Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 May;88(5):402-411.
doi: 10.1136/jnnp-2016-314956. Epub 2017 Mar 1.

Predictors of Survival in Progressive Supranuclear Palsy and Multiple System Atrophy: A Systematic Review and Meta-Analysis

Affiliations
Review

Predictors of Survival in Progressive Supranuclear Palsy and Multiple System Atrophy: A Systematic Review and Meta-Analysis

Stella Andrea Glasmacher et al. J Neurol Neurosurg Psychiatry. .

Abstract

Objective: To undertake a systematic review and meta-analysis of studies that investigated prognostic factors and survival in patients with progressive supranuclear palsy (PSP) and multiple system atrophy (MSA).

Methods: Publications of at least 10 patients with a likely or confirmed diagnosis of PSP or MSA were eligible for inclusion. Methodological quality was rated using a modified version of the Quality in Prognostic Studies tool. For frequently examined prognostic factors, HRs derived by univariate and multivariate analysis were pooled in separate subgroups; other results were synthesised narratively and HRs could not be reported here.

Results: Thirty-seven studies presenting findings on 6193 patients (1911 PSP, 4282 MSA) fulfilled the inclusion criteria. We identified the following variables as unfavourable predictors of survival. In PSP, PSP-Richardson's phenotype (univariate HR 2.53; 95% CI 1.69 to 3.78), early dysphagia and early cognitive symptoms. In MSA, severe dysautonomia and early development of combined autonomic and motor features but not MSA phenotype (multivariate HR 1.22; 95% CI 0.83 to 1.80).In PSP and MSA, survival was predicted by early falls (multivariate HR 2.32; 95% CI 1.94 to 2.77), the Neuroprotection and Natural History in Parkinson Plus Syndromes Parkinson Plus Score and the Clinical Global Impression Disease Severity Score but not sex (multivariate HR 0.93; 95% CI 0.67 to 1.28). There was conflicting evidence regarding the prognostic effect of age at onset and stridor.

Conclusion: Several clinical variables were strongly associated with shorter survival in PSP and MSA. Results on most prognostic factors were consistent across methodologically diverse studies; however, the lack of commonality of prognostic factors investigated is a significant limitation.

Keywords: Progressive supranuclear palsy; meta-analysis; multiple system atrophy; prognosis; prognostic factors; survival; systematic review.

Conflict of interest statement

Competing interests: None declared.

Similar articles

See all similar articles

Cited by 13 articles

See all "Cited by" articles

LinkOut - more resources

Feedback