From the Guidelines
Progressive Supranuclear Palsy (PSP) is characterized by a distinct set of symptoms, including problems with balance and walking, difficulty moving the eyes, stiffness and slowness of movement, speech and swallowing difficulties, and changes in personality and cognition, as described in the study by 1. The primary symptoms of PSP typically develop gradually and include:
- Problems with balance and walking, leading to frequent falls, often backward
- Difficulty moving the eyes, particularly looking up and down (vertical gaze palsy)
- Stiffness and slowness of movement similar to Parkinson's disease
- Speech and swallowing difficulties
- Changes in personality and cognition, including apathy, impulsivity, and executive function problems As PSP progresses, patients may develop a characteristic facial expression with a surprised or staring look, difficulty controlling emotions, and sleep disturbances, as noted in the study by 1. Unlike Parkinson's disease, PSP typically responds poorly to levodopa therapy and progresses more rapidly, highlighting the importance of early recognition and proper diagnosis, as discussed in the study by 1. These symptoms occur because PSP causes degeneration in specific brain areas, particularly the brainstem, basal ganglia, and cerebellum, with accumulation of abnormal tau protein, as described in the study by 1. Early recognition of these symptoms is important for proper diagnosis and management, though treatment currently focuses on symptom relief rather than disease modification, as noted in the study by 1.
From the Research
Symptoms of Progressive Supranuclear Palsy (PSP)
- Mobility, balance, speech, swallowing, vision, and cognitive changes are associated with PSP 2
- Commonly experienced symptoms include mobility, speech, and swallowing problems, with aspiration pneumonia being the leading cause of death 2
- Prediagnostic symptoms of PSP can include visual, dizziness, motor, mood/apathy, cognitive, behavioral, sleep, gastrointestinal/urinary, and miscellaneous symptoms 3
- Over 50% of prediagnostic falls, apathy, anxiety, depression, and memory-attention-executive symptoms can start more than three and up to ten years before diagnosis 3
- Cognitive and behavioral disturbances are common in PSP, including impairment in frontal executive domains 4
- Motor deficits are a key feature of PSP, with different phenotypes exhibiting distinct motor symptoms 5, 4
Specific Symptoms
- Vertical supranuclear gaze palsy and falls in the first symptomatic year are classic symptoms of PSP 5
- Gait disturbances, apathy, anxiety, depression, and memory-attention-executive symptoms are common prediagnostic symptoms 3
- Cognitive impairment, including executive dysfunction, is a frequent symptom of PSP 4
- Speech and language disorders can be a prominent feature of certain PSP phenotypes, such as PSP-SL 4
Phenotypes of PSP
- Richardson's syndrome (PSP-RS) is the most common phenotype, accounting for 64.6% of cases 4
- Other phenotypes include PSP with predominant Parkinsonism (PSP-P), PSP with progressive gait freezing (PSP-PGF), and PSP with predominant speech/language disorder (PSP-SL) 4
- Each phenotype exhibits distinct motor and non-motor symptoms, although cognitive and behavioral disturbances do not clearly differentiate between phenotypes 4