title: Progressive supranuclear palsy combined with Alzheimer's disease: a clinicopathological study of two autopsy cases.
abstract: We present here the clinicopathological characteristics of two autopsy-confirmed cases comorbid of progressive supranuclear palsy (PSP) and Alzheimer's disease (AD). Histopathologically, the amount and distribution of neurofibrillary tangles (NFTs) in the basal ganglia and brainstem fulfilled the pathological criteria of PSP proposed by the National Institute of Neurological Disorders and Stroke--The Society for PSP (NINDS-SPSP). The Braak stages of senile plaques and NFTs were stage C and stage V in Case 1, and stage C and stage IV in Case 2. These neuropathological findings confirmed that the two patients had combined PSP with AD. Our patients presented clinically with executive dysfunction prior to memory disturbance as an early symptom. Not only neurological symptoms such as gait disturbance, supranuclear ophthalmoplegia and pseudobulbar palsy, but emotional and personality changes and delirium were prominent. Therefore, symptoms of subcortical dementia of PSP were more predominant than AD-related symptoms in the present two patients. Comorbid PSP and AD further complicates the clinical picture and makes clinical diagnosis even more difficult.
authors.affiliation: Department of Psychiatry, Yokufukai Geriatric Hospital, Showa University School of Medicine, Tokyo, Japan. sakamoto@rhythm.ocn.ne.jp
authors.forename: Rieko
authors.initials: R
authors.lastname: Sakamoto
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Yoshida
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Itoh
authors.forename: Nobuo
authors.initials: N
authors.lastname: Furuta
authors.forename: Asako
authors.initials: A
authors.lastname: Kosuga
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sugai
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D001253:Astrocytes / Q000473:pathology; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016874:Neurofibrillary Tangles / Q000000981:diagnostic imaging / Q000473:pathology; D012720:Severity of Illness Index; D013494:Supranuclear Palsy, Progressive / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed