Stage 4. The Advanced Stage of Multiple System Atrophy
When the journey of a patient with Multiple System Atrophy reaches the fourth stage, the disease is considered advanced. In this stage, the symptoms not only become more severe but also greatly disrupt the patient’s life. New issues may emerge that, when combined with the continuation of symptoms from the earlier stages, considerably affect the patient’s overall well-being and daily functioning.
One of the most noticeable symptoms that intensify during the advanced stage of MSA is mobility loss. From the subtle balance issues and slight clumsiness noticed in the first stage to the pronounced difficulties in coordination and changes in gait observed in the second and third stages, the disease now takes a significant toll on the patient’s ability to move independently.
In this fourth stage, mobility issues are often severe to the point where patients may find it almost impossible to walk even short distances without aid. Balance problems that were once minor inconveniences have now evolved into substantial challenges, with patients experiencing frequent falls or needing to rely heavily on support to stay upright.
Moreover, the rigidity or stiffness in the limbs that was initially mild or moderate becomes significantly more pronounced at this stage. Patients may find it hard to flex or extend their arms and legs, making it difficult to perform daily tasks such as bathing, dressing, or even turning over in bed. The need for assistive devices like wheelchairs becomes almost inevitable at this stage.
In addition to the physical hurdles, this severe loss of mobility often carries psychological implications. It can lead to feelings of frustration, helplessness, and dependence, all of which can affect a patient’s mental health. Therefore, comprehensive care in this stage should address both the physical and psychological aspects of these symptoms.
The issues with speech and swallowing, which were already noticeable from the second stage, become even more problematic during the fourth stage of MSA. At this point, patients might have a significantly harder time articulating words or even making comprehensible sentences. Speech may become so slurred and slow that it can lead to severe communication difficulties. (4)
