Reduced vertical eye movement is usually the first clue that the diagnosis is PSP. This problem is not usually as vexing for the patient and family as the inability to maintain eye contact or to coordinate eye movements while reading, but is much easier for the doctor to detect. This can interfere with eating or with descending a flight of stairs, among other things.
The most common and characteristic eye movement problem in PSP is an impaired ability to move the eyes up or down. The same eye movement problem can create the symptom of tunnel vision and interfere with driving a car. This can give the mistaken impression that the patient is senile, hostile or uninterested. Some patients have their mild cataracts extracted in a vain effort to relieve such a visual problem.Īnother common visual problem is an inability to maintain eye contact during conversation. An eye doctor unfamiliar with PSP may be baffled by the patient’s complaint of being unable to read a newspaper despite normal ability to read the individual letters on an eye chart. This is very different from just needing reading glasses. The patient finds it hard to automatically shift down from line to line. Because aiming the eyes properly is the main difficulty, reading often becomes challenging. In most cases, the visual problem is at least as important as the walking difficulty, though it does not typically appear until three to five years after. PSP-parkinsonism comprises about a quarter of all PSP. These typically have a better early response to antiparkinson drugs than is typical for PSP. Its early stages more closely resemble those of Parkinson’s disease, with less emphasis on balance problems and behavior changes and more on tremor. The second most common form of PSP is called PSP-parkinsonism. This often prompts the doctor to suspect an inner ear problem or hardening of the arteries supplying the brain. Sometimes the falls are described by patients as attacks of dizziness. This may take the form of unexplained falls or of a stiffness and awkwardness in a person’s gait that can resemble Parkinson’s disease. The most common first symptom, which occurs, on average, when a person is in her or his 60s, is loss of balance while walking. Richardson, who only recently retired from a career in neurology research.Ībout half of everyone with PSP has the Richardson’s syndrome type. The most common form is Richardson’s syndrome, after Dr. PSP is occasionally referred to as Steele-Richardson-Olszewski syndrome, after the three physicians who first described the disease in 1963. These figures are nearly identical wherever they have been carefully measured, which is in only three countries-the U.K., the U.S.
and motor neuron disease elsewhere), ALS is easier to diagnose than PSP and often affects much younger people.Įach year an average of 1.1 people per 100,000 are newly diagnosed with PSP five or six people per 100,000 are living with the disease. The brain under the microscope is almost identical to that of “post-encephalitic parkinsonism,” a common condition in the early 20th century but now nearly extinct, which also made for erroneous diagnoses during that era.Īlthough PSP is slightly more common than the well-known amyotrophic lateral sclerosis (called ALS, or Lou Gehrig’s disease in the U.S. In retrospect, at least 12 cases of PSP had appeared in the medical literature between 19, but because of its resemblance to Parkinson’s, it wasn’t recognized as a distinct disease. PSP is rare: no one even realized it existed until 1963, when several patients were first described at a national neurology research convention and the disease was given its name.