What are the symptoms?

Symptoms usually start between 50 and 60 years of age, but can start any time after 30.

Manydifferent functions of the body can be affected, including the urinary system, blood pressure control and muscle movement.

The range ofsymptoms is described below, although it is important to note that a person with multiple system atrophy won't necessarily developall of these.

Bladder problems

Men and women with multiple system atrophy will usually have one or more of the following bladder symptoms:

• constantly feeling the need tourinate
• urinating more frequently
• passing urineunintentionally read more about urinary incontinence
• not being able to empty the bladder properly
• not being able to urinate

Erection problems

Men with multiple system atrophywill usually experience erectile dysfunction (the inability to get and maintain an erection),although this is a common problem that many men without the disease develop.

Low blood pressurewhen standing up

It's common for someone with multiple system atrophy to feel lightheaded, dizzy and faint when they suddenly sit or stand up.This is because their blood pressuredrops when they become upright,which is known as postural hypotension.

When you stand up after lying down,your blood vessels usually narrow quickly and your heart rate increases slightly, topreventblood pressure dropping and maintain blood flow to the brain. This function is carried out automatically by the autonomic nervous system.

However, because this doesn't work properly in people with multiple system atrophy, this control is lost.

Problems with coordination, balance and speech

A part of the brain called the cerebellum becomes damaged in multiple system atrophy, which can make the person clumsy and unsteady when walking, and can also cause slurred speech.

These problems are collectivelyknown as cerebellar ataxia .

Feeling stiff, and slowness of movement

A person with multiple system atrophy typically has much slowermovements than normal. This is referred to as "bradykinesia" and can make everyday tasks difficult. Movement is hard to initiate, and they often have a distinctive slow, shuffling walk with very small steps.

Some people may also have stiffness and tension in the muscles, which can make it even more difficult to move around and can result in painful muscle cramps ( dystonia ).

The above symptoms are typical of Parkinson's disease, but unfortunately the medication used to relieve these symptoms in people with Parkinson's disease (levodopa therapy) is not veryeffective for people with multiple system atrophy.

Other signs and symptoms

People with multiple system atrophy may also have:

• shoulder and neck pain
• constipation
• cold hands and feet
• problems controlling sweating
• muscle weakness in the body and limbs it may be more pronouncedin one arm or leg
• uncontrollable laughing or crying
• sleep problems insomnia, snoring, restless legs, nightmares
• noisy breathing and unintentional sighing
• a weak, quiet voice
• swallowing problems
• blurred vision
• depression
• dementia (although this is uncommon)