Objective: To define differences of neuropsychiatric and neuropsychological profile among Progressive Supranuclear Palsy (PSP) -Richardson syndrome (PSP-RS), PSP-parkinsonism (PSP-P), and Parkinson’s disease (PD), in order to identify non-motor predictors of precocious PSP diagnosis.

Background: The two main variants of PSP, PSP-RS and PSP-P, display motor and non-motor features similar to PD, particularly in the early stage.

Methods: 180 subjects suffering from degenerative parkinsonism since less than 24 months were enrolled in the period 2006-2012. They were diagnosed retrospectively according to international diagnostic criteria as suffering from PD (n=155), PSP-P (n=11) and PSP-RS (n=14). At enrollment, all patients were submitted to neuropsychiatric diagnostic evaluation and a comprehensive neuropsychiatric and neuropsychological evaluation. Multivariate logistic regressions including neuropsychiatric and neuropsychological features that differed significantly among groups was applied to identify predictors of PSP diagnosis.

Results: There were no significant differences at any demographic or neurological feature among groups. Prevalence of apathy and depression was significantly higher in the 2 PSP groups with respect to PD. As to neuropsychiatric scales, the three groups differed significantly only in Apathy Rating Scale score. PSP-P and PSP-RS patients displayed significantly worse performances at several neuropsychological examined with respect to PD. Phonological verbal fluency deficit significantly predicted PSP-RS diagnosis whereas a formal diagnosis of apathy significantly predicted PSP-P diagnosis.

Conclusions: Our results demonstrate that PSP-P and PSP-RS patients are characterized by peculiar patterns of neuropsychiatric and cognitive symptoms, detectable early along disease course. Thus, within the first 24 months after onset of symptoms, poor performances in tests investigating apathy and phonologic verbal fluency may support diagnosis of PSP rather than PD. In particular, impairment of phonological verbal fluency predicts diagnosis of PSP-RS, whereas the presence of apathy supports PSP-P diagnosis. These findings suggest that comprehensive cognitive and neuropsychiatric evaluations might represent useful and cost-effective contributors to the diagnostic work-up of patients with progressive parkinsonism early along disease course.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuropsychiatric-and-cognitive-predictors-of-early-diagnosis-of-progressive-supranuclear-palsy/