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Clinical Autonomic Research

Erschienen in:

30.03.2020 | Review Article

Diagnosing multiple system atrophy at the prodromal stage

verfasst von: Chenjie Xia, Ronald B. Postuma

Erschienen in: Clinical Autonomic Research | Ausgabe 3/2020

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Abstract

Identifying individuals at the earliest disease stage becomes crucial as we aim to develop disease-modifying treatments for neurodegenerative disorders. Prodromal diagnostic criteria were recently developed for Parkinson’s disease (PD) and are forthcoming for dementia with Lewy bodies (DLB). The latest 2008 version of diagnostic criteria for multiple system atrophy (MSA) have improved diagnostic accuracy in early disease stages compared to previous criteria, but we do not yet have formal criteria for prodromal MSA. Building on similar approaches as for PD and DLB, we can identify features on history-taking, clinical examination, and ancillary clinical testing that can predict the likelihood of an individual developing MSA, while also distinguishing it from PD and DLB. The main clinical hallmarks of MSA are REM sleep behavior disorder (RBD) and autonomic dysfunction (particularly orthostatic hypotension and urogenital symptoms), and may be the primary means by which patients with potential prodromal MSA are identified. Preserved olfaction, absence of significant cognitive deficits, urinary retention, and respiratory symptoms such as stridor and respiratory insufficiency can be clinical features that help distinguish MSA from PD and DLB. Finally, ancillary test results including neuroimaging as well as serological and cerebrospinal fluid (CSF) biomarkers may lend further weight to quantifying the likelihood of phenoconversion into MSA. For prodromal criteria, the primary challenges are MSA’s lower prevalence, shorter lead time to diagnosis, and strong overlap with other synucleinopathies. Future prodromal criteria may need to first embed the diagnosis into a general umbrella of prodromal alpha-synucleinopathies, followed by identification of features that suggest prodromal MSA as the specific cause.

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Titel: Diagnosing multiple system atrophy at the prodromal stage
verfasst von: Chenjie Xia
Ronald B. Postuma
Publikationsdatum: 30.03.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Autonomic Research / Ausgabe 3/2020
Print ISSN: 0959-9851
Elektronische ISSN: 1619-1560
DOI: https://doi.org/10.1007/s10286-020-00682-5

Springer Medizin

Diagnosing multiple system atrophy at the prodromal stage

Abstract

Neu in den Fachgebieten Neurologie und Psychiatrie

Typ-2-Diabetes und Depression folgen oft aufeinander

Schützt Olivenöl vor dem Tod durch Demenz?

Darf man die Behandlung eines Neonazis ablehnen?

Chirurginnen und Chirurgen sind stark suizidgefährdet

Springer Medizin

Abstract

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