A case report published earlier this year in the journal Radiology Case Reports discusses the symptoms and features of progressive supranuclear palsy (PSP) and explores different ways to diagnose it.

PSP falls within a category of FTD disorders that primarily affect movement, with some symptoms of the disease resembling those seen in Parkinson’s disease. Like other FTD disorders, behavioral and emotional symptoms can develop in people living with PSP, such as depression, apathy, and emotional instability. It is also possible for cognitive symptoms to develop, such as impairments in planning and problem-solving.

PSP symptoms include difficulty with eye movement, instability in posture, an unstable gait, and abnormally slow movement. As highlighted in the report, PSP symptoms overlap with other conditions such as multiple system atrophy, Lewy body dementia, and corticobasal syndrome, another movement-related FTD disorder. Because of this overlap, PSP is difficult for clinicians to diagnose on symptoms alone. The man living with PSP featured in the study experienced symptoms that initially made clinicians suspect that he had Parkinson’s disease. In addition to difficulty opening his eyes, the man had problems with vertical eye movement and an increased frequency of falling incidents.

The report notes that medical imaging can be helpful in achieving an early diagnosis, as there are indicators in atrophy patterns that can inform medical professionals of the potential presence of PSP or a related disease. One such indicator is the “hummingbird sign,” an atrophy pattern in the midbrain that resembles the head of a hummingbird, which was discovered in the imaging results of the person diagnosed featured in the study. Medical imaging is also helpful in ruling out potential non-dementia causes of symptoms as well, such as a brain lesion or vascular dysfunction.

PSP is divided into various subtypes based on the presenting symptoms and the underlying pathological mechanisms driving the disease, with its most common type, PSP-Richardson-Steele (PSP-RS), making up more than half of cases. PSP-RS is known for causing dysfunction in eye movements and posture instability before the eventual onset of symptoms more consistent with Parkinson’s disease. Differentiating between types of PSP is essential, the report says, as different subtypes have different prognoses.

The report highlights the progress in molecular imaging and its diagnostic potential for PSP, such as recent research suggesting that FDG-PET scans have diagnostic potential for PSP.

While there is no cure for PSP, some of its symptoms — such as abnormal eye movements, depression, anxiety, or “Parkinsonian” symptoms – can be addressed with medicines and other interventions. However, this is not guaranteed to work – the man featured in the report, for example, was prescribed the Parkinson’s drug levodopa, which did not improve his symptoms.

Are you curious about PSP, its symptoms, and how it can be diagnosed? AFTD’s HelpLine has the answers you need about PSP and any other form of FTD: contact the HelpLine at 1-866-507-7222 or info@theaftd.org.

Are you interested in learning more about PSP? A previous pilot study looked into the benefits of therapeutic exercise for people living with PSP and found significant improvements in multiple areas. Another study evaluated the use of wearable technology to monitor the progression of PSP.