Objective: To compare motor and non-motor symptoms in the prediagnostic phase of progressive supranuclear palsy (PSP) with control subjects without neurodegenerative disease (C) as well as Parkinson’s disease (PD) patients from a University Hospital Movement Disorder’s Unit.

Background: The new category “suggestive of” in the MDS PSP diagnostic criteria could allow an early diagnosis. However there is still limited information about prediagnostic motor and non-motor PSP symptoms, which might provide information on when and how PSP starts as well as the opportunity to more reliably test experimental therapies compared to advanced disease stages.

Method: This is a retrospective case-control study based on clinical charts review and a structured questionnaire administered to the patients and their caregivers. We included 134 subjects: 44 probable PSP patients (39% females, age 77±7) and an age and sex matched control group of 46 PD patients and 44 C. Prediagnostic symptoms were those present at least one year before the diagnosis. We explored 39 symptoms in the following domains: visual, motor, cognitive, mood, gastrointestinal/urinary, dizziness and miscellaneous. Comparative analysis was done using non-parametric tests. Significance threshold was set at <0.05 with FDR correction for multiple comparisons.

Results: Richardson’s syndrome was the most frequent phenotype (56.8%), followed by PSP-parkinsonism (18.2%) and PSP-freezing (18.2%). The most frequent prediagnostic symptoms in PSP patients were motor symptoms (86.4%; falls 52%, gait disorders 46%), mood disturbances (43.18%; sadness 34%, anxiety 22%), visual symptoms (34%) and dizziness (27%). Falls and mood disturbances were the earliest features and were present 3.5 to 10 years before diagnosis in a 50% and a 30%, respectively. PSP patients had more falls (p < 0.001), gait disturbances (p < 0.001), dizziness (p < 0.007), cognitive (p <0.004) and visual problems (p< 0.003) than PD patients who showed more tremor (p <0.04), nightmares (p <0.03), nocturnal movements (p <0.03) and constipation (0.003). PSP patients had more consultations to ENT and ophthalmologist before the diagnosis than C.

Conclusion: Falls and mood disturbances were the most frequent features among a wide range of prediagnostic motor and non-motor PSP symptoms, suggesting that a prediagnostic or prodromal phase can be identified in PSP.

References: [1]. Hoglinger G, Respondek G, Stamelou M, et al. Clinical Diagnosis of Progressive Supranuclear Palsy – The Movement Disorder Society Criteria. MovDisord. 2017 Jun;32(6):853-864.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/motor-and-non-motor-symptoms-in-the-prediagnostic-phase-of-progressive-supranuclear-palsy-the-step-back-psp-study/