Long‐Duration Progressive Supranuclear Palsy: Clinical Course and Pathological Underpinnings

Abstract

Objectives: To identify the clinical characteristics of the subgroup of benign progressive supranuclear palsy with particularly long disease duration; to define neuropathological determinants underlying variability in disease duration in progressive supranuclear palsy. Methods: Clinical and pathological features were compared among 186 autopsy-confirmed cases with progressive supranuclear palsy with ≥10 years and shorter survival times. Results: The 45 cases (24.2%) had a disease duration of ≥10 years. The absence of ocular motor abnormalities within the first 3 years from disease onset was the only significant independent clinical predictor of longer survival. Histopathologically, the neurodegeneration parameters in each survival group were paralleled anatomically by the distribution of neuronal cytoplasmic inclusions, whereas the tufted astrocytes displayed anatomically an opposite severity pattern. Most interestingly, we found significantly less coiled bodies in those who survive longer, in contrast to patients with less favorable course. Interpretation: A considerable proportion of patients had a more "benign" disease course with ≥10 years survival. They had a distinct pattern and evolution of core symptoms compared to patients with short survival. The inverted anatomical patterns of astrocytic tau distribution suggest distinct implications of these cell types in trans-cellular propagation. The tempo of disease progression appeared to be determined mostly by oligodendroglial tau, where the high degree of oligodendroglial tau pathology might affect neuronal integrity and function on top of neuronal tau pathology. The relative contribution of glial tau should be further explored in cellular and animal models.

Progressive supranuclear palsy’s economical burden: the use and costs of healthcare resources in a large health provider in Israel

“…Forth, it is known that some PSP phenotypes may be more severe; however, we were not able to differentiate between PSP's different phenotypes. In addition, it is known that PwPSP surviving 10 years post-diagnosis are most likely the less severe cases [34]; still, we were able to observe an increased direct medical expenditure. Fifth, we were unable to extract the cause of admission to the hospital to understand and help a more targeted supportive care.…”

Clinical and neuroimaging features of the progressive supranuclear palsy- corticobasal degeneration continuum

“…Depression is observed across PSP variants, except in PSP-speech/language [34]. The absence of ocular motor impairments was a predictor of long (≥10 years) survival, while early frontal lobe dysfunction predicted shorter survival, in PSP in another study, with PSP-parkinsonism particularly frequent in the long survival group [35 ▪ ]. These studies help improve prognostic and survival estimates, which will differ depending upon the specific PSP presentation.…”

Progressive supranuclear palsy: current approach and challenges to diagnosis and treatment

“…Although the disease is typically sporadic, rare patients with mutations in microtubule-associated protein tau ( MAPT ) genes may have a clinical presentation similar to PSP, although the structure of tau filaments is different than in sporadic cases [7 ▪▪ ]. No cases of sporadic PSP have been reported with onset of symptoms before age 40, so an earlier age of onset should prompt consideration of an alternative diagnosis [3,8,9 ▪ ].…”