title: Differentiation of PA from early PSP with different patterns of symptoms and CBF reduction.
abstract: OBJECTIVE
  To clarify the features of pure akinesia (PA) and progressive supranuclear palsy (PSP) in the early stage of disease.
  
  
  METHODS
  We investigated 15 PA and 41 PSP patients' clinical and radiologic features including head MRI, ethyl cysteinate dimmer-single photon emission-computed tomography (ECD-SPECT) and iodine-123 meta-iodobenzyl guanidine (123I-MIBG) myocardial scintigraphy. In ECD-SPECT study, cerebral blood flow (CBF) reduction was quantitatively expressed as Z-score, and that in the frontal lobe was evaluated.
  
  
  RESULTS
  Many PSP patients claimed falls as the initial symptom but no PA patients did. Eye movement, as well as optokinetic nystagmus elicitation, was more frequently disturbed in PSP. Dementia, dysarthria and rigidity were also more frequent in PSP than in PA. Midbrain tegmentum atrophy in head MRI was more frequently observed in PSP. CBF in the frontal lobe, especially in the frontal eye field, was significantly lower in PSP than in PA. MIBG myocardial scintigraphy showed no difference between two groups.
  
  
  CONCLUSIONS
  PA and PSP show distinct symptoms from the early stage, indicating that they are distinct disorders. The occurrence of falls and eye movement disturbance, as well as CBF reduction at the frontal eye field, is very important for distinguishing these disorders.
authors.affiliation: Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. toko11@cc.okayama-u.ac.jp
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kurata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Murakami
authors.forename: Kazunori
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Morimoto
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ohta
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takehisa
authors.forename: Makiko
authors.initials: M
authors.lastname: Nagai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawarabayashi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Takao
authors.forename: Taisei
authors.initials: T
authors.lastname: Ohta
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Harigaya
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Manabe
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Kamiya
authors.forename: Mikio
authors.initials: M
authors.lastname: Shoji
authors.forename: Koji
authors.initials: K
authors.lastname: Abe
mesh_terms: D000368:Aged; D001284:Atrophy / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003545:Cysteine / Q000031:analogs & derivatives; D003704:Dementia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D005133:Eye Movements / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D007457:Iodine Radioisotopes; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009069:Movement Disorders / Q000175:diagnosis* / Q000503:physiopathology; D009127:Muscle Rigidity; D017120:Nystagmus, Optokinetic / Q000502:physiology; D015609:Organotechnetium Compounds; D011859:Radiography; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes; D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine