Objective: Characterize the clinical phenotype of a Sri Lankan Progressive Supranuclear Palsy (PSP) cohort and identify correlations between severity  with cognitive impairment and functional status.

Background: PSP is a heterogeneous tauopathy characterized by early falls and vertical gaze palsy.  As part of the GP2 study, this study aims to describe the clinical landscape and functional status of patients with PSP in Sri Lanka.

Method: This multicenter cross-sectional study (November 2025–February 2026) evaluated patients diagnosed PSP. Clinical features were mapped using MDS-PSP scores. Disease severity was quantified via the PSP Rating Scale (PSP-RS), cognitive status via the Montreal Cognitive Assessment (MoCA), and functional independence via the Barthel Index (BI). Statistical significance was determined using Spearman’s correlation (⍴) and multiple linear regression to identify independent predictors of functional impairment and cognitive decline.

Results: The cohort (n=36) had a median age of 68.0 years (IQR 61.8–73.0) and a median onset of 65.5 years (IQR 58.8–70.3), with a male-to-female ratio of 1.4:1. Predominant clinical features included postural instability (97.2%;n=35), akinesia (94.4%;n=34), and ocular motor dysfunction (91.7%;n=33). Cognitive impairment was prevalent (72.2%;n=26), with a median MoCA score of 18.0 (IQR 10.5–22.5). Neuroimaging was available in 12 patients with midbrain atrophy in 50%(n=6).Total PSP-RS scores showed significant inverse correlations with BI (⍴= -0.830, p< 0.001) and moderate inverse correlation with MoCA (⍴= -0.615, p < 0.001).In a multiple linear regression model, all six domains were negatively correlated with BI, and all of those correlations were statistically significant. Gait and Midline (PSP-RS Part VI) was the primary independent driver of functional disability (standardized 𝛃 = -0.506, p < 0.001). However, none of the individual domains emerged as a statistically significant independent predictor of the MoCA score.

Conclusion: In this Sri Lankan cohort, axial motor impairment and gait instability are the most prominent clinical features and the strongest independent predictors of functional dependency. These findings highlight the significant impact of axial symptoms on daily functioning.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-analysis-of-progressive-supranuclear-palsy-in-sri-lanka-preliminary-results-from-a-cross-sectional-collaborative-study-with-global-parkinsons-genetic-program-gp2/