1. #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 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).
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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