{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:58:22Z","timestamp":1774972702900,"version":"3.50.1"},"reference-count":69,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple system atrophy (MSA) is a fatal alpha\u2010synucleinopathy characterized by variable combinations of parkinsonism and autonomic and cerebellar dysfunctions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to prospectively study the natural history of probable MSA, including cardiovascular autonomic dysfunction (CAD) and serum alpha\u2010synuclein.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty probable MSA patients (MSA\u2010P\u2009=\u200919; MSA\u2010C\u2009=\u200941) and 30 age\u2010and\u2010gender\u2010matched healthy controls were recruited. Disease severity (UPDRS III, UMSARS I, II, IV), CAD, and serum alpha\u2010synuclein (ELISA) were assessed at baseline, 6\u2010month (6\u2009M\u2010FU), and 12\u2010month (12\u2009M\u2010FU) follow\u2010ups. Survival probabilities (Kaplan\u2013Meir analysis) and prognostic factors (Cox proportional hazards analysis) were assessed at the study's end period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total serum alpha\u2010synuclein was higher in MSA patients than controls (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). There was severe CAD in MSA patients at baseline (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), which further deteriorated at 12\u2009M\u2010FU (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). A greater proportion of MSA\u2010P patients had a dopaminergic benefit than MSA\u2010C patients (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). CAD had a positive correlation with serum alpha\u2010synuclein and disease severity. UPDRS III and UMSARS II scores were higher at follow\u2010ups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Disease progression was more rapid in MSA\u2010C patients than MSA\u2010P patients (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The median time to one\u2010person support for walking and activities of daily living (ADL), wheelchair support, bedbound state, and death were 27, 48, 66, and 70\u2009months, respectively. The probabilities of needing one\u2010person support and wheelchair support were lower in MSA\u2010P patients than MSA\u2010C (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.03), whereas the probabilities of bedbound state and death were similar.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Probable MSA patients had a rapid progression, autonomic failure, and a shorter survival of 5.8\u2009years in this Asian\u2010Indian cohort compared to the other MSA cohorts worldwide (9\u201310\u2009years). MSA\u2010P patients had a better prognosis than MSA\u2010C. Elevated serum alpha\u2010synuclein and its positive correlation with CAD provide evidence for its role as a potential biomarker.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70301","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T15:09:47Z","timestamp":1756134587000},"page":"2113-2127","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rapid Progression and Shorter Survival in Indians Affected with Probable\n                    <scp>MSA<\/scp>\n                    : A Prospective Cohort Study"],"prefix":"10.1002","volume":"12","author":[{"given":"Malligurki Raghurama","family":"Rukmani","sequence":"first","affiliation":[{"name":"Department of Neurophysiology National Institute of Mental Health and Neuro Sciences (NIMHANS)  Bangalore 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Narasappa","family":"Sathyaprabha","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology National Institute of Mental Health and Neuro Sciences (NIMHANS)  Bangalore 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