#14-A-1124 AAN Department of Neurology and Epidemiology, University of Oklahoma Medical Center; Oklahoma City, OK Cognitive and Behavioral Changes in PSP:

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#14-A-1124 AAN Department of Neurology and Epidemiology, University of Oklahoma Medical Center; Oklahoma City, OK Cognitive and Behavioral Changes in PSP: Comparison of PSP-Parkinsonism with PSP-Richardson Syndrome. Saria Refai, MD; Linda Hershey, MD, PhD, FAAN; David Thompson; Jennifer Lippoldt, MPH BACKGROUND: The PSP-P variant of PSP is characterized by bradykinesia and rigidity that responds to levodopa for 1-2 years. PSP-P patients may still be able to look down at their initial visit, while most all PSP-R patients have vertical gaze palsy at onset. Few PSP-P cases have dementia at onset, but little is known about the behavioral differences between these two syndromes. DESIGN/METHODS: This was a retrospective chart review of PSP patients seen in one neurology clinic during 2011- 12. Patients met NINDS criteria for possible or probable PSP. They met criteria for PSP-P or PSP-R, according to Williams er al, (2005; 2008). They were tested with the Neuropsychiatric Inventory (NPI) of Cummings et al (1994) and with the MMSE of Folstein et al (1975). RESULTS: We saw 5 patients with PSP-P (mean age at presentation = 71.0 years) and 6 patients with PSP-R (mean age at presentation = 74.3 years). M:F ratio in the PSP-P group was 1.5:1, whereas M:f ratio in the PSP-RS group was 2:1. The initial MMSE score in the PSP-P group (mean=25.0+/-4.8) was significantly higher than that of the PSP-RS group (mean=12.7+/-9.8; p=0.041). The initial NPI score in the PSP-P group (mean=3.0+/-1.6) was not significantly different from that of the PSP-RS group (mean=4.2+/-1.2; p=0.214). Apathy was the most common behavioral symptom seen in both groups (all 6 of the PSP-RS patients and 4 of the 5 PSP-P patients). Anxiety was common in the PSP-R group (3 cases), but was not seen at all in the PSP-P group. OBJECTIVE: To compare cognitive and behavioral features of patients with progressive supranuclear palsy-parkinsonism (PSP-P) and PSP-Richardson syndrome (PSP-R) at their initial visit. Fig. 2 NPI scores in each group. The initial NPI score in the PSP group (mean=3.0+/-1.6) was not significantly different from that of the PSP-RS group (mean=4.2+/-1.2 ; P=0.2134). Figure-1 NPI findings. Fig. 3 MMSE in each group. The initial MMSE score in the PSP-P group (mean=25.0+/-4.8 was significantly higher than that of the PSP-RS group (mean=12.7+/-9.8; P=0.041). References: 1.43.Dubois B, Pillon B, Legault F, et al. Slowing of cognitive processing in progressive supranuclear palsy. A comparison with Parkinson's disease. Arch Neurol 1988; 45:1194. 2.46.Brown RG, Lacomblez L, Landwehrmeyer BG, et al. Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy. Brain 2010; 133:2382. 3.Hensel A, Angermeyer MC, Riedel-Heller SGSOJ Measuring cognitive change in older adults: reliable change indices for the Mini-Mental State Examination. Neurol Neurosurg Psychiatry. 2007;78(12):1298. 4.48.Litvan I, Mega MS, Cummings JL, Fairbanks L. Neuropsychiatric aspects of progressive supranuclear palsy. Neurology 1996; 47:1184. 5.49.Schrag A, Sheikh S, Quinn NP, et al. A comparison of depression, anxiety, and health status in patients with progressive supranuclear palsy and multiple system atrophy. Mov Disord 2010; 25:1077. 6.50.Fukui T, Lee E, Hosoda H, Okita K. Obsessive-compulsive behavior as a symptom of dementia in progressive supranuclear palsy. Dement Geriatr Cogn Disord 2010; 30:179. 7.53.Williams DR, de Silva R, Paviour DC, et al. Characteristics of two distinct clinical phenotypes in pathologically proven progressive supranuclear palsy: Richardson's syndrome and PSP-parkinsonism. Brain 2005; 128:1247. 8.Wenning GK, Litvan I, Tolosa E. Milestones in atypical and secondary Parkinsonisms. Mov Disord 2011; 26:1083. Fig. 1 The NPI findings in each group showing Apathy is the most common behavioral symptom seen in both groups ( all 6 of the PSP-RS patients and 4 of the 5 PSP-P patients). Anxiety was common in the PSP-R group but not in the PSP-P group. CONCLUSIONS: Patients with PSP-P are less likely than PSP-R patients to be demented when they first present to a neurologist’s office. Both PSP subtypes are likely to have apathy as a prominent behavioral feature of their disease. Last Edited: April/11/2014 Author Disclosures: none Email: saria-refai@ouhsc.edu