Objective: To identify clinical bedside examination signs indicative of frontal lobe dysfunction with a prognostic value in patients with progressive supranuclear palsy (PSP).

Background: The systematic assessment of clinical bedside signs reflecting frontal-lobe dysfunction, and their importance for prediction of outcomes, has not been thoroughly studied in patients with PSP.

Method: Cross-sectional study of 61 patients accomplishing current criteria for “probable” and “possible” PSP during the years 2012-2022. At first visit, all patients were evaluated by a neurologist and a neuropsychologist expert in movement disorders who systematically assessed the presence of utilization behavior, grasping, groping, orobuccal apraxia, echolalia, ecopraxia, anosognosia, greed for food and emotional incontinence. The PSP Rating Scale (PSPRS) was also administered, and all patients underwent a comprehensive neuropsychological examination. Mortality data were collected for censoring date 15 December 2022.

Results: Mean age of patients was 73.6 years, 54.8% female, and mean disease duration was 3.12 years. 55.74% had PSP-Richardson syndrome. The mean PSPRS score was 34.2. At first visit, grasping was the most prevalent sign (63.9%), followed by greed for food (60.6%), ecopraxia (50.8%), emotional incontinence (49.2%), groping (32.8%), anosognosia (22.9%), echolalia (22.9%), orobuccal apraxia (11.5%), and utilization behavior (9.8%). Higher PSPRS scores were found in patients with grasping (39.5 vs 25, p<0.01), groping (43.6 vs 29.3, p<0.01), orobuccal apraxia (51.1 vs 32, p<0.01), and anosognosia (42.5 vs 31.8, p=0.04) [Figure1]. In multivariate linear regression analysis grasping, orobuccal apraxia, and anosognosia were independent predictors of PSPRS score. Patients with these three clinical signs showed poorer performance on tests of executive and visuoperceptive function. In a sub-analysis of 51 patients evaluated during the first 4.3 years of the disease, groping was found as an independent risk factor for mortality, with a survival rate of 41.5% at 6.7 years (HR 3.59; 95% CI 1.13 – 11.44, p<0.05; [Figure2].

Conclusion: Grasping, orobuccal apraxia, and anosognosia appear as clinical bedside signs able to predict disease severity in patients with PSP. Early onset groping may be a predictor of mortality, although future studies are needed to confirm these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prognostic-impact-of-frontal-lobe-clinical-bedside-signs-in-progressive-supranuclear-palsy/