Our research measured the HRQoL of MSA using EQ-5D-5L, providing important data on the QoL of Chinese MSA patients. We found that patients with MSA in a Chinese population had poor HRQoL. Mobility was the most commonly reported problem and pain/discomfort was the least common problem, which was consistent with the previous study using EQ-5D-3L. [4] Besides disease severity, sex, fatigue, and PD-SP were found to be the determinants for health utility value of MSA, and anxiety symptom, fatigue, and PD-SP were the determinants for EQ-VAS of MSA. Additionally, we found there were some differences in the determinants for HRQoL of MSA between MSA-C and MSA-P patients.
The mean health utility index (0.558) and the mean EQ-VAS score (59.5) of patients with MSA were lower than those of the Chinese healthy population (0.943, 82.9) and those of patients with coronary heart disease and stroke history (0.850, 61.0). [23, 24] The mean EQ-VAS score of Chinese patients with MSA (59.5) was higher than the results of the European study (44.5 and 36.9). [4, 5] This may be explained by the shorter disease duration and mild disease severity of patients enrolled in our study. Consistent with the previous study, we also found that the total UMSARS score was the determinant of health utility value and VAS scores in the MSA and two subtypes. [4]
We found that mobility was the most commonly reported problem and pain/discomfort was the least common problem, which was consistent with previous studies. [4, 5] Furthermore, we found that a higher frequency of problem of mobility was reported in patients with MSA-C than patients with MSA-P, which was consistent with the previous study assessed by EQ-5D-3L. [4] However, we found there was no difference in the mean scores of motor examination and global disability scale of UMSARS between the two subtypes. Our finding suggested that UMSARS has limited ability to reflect mobility in patients with MSA-C. In addition, we found that patients with MSA-P reported more pain/discomfort than patients with MSA-C, which was consistent with the previous study assessed with EQ-5D-3L. [5] This may be due to the severer damage in the basal ganglia in MSA-P than in MSA-C. [25]
Depression was reported to be a determinant of the QoL of MSA.[3, 4, 26, 27] In our study, the depressive emotion was related to the EQ-VAS score of MSA-C. We also found that anxiety played an important role in the decreasing EQ-VAS score of MSA. [3] Attempts to treat these symptoms are important to improve the HRQoL of patients with MSA. Similar to the result of the previous study, we found that female sex was a negative determinant of health utility values of MSA. [4] Additionally, females were more likely to initially manifest motor symptoms and recurrent falls within three years. [28] More researches should be made to understand the gender difference in MSA.
Fatigue is common in several neurological diseases including PD and multiple sclerosis. [29] There were 29–82% of MSA patients who suffered from fatigue. [30], which was significantly higher than that of patients with PD and healthy control. [31] In the current study, we found that fatigue was negatively correlated with health utility value and EQ-VAS score of MSA, which was consistent with our previous study evaluating QoL of MSA patients using PDQ-39. [11] The pathological mechanisms of fatigue are still uncertain. A study found that fatigue in MSA was related to the decrease of the 5-hydroxytryptamine receptor in the raphe nuclei and brain stem. [31] We should pay more attention on fatigue when managing patients with MSA.
In our previous study, sleep-related disorders including PD-SP, RBD, and EDS were found to be associated with higher disease severity in MSA. [32] In the current study, PD-SP but not RBD and EDS was found to be a determinant of the health utility value and EQ-VAS score of MSA. Since PD-SP includes motor symptoms at night, PD symptoms at night, and disturbed sleep, the etiology of PD-SP in MSA is complex and is still under research. Management of PD-SP in MSA is necessary.
Recent studies found that a varying degree of cognitive impairment was common in MSA assessed by comprehensive neuropsychological testing. [33, 34] Our current study found that cognitive impairment was the determinant of health utility value in MSA-P but not in MSA-C. [35, 36] Kawai reported that patients with MSA-P had wider and severer cognitive impairment than patients with MSA-C. [35] Patients with MSA-P were reported to have lower MoCA scores than patients with MSA-C in a Chinese study. [37] Additionally, we found that frontal lobe dysfunction was the determinant of EQ-VAS score in MSA-P but not in MSA-C, which was similar to our previous finding that frontal lobe dysfunction was the determinant of HRQoL assessed by PDQ-39 in MSA. [26] Further study should pay attention to the cognitive function in patients with MSA.
This research had several limitations. First, this cross-sectional research explored the features and determinants of the EQ-5D-5L score in MSA. Further study should concentrate on the longitudinal change of the EQ-5D-5L scores of MSA. Second, the diagnosis of MSA was based on the clinical features but not the autopsy. Further study should build autopsy confirmed cohort to study the HRQoL of MSA.