Objective: To characterize the clinical profile, cognitive performance, sleep and psychiatric features among patients with atypical parkinsonism.

Background: Atypical Parkinson syndromes (APS) are group of neurodegenerative disorders characterized by rapid progression, early disability, and overlapping clinical features. It includes Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA), and Corticobasal Syndrome (CBS). Understanding their clinical profile, cognitive impairment is essential for improving patient management.

Method: A total of 223 patients (PSP-113, MSA-71, CBS-16 NPH – 12, FTD-3, and uncharacterized-8 were recruited from inpatient and outpatient services at NIMHANS and Ramaiah Hospital, Bengaluru, India.  Clinical, sleep, and psychiatric assessments were performed using disease rating scales such as PSPRS, UMSARS, UPDRS, and including MOCA, Hamilton Depression and Anxiety Scales, Epworth Sleepiness Scale, and PSQI. Cognitive domains were further evaluated using FAB, ACE-III, and NIMHANS Neuropsychological Battery for Elderly (NNBE).

Results: Among the 223 patients, with a mean age of 61.87±8.11 years. Age of onset was earlier in MSA (55.79±8.29 years) than PSP (60.06±8.25 years). The symptoms includes loss of balance, falls, and gait disturbances. 32.5% at high risk for obstructive sleep apnea, 18.6% with excessive daytime sleepiness, and 55.3% reporting poor sleep quality. Depression and anxiety were prevalent, with 62.8% having mild–moderate depression and 59.06% mild–moderate anxiety. The MOCA score was 17.77±6.71. Comparative cognitive analysis showed slightly higher executive, language, and memory scores in MSA compared to PSP, although variability was high. Disease severity using PSP Rating Scale (PSPRS) score in PSP patients was 35.79 ± 14.91 whereas in MSA patients, the Unified MSA Rating Scale (UMSARS) scores were 16.32 ± 8.01 (Part I) and 18.34 ± 9.28 (Part II). UPDRS Part III showed mean scores of 38.66 ± 20.11 in PSP and 35.12 ± 21.03 in MSA.

Conclusion: Our finding showed that the patients with atypical parkinsonism demonstrate significant motor impairment along with prominent cognitive, psychiatric, and sleep disturbances. Although MSA patients showed slightly better performance, but both groups exhibited substantial variability emphasizing the need for comprehensive multidisciplinary evaluation and support.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-cognitive-profile-in-patients-with-atypical-parkinsonian-syndromes-a-longitudinal-study-from-a-tertiary-care-center/