Communication impairments in people with progressive supranuclear palsy: A tutorial

Abstract

Progressive supranuclear palsy (PSP) is a progressive neurological condition, whose main features include supranuclear gaze palsy, frequent falls, bradykinesia, axial rigidity, cognitive decline and communication impairments. Even though communication impairments are early and prominent manifestations, there is a significant lack of research on the nature of these impairments in PSP and the role of speech-language pathologists (SLPs). This tutorial article aims to describe the communication impairments observed in people with PSP; provide clinical guidelines for SLPs when assessing motor speech, language and other communication impairments; and to present facilitation and compensation approaches to treatment for people with PSP. The predominant motor speech impairment is mixed dysarthria, but there is a lack of consensus about the classification of language impairments. The involvement of SLPs in the assessment and treatment of people with PSP should be early, on-going and in collaboration with other health professionals, with the primary focus of maintaining quality of life for these patients and their family members.

Language impairment in progressive supranuclear palsy and corticobasal syndrome

“…Where frank naming errors do occur in PSPs, they are often visually related to the target objects [36] and thus may be indirectly due to gaze palsy or other visual problems that are common in PSPs [36,58,100]. There are also a few reports of errors at the semantic or lexical retrieval stage [59,95], though these could reflect attentional deficits rather than a genuine degradation of semantic knowledge.…”

“…Where motor or visual problems are detected, assessment should be adapted appropriately, for example using tests which do not rely on visual processing (such as orally-presented syntactic comprehension tests in addition to a sentence-picture matching task). Presenting tests at eye-level may also facilitate assessment of PSP patients, who lack vertical eye movements [58].…”

Managing Cognition in Progressive Supranuclear Palsy

“…There is some evidence that Lee Silverman exercises, designed to address hypophonia in idiopathic PD, can be of benefit in promoting communication in PSP [89]. Further specific guidance for improving communication in PSP is greatly needed but currently lacking [90]. In addition to the medical and nonmedical measures to improve cognition outlined in preceding sections, the environment in which a decision is made can be optimized to assist decision-making [91].…”

The midbrain‐to‐pons ratio distinguishes progressive supranuclear palsy from non‐fluent primary progressive aphasias

“…The patients with PSP also had a high rate of aphasia and cognitive dysfunction more generally, potentially reflecting a referral bias, but arguably representative of cases of PSP seen in behavioural neurology clinics, where most cases of PPA are likely to be assessed. Language deficits are frequently reported in PSP , even if the prevalence and characteristics of PSP aphasia remain relatively underinvestigated. As mentioned, patients who present with PNFA may develop a PSP motor phenotype or be found to have PSP pathology at autopsy .…”