Men are affected twice as frequently as women are. The autonomic nervous system is affected, leading to a multitude of symptoms. Patients complain of impotence, change in writing style, slurred speech, sleep apnea, difficulty with urination, frequent urinary tract infections, a hoarse voice, passing out, headache, neck pain, dimming of vision and yawning. Syncope, or passing out, is most frequently associated with orthostatic hypotension, or a low blood pressure with standing, even though blood pressure while lying down may be very high. Patients also complain of imbalance and gait changes that have parkinsonian features, along with a tremor.
Depression is a common finding as the symptoms progress.
In order to diagnose multiple system atrophy, thoughtful and careful evaluation should be undertaken. Posture studies with blood pressure and heart rate monitoring with catecholamine levels in the supine and upright position should be done. This testing can be helpful in suggesting whether a patient has multiple system atrophy, but true diagnosis can only be accomplished by examination of the brain post-mortem. The prognosis is more guarded in the multiple system atrophy patient than in pure autonomic failure. It is rare for a patient to survive 10 years.