I have recently seen some patients with multiple system atrophy (MSA) in my clinic, and from their journey to the doctor, I would like to talk to my patients today about how to identify this disease early. I will teach you a few tricks. First of all, multisystem atrophy is preceded by more pronounced genitourinary and other symptoms, which we call non-motor symptoms, for several years before the onset of Parkinson’s disease-like symptoms or the development of cerebellar signs of unsteadiness in walking. Men will basically have erectile dysfunction and women have reduced sensitivity of the external genitalia. Other symptoms are urinary urgency, urinary frequency, urinary incontinence, and bladder emptying disorders. Secondly, cardiovascular system: the clinical manifestation is postural hypotension, and patients can show repeated syncope, vertigo, headache, etc. Sometimes, they can also have neck and shoulder as the center-like pain (also called hanger-like pain); nearly half of them are accompanied by postprandial hypotension. If you have the above symptoms, it is recommended to go to the hospital and have your doctor measure your blood pressure in the prone position. It is important to remind that a single measurement alone, which does not meet the diagnostic criteria for upright hypotension, does not negate the diagnosis, and sometimes repeated, multiple measurements are needed. Finally, most patients with MSA have symptoms of rapid eye movement sleep behavior disorder (RBD), which manifests as nocturnal yelling, punching and kicking, and nocturnal wheezing. The above phenomena are collectively referred to as autonomic dysfunction. The clinical focus of MSA needs to be differentiated from Parkinson’s disease. (1) MSA starts at an earlier age, mostly around 60 years old; (2) autonomic dysfunction appears later and progresses more slowly in Parkinson’s patients than in MSA patients; (3) MSA patients have a shorter drug maintenance interval, usually not more than 3-5 years, and even dopaminergic drugs are ineffective (regular doses of methadopa totaling 1000 mg per day for more than 1 month are required); (4) Parkinson’s disease has a shorter drug maintenance interval. (4) Patients with Parkinson’s tend to have frequent and urgent urination, and rarely incontinence. In contrast, MSA is firstly erectile dysfunction, followed by urinary tract pathology and finally postural hypotension; (5) From the onset of motor symptoms to the occurrence of frequent falls, catheterization, dysarthria or dysphagia, and wheelchair dependence, MSA patients present at short time intervals and the above adverse events accumulate in a very short period of time.