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The Unified Multiple System Atrophy Rating Scale: Status, Critique, and Recommendations.

Mov Disord. 2022 Sep 8. doi: 10.1002/mds.29215. Epub ahead of print. PMID: 36074648.

Authors/Editors: Krismer F, Palma JA, Calandra-Buonaura G, Stankovic I, Vignatelli L, Berger AK, Falup-Pecurariu C, Foubert-Samier A, Höglinger G, Kaufmann H, Kellerman L, Kim HJ, Klockgether T, Levin J, Martinez-Martin P, Mestre TA, Pellecchia MT, Perlman S, Qureshi I, Rascol O, Schrag A, Seppi K, Shang H, Stebbins GT, Wenning GK, Singer W, Meissner WG.
Publication Date: 2022


The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed almost two decades ago as a clinical rating scale to capture multiple aspects of the disease.1, 2 It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability, UMSARS-II (14 items) assesses motor impairment based on a clinical examination, UMSARS-III records blood pressure and heart rate in the supine and standing positions, and UMSARS-IV (1 item) rates chore-based disability. Higher scores on the UMSARS indicate greater disability. Since its development and validation, the UMSARS has been widely used, in particular as an endpoint of clinical trials and academic research.3-12

With its increasing use, potential areas of improvement in the UMSARS have become apparent. We here address the limitations of the UMSARS and suggest a framework to develop an improved multiple system atrophy (MSA) clinical outcome assessment. To this end, a task force, involving clinicians, researchers, patient support groups, and industry representatives, has recently been endorsed by the International Parkinson's Disease and Movement Disorder Society (MDS).

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