did not correlate with QOL measures. Depression, as reflected by the BDI, correlated with the mental component score of the SF-12 in MSA patients. Conclusions: Neuropsychiatric symptoms are very frequent in patients with MSA and are dominated by depression and apathy. They appear independent from physical disability and loosely map onto the known brain pathology of MSA. Only depression, as reflected by the BDI, negatively affected mental QOL. The discrepancy between the BDI and NPI-depression scores likely stems from the different approaches to symptoms by these questionnaires