{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:34:39Z","timestamp":1792636479333,"version":"4.5.0"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"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 Disorders"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple system atrophy (MSA) is a rare neurodegenerative synucleinopathy whose epidemiological risk factors remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize pre\u2010diagnostic features and identify candidate risk factors for coding\u2010based incident MSA in the UK Biobank (UKB), compared with Parkinson's disease (PD) and healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Iterative logistic regression models were used to derive risk factors from sociodemographic, lifestyle, environmental, and medical factors, adjusting for baseline age and sex, with Benjamini\u2013Hochberg correction in the fully adjusted model. Candidate risk factors were evaluated in multivariate models at baseline and using 5\u2010 and 10\u2010year latency windows to assess reverse causation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 114 coding\u2010based incident MSA diagnoses, 1139 age\u2010 and sex\u2010matched incident PD cases, and 1075 matched controls. We identified several baseline associations that attenuated with latency windows, including antihistamine use, alcohol use, and reduced physical activity, suggesting reverse causation. Statin use was associated with reduced risk at baseline (odds ratio [OR] 0.34, 95% confidence interval [95% CI] 0.17\u20130.69) and 5\u2009years' latency but attenuated at 10\u2009years, and was discordant with findings of reduced risk with moderately elevated cholesterol (OR 0.41, 95% CI 0.24\u20130.72). Rural living was the only candidate exposure whose effect strengthened with longer latency windows (5\u2010year OR 2.73, 95% CI 1.32\u20135.65).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Coding\u2010based incident MSA in the UKB exhibits a long pre\u2010diagnostic phase consistent with autonomic and lifestyle changes several years prior to the diagnosis of an autonomic or parkinsonian disorder. Rural living may be an environmental signal warranting further investigation. \u00a9 2026 International Parkinson and Movement Disorder Society.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mds.70434","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T06:13:50Z","timestamp":1785046430000},"page":"2615-2627","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre\u2010Diagnostic Factors Associated with Coding\u2010Based Incident Multiple System Atrophy: A Nested Case\u2013Control Study of the\n                    <scp>UK<\/scp>\n                    Biobank"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8670-0985","authenticated-orcid":false,"given":"Charlie Weige","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Neurology Mass General Brigham  Boston MA USA"},{"name":"Harvard Medical School  Boston MA 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