Are There Signs And Symptoms Of Progressive Supranuclear Palsy That Are More Common Or Appear First
The most common first sign is a loss of balance when walking or climbing stairs. You might feel stiff, awkward when walking and have falls for reasons you can’t explain. The second most common symptom is difficulty looking downward. Then, you might have a hard time finding words, freezing in the middle of walking and have forgetfulness, personality changes, increased irritability and loss of interest. Another very common initial symptom is a “stare” look on your face. Other symptoms that occur at first, but are less common, include slurred speech, difficulty driving and shaky hands.
What Questions Should I Ask My Healthcare Provider About Progressive Supranuclear Palsy
- What exercises are safe to do?
- Are there any vitamins I should take?
- How can my friends and family support me?
- Can you refer me to a psychiatrist to help with medications for clinical depression?
- Can you refer me to a therapist for counseling?
- Do you think I will need to have a gastrostomy?
- Is there a speech-language therapist I should see?
- Should I see an ophthalmologist to help with my eyesight?
- Where can I get a weighted walker to help me get around?
- Can I continue to go to work/school?
A note from Cleveland Clinic
Progressive supranuclear palsy is a serious disorder that can negatively affect you in many ways and shorten your lifespan. It’s a rare brain disease that affects your walking, balance, eyesight, thinking, emotions and more. Keep a close eye on your symptoms and report them. Don’t hesitate to stay in contact with your healthcare providers. See your specialists, go to therapy, take prescribed medications and do everything you can to improve your quality of life!
Last reviewed by a Cleveland Clinic medical professional on 10/23/2020.
References
What Is The Difference Between Progressive Supranuclear Palsy And Parkinsons Disease
PSP frequently resembles Parkinson’s disease, often making it difficult to distinguish these conditions from one another. Both cause difficulty with stiffness and clumsiness. Both cause slow movement and start later in life. And both show damage to the same areas of the brain that affect movement. In particular, PSP-P can be nearly indistinguishable from Parkinson’s disease by clinical examination.
But, PSP and Parkinson’s disease are different in several ways. On average, PSP gets worse quicker than Parkinson’s and doesn’t respond as well to medications. People with Parkinson’s usually bend forward, while people with PSP stand very straight, or even slightly backwards. Problems with swallowing and with speaking appear early with PSP and they are far more severe. A tremor is rare with people who have PSP and common in people who have Parkinson’s. Motor symptoms, such as slowing and loss of dexterity, typically start very asymmetrically in Parkinson’s disease .
Additionally, their underlying pathological processes differ at the molecular level. Abnormalities relating to the protein tau and its effect on brain cells is central to PSP pathology. And, when looked at through a microscope, the damaged brain cells in someone with PSP look different than those of people who have Parkinson’s.
Comparative Gait Analysis In Progressive Supranuclear Palsy And Parkinson’s Disease
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What Is The Difference Between Progressive Supranuclear Palsy & Parkinsons Disease
Both PSP and Parkinson’s disease show similar symptoms such as stiffness, movement difficulties, and clumsiness, but the severity of the condition is often based on the symptoms.1
Progressive supranuclear palsy is more progressive when compared to Parkinson’s disease.2
PSP is a rare brain disorder that causes serious and progressive problems whereas Parkinson’s disease is a nervous system disorder that affects movements.3,4
Many studies were conducted based on the facts of the two diseases that presented very similar symptoms, but they are quite different from each other when analyzed in detail.
PSP and Parkinson’s have overlapping symptoms, but diagnosis often becomes complicated. However, experts suggest that PSP is more severe with cognitive impairment when compared to Parkinson’s disease. Concentration and memory are most severely affected in patients with progressive supranuclear palsy.
Distinguishing Between Progressive Supranuclear Palsy And Parkinson’s Disease
Researchers from the University of Melbourne have established how two diseases that present in similar ways are in fact quite different.
Progressive Supranuclear palsy and Parkinson’s Disease have overlapping symptoms but remain difficult to distinguish.
However, a first ever paper on the topic published in the Journal of Neuropsychology now suggests that people with PSP experience more severe and extensive cognitive impairments than those with PD early on.
The study indicates that patients with PSP experience more severe and extensive impairments in higher order functions such as planning, abstract thinking, memory retrieval than those with PD.
Lead researcher Dr Young-Eun Claire Lee said the two conditions are so similar that in some cases, patients with PSP often go undiagnosed for the main part of their illness.
“PD and PSP are the two of the most common forms of neurodegenerative diseases resulting in loss of balance and deterioration in mobility,” said Dr Lee.
“Telling these differences apart can be challenging because most patients with PSP do not develop distinctive symptoms such as paralysis or weakness of the eye muscles and episodes of frequent falling until later stages,” she said.
While the study sample was small, the results indicate that cognitive profiles may aid differential diagnosis in earlier stages. PSP claimed the life of musician/actor Dudley Moore.
There are no current treatments for PSP.
Explore further
What Are The Causes Of Parkinsons Disease And Progressive Supranuclear Palsy
Both conditions are caused by damage to a specific area of the brain called the Substantia Nigra. As a result both conditions have similar symptoms.
Parkinson’s disease is caused by a loss of cells in a specific region of the brainstem deep within the brain. This leads to a reduction in a chemical called dopamine which is responsible for sending messages to the body to help control movements.
PSP occurs when cells in an area of the brain called the brainstem are damaged as a result of a build-up of a protein called Tau. Tau occurs naturally in the brain and is usually broken down before it reaches high levels. In people with PSP it is not broken down properly which prevents information passing between nerve cells.
What Can I Expect If Ive Been Diagnosed With Progressive Supranuclear Palsy
Your symptoms will slowly worsen with time. PSP can’t be reversed, and it can’t be cured. However, the sooner the diagnosis is made and a treatment plan is put into place, the better your quality of life will be.
Most patients with PSP become wheelchair-bound. They may need part or full time care as early as three to four years into the disease. This depends on the person.
Unfortunately, in the long-term, complications of the disease can be fatal. PSP won’t directly kill you, but it is deadly. Common complications include choking, pneumonia, fractures and head injuries .
How Can My Friends And Family Help If I Have Progressive Supranuclear Palsy
Tell your friends and family about your symptoms. Let them know what you can and can’t do. Help them understand that changes in your personality, eye contact and mood are part of the illness. It’s also important to explain to them that the severity of your symptoms can come and go. One hour, you may be walking, eating and writing just fine, and the next hour you might barely be able to do those things at all.
If you’re a caregiver for someone with PSP, be sure to take care of yourself, too!
Comparison Of Gait Patterns In Newly Diagnosed Pd Versus Early Psp Patients
Application of predictive models on single task data revealed that increased cycle length was a gait variable characteristic of newly diagnosed PD patients, whereas longer stance phase was a gait feature that typified early PSP gait pattern. In the dual task condition, longer stance phase was confirmed as the best predictor for PSP diagnosis, whereas increased cadence was the strongest predictor for PD diagnosis. These findings indicate that from an early stage, PSP patients exhibit more alterations in temporal gait features when compared to PD patients. Further, they suggest that the dual task condition exerts a major effect on step length35 in PD patients from a very early stage, as reflected by increased cadence.
In conclusion, the present study demonstrates that quantitative gait evaluation clearly distinguishes PSP patients from PD patients since the earliest stages of disease. Our findings indicate that gait analysis could be candidate as a reliable biomarker in both clinical and research setting. In addition, our results may offer speculative clues for conceiving early disease-specific rehabilitation strategies.
Whats The Difference Between Progressive Supranuclear Palsy And Parkinsons
People with PSP generally progress more rapidly than people with Parkinson’s. A person with Parkinson’s tends to lean forward while a person with PSP tends to lean backward. Tremors are common in people with Parkinson’s and rare in people with PSP. Speech and swallowing abnormalities are more severe and show up sooner in those living with PSP.
For more information on progressive supranuclear palsy, read this fact sheet and insights from the CurePSP organization website.
There Are Stark Differences Between Cerebral Palsy And Parkinsons Disease
While some of the symptoms of cerebral palsy are also associated with Parkinson’s disease, there are stark differences between the two conditions.
Parkinson’s Disease vs. CP
Parkinson’s disease is a neurological disorder which usually affects certain individuals over the age of 60. This condition is characterized by movement difficulties such as a shuffling gait, memory problems, tremors and stiffness. Despite the advances made in medicine, there is no definitive test for Parkinson’s, and most individuals who suffer from it may not get a cure.
Parkinson’s is mostly seen in the elderly; however, it’s not unheard of the condition affecting people who are as young as 20. Genetics, environment and stress all play a part in the development of the disorder.
How Do I Take Care Of Myself If I Have Progressive Supranuclear Palsy
Take as many precautions as you can to keep yourself safe. Put railings in your hallways and bathtub to help when you lose your balance. Use a weighted walker or a wheelchair. Consider getting rid of objects that are on the floor or near it such as rugs and short coffee tables. It is likely you’ll trip over these objects because, as your symptoms worsen, you’ll be unable to look down without prism glasses.
Also, purchase shoes with smooth soles instead of rubber soles. If you’re unable to lift your foot when you start to walk, you might fall forward. Smooth soles make it easier for the foot to slide forward. You can also wear bifocals or prism glasses to help with looking down. Follow any other instructions your healthcare provider gives you.
Whats The Difference Between Dementia With Lewy Bodies And Parkinsons
In dementia with Lewy bodies, dementia always appears first. There can also be changes in alertness as well as visual hallucinations. However, because of the presence of Lewy bodies throughout the entire brain, characteristics of this disease not only include cognitive characteristics, but also physical, sleep, and behavioral changes. As the disease progresses, the motor symptoms common to Parkinson’s such as tremor, slowness, stiffness, and walking and balance problems will appear.
For more information on dementia with Lewy bodies, visit www.lbda.org.
Whats The Difference Between Corticobasal Degeneration And Parkinsons
The main difference between CBD and Parkinson’s is that it usually starts on one side with the gradual loss of use of one hand or leg , and there may be little flicks of involuntary muscle jerks. Walking and balance difficulties usually occur later in CBD than in Parkinson’s. Also, in CBD, a person may have trouble with purposeful movements, such as buttoning a shirt or cutting food.
For more information on corticobasal degeneration, read this information page.
Whats The Difference Between Multiple System Atrophy And Parkinsons
Parkinson’s and MSA both affect the movement control system and the involuntary autonomic control system and early symptoms can make a differential diagnosis a challenge. MSA, however, tends to progress faster than Parkinson’s; balance problems and a stooped posture happen earlier and get worse more quickly with MSA; and autonomic functions such as blood pressure, heart rate, breathing, sweating, bladder function, and sexual problems are more severe in people with MSA.
For more information on multiple symptom atrophy, read this fact sheet.
What Parts Of The Brain Does Progressive Supranuclear Palsy Affect
Eventually PSP will spread to virtually every part of your brain. PSP affects various parts of your brain to a varying extent and at various stages of the disease. Your basal ganglia and brainstem tend to be affected early and more severely. The brainstem is responsible for a large number of vital functions, including your ability to swallow, and posture control. The basal ganglia also help with posture, as well as eye movements, thinking and emotions. Additionally, the basal ganglia are essential to the control of automated movements.
What Are The Signs And Symptoms Of Progressive Supranuclear Palsy
If you have PSP, you’ll likely experience the following symptoms that worsen with time. You’ll likely:
- Lose your balance frequently. You may fall, especially backwards.
- Lose the ability to aim your eyes. You might not be able to look up or down, follow something that’s moving, or keep your eyes fixed on something still. Your eyelids might retract , giving your face a surprised look.
- Have trouble swallowing.
- Feel stiff muscles and move slowly.
- Have trouble speaking. Your speech might be quieter and slurred, impairing your ability to pronounce words.
- Feel mood changes and observe behavioral changes.
- Experience depression and apathy .
- Get dementia. Your thoughts will be slow, you’ll have difficulty resisting impulses and you may find problem-solving difficult.
- Have insomnia .
- Feel irritable and agitated.
Whats The Difference Between Vascular Parkinsonism And Parkinsons
As the name implies, vascular parkinsonism is caused by cerebrovascular disease which affects the blood supply to the brain. Vascular parkinsonism is caused by one or more small strokes, while Parkinson’s is caused by a gradual loss of nerve cells. One major difference from Parkinson’s is that it’s not progressive, while Parkinson’s becomes worse with time. Another difference is that there are no tremors in vascular parkinsonism.
For more information on vascular parkinsonism, read this journal article.
What Is Parkinsons Disease And Progressive Supranuclear Palsy
Parkinson’s disease and Progressive Supranuclear Palsy are similar conditions in which there is a premature deterioration of nerve cells in the midbrain. Onset of both diseases is in late middle age with men more likely to be affected by both conditions. PSP occurs less frequently than Parkinson’s disease.
Cerebral Palsy Vs Parkinsons: Causes Symptoms And Management
Do you know what the main differences between cerebral palsyand Parkinson’s disease are?
Both are neurological disorders, but they affect individualsat very different times in their lives.
This article will help you differentiate the causes, symptoms, and management of cerebral palsy vs Parkinson’s.
Mri Technique In Distinguishing Psp And Parkinsons Disease
A medical study was conducted on 10 patients who showed motor symptoms. All the 10 patients have Parkinson’s and 5 patients were experiencing vertical supranuclear gaze palsy with increased imaging biomarker values and slowness in vertical saccades.
MRI was performed on these patients that included both MRPI and MRPI 2.0. The values showed different ranges between these patients and it also helped to identify the condition during the early stage of the symptoms.
Clinical variables assessed the motor functions and cognitive functions. Results were prepared based on the imaging biomarkers and clinical variables and it showed that disease progression was most severe in PSP when compared to Parkinson’s disease.3,4
Also Read:
What Should I Avoid Eating Or Drinking With This Condition
There are no foods that improve progressive supranuclear palsy or worsen it. However, you should always drink water, eat healthy and exercise .
As your symptoms progress, you may find eating and drinking more difficult because you’ll have difficulty swallowing. Be sure to adjust your diet to avoid choking. The muscles in your throat may not be able to direct your food and water down the right “pipe” – that is, into your stomach and not your lungs. This is dangerous because you could choke, or you could possibly get pneumonia. Talk to your healthcare provider about what you can and can’t eat and drink as your condition progresses.
Which Disease Is Similar To Progressive Supranuclear Palsy
Dr. Adam Lewispalsymemory lossconfusedalzheimer’s diseaseparkinson’s disease
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Characteristics Of Atypical Msa: Parkinsons Disease Mimics
Case illustration
A 67-year-old female : presented with a 1-year history of worsening dexterity of her left hand. Examination revealed an asymmetrical tremor of the hand at rest with cogwheel rigidity and bradykinesia. Her symptoms and signs improved with levodopa therapy . Over the next 3 years, she developed motor fluctuations, generalized peak-dose dyskinesia, worsening dysarthria, urinary frequency and constipation. She also reported intermittent mild non-threatening visual hallucinations. Orofacial dystonia and urinary incontinence then became more intrusive. She died aged 75. The final clinical diagnosis was Parkinson’s disease. Autopsy confirmed the pathological diagnosis of MSA . There were frequent depositions of neuritic plaques but no neurofibrillary tangles were found in the brain. Key clinical features of all Parkinson’s disease mimics are provided in Supplementary Table 2.
Atypical MSA versus typical MSA or Parkinson’s disease
Red flag features in atypical MSA versus typical MSA or Parkinson’s disease
| Pathological diagnosis . |
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What Are The Symptoms Of Atypical Parkinsonian Disorders
Like classic Parkinson’s disease, atypical Parkinsonian disorders cause muscle stiffness, tremor, and problems with walking/balance and fine motor coordination.
Patients with atypical Parkinsonism often have some degree of difficulty speaking or swallowing, and drooling can be a problem. Psychiatric disturbances such as agitation, anxiety or depression may also be part of the clinical picture.
Dementia with Lewy bodies can cause changes in attention or alertness over hours or days, often with long periods of sleep during the day. Visual hallucinations — typically of small animals or children, or moving shadows in the periphery of the visual field — are common in DLB. DLB is second only to Alzheimer’s disease as a cause of dementia in the elderly, and it most commonly affects patients in their 60s.
Patients with progressive supranuclear palsy may have difficulties with eye movements, particularly when looking downward, and with balance — when descending stairs, for instance. Backward falls are common and may occur during the early course of the disease. PSP is not usually associated with tremor, unlike Parkinson’s disease.
Parkinson’s Disease and Movement Disorders Center
What Are The Symptoms Of Progressive Supranuclear Palsy
Symptoms of PSP tend to start out subtly. Then over time they become more noticeable and severe. Often, the first sign is a problem with balance while walking. You may fall a lot or find that you feel a bit rigid or uncomfortable when you walk.
These are also early signs of PSP:
- Becoming more forgetful and cranky
- Having unusual emotional outbursts, like crying or laughing at unexpected times
- Becoming angry for no real reason
- Tremors in the hands
- Depression
- Trouble directing your eyes where you want them to go
- Inability to control the eyelids, such as unwanted blinking or being unable to open your eyes
- Trouble holding someone’s gaze
Parkinsons Disease And Progressive Supranuclear Palsy
Patient Leaflets Team
- Reference Number: HEY1159/2020
- Departments: Ophthalmology Department, Orthoptic
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When And How Should I Talk To My Healthcare Provider
If you currently have no diagnosis and answered yes to several of the above questions or have been diagnosed with PD but think you may be showing signs of PSP instead, further work-up from a healthcare provider may be necessary. Bringing a list of symptoms you have been experiencing, especially ones that may be PSP-specific, may be helpful to guide your appointment with your provider. Asking specifically about PSP and if your symptoms may be a result of this condition may help further guide your appointment and lead to the conversation and answers you’re looking for.
For those with a current PD diagnosis who are not experiencing any changes as a result of treatment, it may be helpful to ask your provider the following:
- Should I have noticed any improvements in my symptoms as a result of treatment by now?
- Is it possible I may have a condition that mimics PD and isn’t really PD?
- Are there any tests we can do or treatments to try that might help determine if this is something else besides PD?
What Are The Types Of Progressive Supranuclear Palsy
There are many types of PSP but the two most common types are Richardson syndrome and PD-like variant – which means a Parkinson’s disease-variant. Together, they make up 75% of PSP cases. The symptoms are similar, but there are some unique differences.
Richardson syndrome has many symptoms including problems with walking and balance, abnormal speech, memory and thinking problems, trouble controlling eye movement and an unusual wide-eyed, staring facial expression. People with Richardson syndrome also have personality changes, forgetfulness, apathy , depression, irritability and problems with attention and concentration. These are the most common symptoms.
PD-like variant consists of the above symptoms, but also more closely resembles Parkinson’s disease. A tremor is the main symptom over balance problems and behavioral changes. PSP-parkinsonism responds better to antiparkinson drugs.
Comparison Of Gait Patterns In Pd And Psp Patients
Itn the single task, PSP subjects exhibited reduced velocity and cadence, shortened step and cycle length, increased cycle duration , and increased swing time variability when compared to PD patients. These data indicating that PSP gait pattern is characterized by dynamic instability are consistent with previous findings in smaller samples19,21,29. These results suggest that complex dysfunction of internal motor programming is more prominent in PSP patients than in PD patients, with the former group exhibiting dysfunction in both spatial and temporal domains, and the latter group exhibiting predominantly spatial dysfunction30,31. Notably, because dysfunction of spatial gait variables are generally responsive to dopaminergic treatment in PD patients32, the different gait patterns of the two patient groups could at least partly depend on the effectiveness of medication that is notoriously poor in PSP patients4. Gait patterns of the two groups were similar in both the single and dual tasks, with non-specific detrimental effects of the secondary task on both PSP and PD patients. Importantly, the major effect of the dual task in PSP patients was an increase in step width that could represent an attempt to counteract the lateral instability commonly observed as balance and walking deficits in PSP patients19.
Distinguishing Between Parkinsons Disease And Msa
It can be challenging to differentiate between PD and MSA. Early on in the course of the illness, MSA can manifest with mild parkinsonism and autonomic dysfunction. These clinical features are also often present in PD. Furthermore, in the beginning, the parkinsonism of MSA can be minimally responsive to levodopa, complicating the distinction between the diseases even more. Both diseases have a high rate of REM behavior sleep disorder . Therefore, it is very common for someone with MSA to initially receive a diagnosis of PD.
Over time, clinical features may develop that are not as common in PD and may suggest MSA as a diagnosis. However, although these features are not as common in PD, they can still be present in PD, so diagnosis remains difficult. The more features that are uncommon in PD that are present, the more the clinical situation warrants the consideration of MSA as the diagnosis. These “red flags” include:
- Poor levodopa response
- Facial dystonia from levodopa
- Sleep-disordered breathing such as obstructive sleep apnea
- Inspiratory stridor during daytime or sleep
- Jerky tremor when performing an action
- Axial postural abnormalities
- Cold, darkened/reddened hands and feet
- Severe difficulty with speech
- Severe difficulty with swallowing
- Pseudobulbar affect – the Involuntary and uncontrollable reactions of laughing or crying that are out of proportion to the cause of the emotional response
The Person Who Parkinson’s Disease Is Named After
Parkinson’s disease is a brain condition that can cause sufferers to have random and uncontrollable shaking or trembling, poor nerve function, and eventually destroys the ability to move or speak normally. Boxing legend Muhammad Ali had the disease. The Parkinson’s Foundation reports that actors Michael J. Fox and Alan Alda, as well as singer-songwriter , are also battling the illness. The Foundation also explains that shaking and trembling are not the only symptoms. Individuals might also suffer from a reduced ability to smell, as well as emotional issues like anxiety and depression.
But exactly who was Parkinson, and why is that name attached to what the Parkinson’s Foundation calls a “neurodegenerative disorder”?
The condition was named after an English doctor, James Parkinson. In 1817 Dr. Parkinson published a book regarding a condition he then called, “The Shaking Palsy.” The book was titled An Essay on the Shaking Palsy, and in it he described a series of symptoms he observed in six of his patients.
How Parkinsonism Differs From Parkinsons Disease
Parkinson’s disease is one of many types of parkinsonism. It’s caused by a loss of cells in the part of your brain that produces the neurotransmitter dopamine.
Parkinson’s disease and the different types of parkinsonism progress in different ways. Some may progress more rapidly than Parkinson’s disease. Others, like secondary parkinsonism, may be reversible.
The conditions also respond differently to treatments. For instance, someone who has a type of parkinsonism may not respond to the drug levodopa, which is commonly used for Parkinson’s disease.
It can be hard to tell the difference between types of parkinsonism. Here’s a look at some of the identified categories of parkinsonism with their typical symptoms and treatments.
- involuntary muscle contractions
Treatment
No treatment has been found to slow the progression of corticobasal syndrome. Parkinson’s drugs are generally ineffective but may help manage stiffness in some people.
How Is Progressive Supranuclear Palsy Diagnosed
A careful evaluation of symptoms can diagnose PSP. But it is often hard to diagnose in its early stages as it may mimic Parkinson disease or an inner ear infection. This is because balance is so affected by PSP. Diagnosis usually includes ruling out other conditions.
Balance problems and changes in gait are the clearest symptoms that can identify PSP, particularly when combined with an inability to control or move the eyes.
Multiple Causes Multiple Possibilities For Hope
Many areas of medicine fully accepted the notion that there can be several causes, even several types of cause, for one kind of disorder. For example, everyone recognizes that cancer can be caused by genes, chemical agents, infective agents, or some combination of these. In the ?eld of neurodegenerative diseases, such as idiopathic Parkinsonism, however, people seem oddly reluctant to draw the same conclusion, in spite of a rather convincing body of evidence. The facts now indicate that, for most patients with idiopathic Parkinsonism, their environment plays a more important role in causation than do their genes, though their genes may contribute to susceptibility.
How Is Psp Different From Parkinson’s Disease
PSP is often misdiagnosed as Parkinson’s disease, especially early in the disorder, as they share many symptoms, including stiffness, movement difficulties, clumsiness, bradykinesia , and rigidity of muscles. The onset of both diseases is in late middle age. However, PSP progresses more rapidly than Parkinson’s disease.
- People with PSP usually stand exceptionally straight or occasionally tilt their heads backward . This is termed “axial rigidity.” Those with Parkinson’s disease usually bend forward.
- Problems with speech and swallowing are much more common and severe in PSP than in Parkinson’s disease and tend to show up earlier in the disease.
- Eye movements are abnormal in PSP but close to normal in Parkinson’s disease.
- Tremor is rare in PSP but very common in individuals with Parkinson’s disease.
Although individuals with Parkinson’s disease markedly benefit from the drug levodopa, people with PSP respond minimally and only briefly to this drug.
People with PSP show accumulation of the protein tau in affected brain cells, whereas people with Parkinson’s disease show accumulation of a different protein called alpha-synuclein.