Objective: The purpose of this study was to identify which symptoms predict the life prognosis in progressive supranuclear palsy (PSP).

Background: Patients with PSP are characterized by ocular motor dysfunction, postural instability, akinesia, gait freezing and cognitive dysfunction, though all symptoms are not always identified especially in early stage of the disease. Previous studies have demonstrated controversial results regarding clinical milestones and prognostic factors [1].

Method: In this retrospective study, clinically diagnosed PSP patients were consecutively enrolled from Jan 2005 to Oct 2017. Demographic data, clinical symptoms, neurological findings, decline in activity of daily living and a survival time were obtained from the medical records. Core clinical features in the diagnostic criteria of PSP at 3 years from the onset were also collected [2]. We assessed the relationship between the particular PSP symptoms and life prognosis by Kaplan-Meier survival analyses and the adjusted hazard ratios (HRs) were estimated in Cox regression analyses.

Results: We analyzed 70 patients with PSP, 40 of men, with a mean age at disease onset of 70.7±7.3 years and a mean follow-up period of 6.5±3.1 years. Fourteen patients (20%) died and a mean survival time from the onset was 9.2±4.2 years. At 3 years from the onset, the number of patients with vertical gaze palsy, slow saccade, fall, retropulsion or gait freezing was 21 (30%), 25 (36%), 54 (77%), 52 (74%) and 43 (61%), respectively. Kaplan-Meier analyses revealed that patients with vertical gaze palsy had significantly shorter period to wheelchair-bound, disabled food intake and death than those without (log rank test p=0.018, p<0.001, p<0.001). The risks of disabled food intake and mortality were significantly higher in patients with vertical gaze palsy (adjusted HR 10.5, p<0.001, adjusted HR 18.3, p=0.001).

Conclusion: Vertical gaze palsy was a poor prognostic factor for dysphagia and shortened life expectancy.

References: [1] Glasmacher SA, et al. J Neurol Neurosurg Psychiatry 2017; 88: 402-411. [2] Höglinger GU, et al. Mov Disord 2017; 32: 853-864.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ocular-motor-dysfunction-as-the-predictable-milestone-of-life-prognosis-in-progressive-supranuclear-palsy/