Health-related quality of life in multiple system atrophy.
Although multiple system atrophy (MSA) is a neurodegenerative disorder leading to progressive disability and decreased life expectancy, little is known about patients' own evaluation of their illness and factors associated with poor health-related quality of life (Hr-QoL). We, therefore, assessed Hr-QoL and its determinants in MSA. The following scales were applied to 115 patients in the European MSA-Study Group (EMSA-SG) Natural History Study: Medical Outcome Study Short Form (SF-36), EQ-5D, Beck Depression Inventory (BDI), Mini-Mental state examination (MMSE), Unified MSA Rating Scale (UMSARS), Hoehn & Yahr (H&Y) Parkinson's disease staging scale, Composite Autonomic Symptom Scale (COMPASS), and Parkinson's Disease Sleep Scale (PDSS). Forty-six percent of patients had moderate to severe depression (BDI > or = 17); Hr-QoL scores on the SF-36 and EQ-5D were significantly impaired. Pain, the only domain with similar scores in MSA and published PD patients, was reported more frequently in patients with MSA-P (predominantly parkinsonian motor subtype) than MSA-C (predominantly cerebellar motor subtype; 76% vs. 50%; P = 0.005). Hr-QoL scores correlated most strongly with UMSARS motor, COMPASS, and BDI scores but not with MMSE scores, age at onset, or disease duration. The COMPASS and UMSARS activities of daily living scores were moderate-to-strong predictors for the SF-36 physical summary score and the BDI and UMSARS motor scores for the SF-36 mental summary score. This report is the first study to show that Hr-QoL is significantly impaired in MSA. Although not all possible factors related to impaired Hr-QoL in MSA could be assessed, autonomic dysfunction, motor impairment, and depression were most closely associated with poor Hr-QoL, and therapeutic management, therefore, should concentrate upon these aspects of the disease.
Schrag
Anette
A
Department of Clinical Neurosciences, Royal Free & University College Medical School, London, United Kingdom.
Geser
Felix
F
Stampfer-Kountchev
Michaela
M
Seppi
Klaus
K
Sawires
Martin
M
Köllensperger
Martin
M
Scherfler
Christoph
C
Quinn
Niall
N
Pellecchia
Maria T
MT
Barone
Paolo
P
Del Sorbo
Francesca
F
Albanese
Alberto
A
Ostergaard
Karen
K
Dupont
Erik
E
Cardozo
Adriana
A
Tolosa
Eduardo
E
Nilsson
Christer F
CF
Widner
Håkan
H
Lindvall
Olle
O
Giladi
Nir
N
Gurevich
Tanya
T
Daniels
Christine
C
Deuschl
Günther
G
Coelho
Miguel
M
Sampaio
Cristina
C
Abele
Michael
M
Klockgether
Thomas
T
Schimke
Nicole
N
Eggert
Karla M
KM
Oertel
Wolfgang
W
Djaldetti
Ruth
R
Colosimo
Carlo
C
Meco
Giuseppe
G
Poewe
Werner
W
Wenning
Gregor K
GK
D001007:Anxiety / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology; D004185:Disability Evaluation; D005060:Europe; D006304:Health Status; D006801:Humans; D009043:Motor Activity; D019578:Multiple System Atrophy / Q000503:physiopathology* / Q000523:psychology; D010146:Pain; D010300:Parkinson Disease / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D044465:White People