parkinsonian features, and those with severe autonomic dysfunction have a poorer prognosis. those with predominantly cerebellar features and those who display autonomic dysfunction later have a better prognosis. causes of death the most common causes of death are sudden death and death caused by infections, which include urinary catheterization infections, feeding tube infections, and aspiration pneumonia. some deaths are caused by cachexia, also known as wasting syndrome. epidemiology multiple system atrophy is estimated to affect approximately 5 per 100,000 people. at autopsy, many patients diagnosed during life with parkinson’s disease are found actually to have msa, suggesting that the actual incidence of msa is higher than that estimate. while some suggest that msa affects slightly more men than women (1.3:1), others suggest that the two sexes are equally likely to be affected. the condition most commonly presents in persons aged 50–60. research mesenchymal stem cell therapy may delay the progression of neurological deficits in patients with msa-cerebellar type. notable cases nikolai andrianov was a soviet/russian gymnast who held the record for men for the most olympic medals at 15 (7 gold medals, 5 silver medals, 3 bronze medals) until michael phelps surpassed him at the 2008 beijing summer olympics. todd j. campbell (1956–2021), united states district judge and counsel to former vice president al gore. singer and songwriter johnny cash wrote in his autobiography that he was diagnosed with shy–drager in 1997. ronald green (1944–2012), american-israeli basketball player joseph c. howard sr. was the first african american to serve as a united states district judge of the united states district court for the district of maryland. kenneth more british actor, originally diagnosed with parkinson's disease. chef kerry simon died from complications of msa. david colin sherrington frs (1945-2014), noted polymer chemist, who was diagnosed in 2012 and died from pneumonia two years later.