Objective: We aimed to determine longitudinal changes in motor and cognitive features of Progressive Supranuclear Palsy using multiple closely spaced follow-up timepoints over a period of 2 years.

Background: PSP is a neurodegenerative condition characterised by postural instability with falls, supranuclear vertical gaze palsy, levodopa-unresponsive parkinsonism and cognitive impairment. Despite the prevalence of these symptoms is well documented, very little is known about their longitudinal change over time. Moreover, the effectiveness of clinical scales to detect changes in symptoms in the early stages of PSP is still a matter of discussion in the literature.

Method: 28 healthy controls and 28 PSP participants, with average time since onset of symptoms of 1.9 years, were prospectively studied every 3 months for up to 24 months of longitudinal follow-up. Changes from baseline scores were calculated at each follow-up timepoint using different clinical scales to identify longitudinal progression of motor and cognitive symptoms and to investigate the effects of baseline variables in the dropout rate among PSP participants.

Results: The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, detected mild cognitive impairment at baseline in PSP. Both scales revealed poor longitudinal sensitivity to clinical change in global cognitive symptoms. Conversely, the Unified Parkinson’s disease Rating Scale – part III and the PSP Rating Scale reliably monitored motor decline less than 2 years after disease onset. Of particular note, postural instability, oculomotor dysfunction and falls progressed faster while bulbar, limbs and behaviour features had a slower and more variable progression.

Conclusion: While better cognitive screening tools are still needed to monitor cognitive decline in PSP, motor decline is consistently captured by clinical rating scales. These results support the inclusion of multiple follow-up timepoints in longitudinal studies alongside with more advanced technology to better monitor changes in cognitive and motor symptoms in early stages of PSP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/early-detection-of-change-in-motor-and-cognitive-symptoms-in-a-longitudinal-progressive-supranuclear-palsy-cohort-the-oxquip-study/