Multiple System Atrophy: A general overview of clinical, cognitive and behavioral manifestations.

In this review we will look at the general characteristics of Multiple System Atrophy, including pathophysiology, etiopathogenesis and the clinical presentation. Pathophysiology is represented by macroscopic brain alterations, glial and neuronal inclusions widely distributed in the brain and neurodegenerative changes. α-synuclein aggregations in oligodendrocytes, and moreover their spread in the neurons represents the key in explaining the pathogenesis. Even though the disease is considered sporadic, genetic and environmental factors will also be mentioned. Motor symptoms in the clinical presentation can help in differentiating between the clinical subtypes (cerebellar and parkinsonian) while many dimensions reflect the non-motor symptoms. Cognitive dysfunctions (eg visuospatial, attention, memory domains) are present and psychiatric symptoms such as depression and anxiety also exist in MSA. Finally, we will look at the symptomatic treatment and future advances of the disease.