Diagnostic Challenges in Progressive Supranuclear Palsy: Early Identification and Mimics

Abstract

AbstractBackgroundProgressive supranuclear palsy (PSP) is an often‐undiagnosed neurodegenerative disorder. There are often delays in diagnosing PSP.MethodRetrospective chart review of all newly diagnosed PSP patients referred to an outpatient clinic. We conducted a review of all initial/new PSP cases in our geriatric clinic. The most common preliminary diagnosis the patients had been given included was idiopathic Parkinson’s disease. Other common diagnoses were vascular Parkinson’s, frontal lobe dementia, psychotic depression and late life psychosis.Clinical records with the subjective accounts, cognitive assessments and brain imaging reports of 23 PSP patients were reviewed.ResultsThe most common cognitive deficits were visuospatial changes (100%), semantic fluency deficits (80.4%), dysexecutive function. Sleep disruption with insomnia with intermittent awakening was also commonly reported.A propensity for falls and multiple falls were also reported. The interval from the onset of symptoms and initial presentation to a clinical provider to diagnosis ranged from 1 ‐ 7 years.ConclusionA high index of suspicion and recognition that PSP might not be as uncommon as previously thought is needed. A timely diagnosis and recognition of the various cognitive and behavioral changes is important.