title: Predictors of survival in a series of clinically diagnosed progressive supranuclear palsy patients.
abstract: BACKGROUND
  Investigations into prognostic factors in progressive supranuclear palsy have shown conflicting results. We performed a retrospective study in order to identify clinical predictors of survival in clinically diagnosed progressive supranuclear palsy patients referred to our centre.
  
  
  METHODS
  Data on medical history, survival and five clinical disability milestones (inability to walk unassisted, unintelligible speech, severe dysphagia, dementia and institutionalization) were collected from outpatients' medical records and by a telephone interview to caregivers. Patients were subdivided into Richardson's syndrome and PSP-Parkinsonism according to symptoms during the first 2 years of disease. Survival was analyzed by the Kaplan-Meier method and Cox regression analysis.
  
  
  RESULTS
  Forty-three consecutive patients were enrolled (86% Richardson's syndrome). Motor disturbances were the most frequent symptoms of onset. During the follow-up, 60.5% of patients died after a median survival of 7.1 years (2.2-18). Older age at onset (>63) (HR 2.8; 95% CI: 1.3-5.7; p = 0.007), early dysphagia (HR 2.3; 95% CI: 1-5.3; p = 0.05) and early cognitive deficits (HR 3.6; 95% CI: 1.6-8.2; p = 0.002) were predictors of shorter survival. Compared to PSP-Parkinsonism patients, Richardson's syndrome patients had shorter survival and higher mortality risk although not statistically significant (HR 3 95% CI: 0.9-9.9; p = 0.07). Seventy-seven percent of patients developed severe disability during follow-up: shorter time to the first clinical disability milestone predicted shorter survival (HR 7.8; 95% CI: 2.3-26; p = 0.0008).
  
  
  CONCLUSIONS
  early dysphagia, cognitive impairment, older age at onset, and time to disability were predictors of shorter survival; Richardson's syndrome had a less favorable course than PSP-Parkinsonism. Clinical milestones should be considered as possible endpoints in future clinical trials.
authors: Department of Basic Medical Sciences, Neurosciences and Organs of Senses, University of Bari, Piazza Giulio Cesare, 9, 70124 Bari, Italy.
authors: Claudia
authors: C
authors: dell'Aquila
authors: Stefano
authors: S
authors: Zoccolella
authors: Valentina
authors: V
authors: Cardinali
authors: Michele
authors: M
authors: de Mari
authors: Giovanni
authors: G
authors: Iliceto
authors: Bruno
authors: B
authors: Tartaglione
authors: Paolo
authors: P
authors: Lamberti
authors: Giancarlo
authors: G
authors: Logroscino
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000401:mortality*; D015996:Survival Rate
keywords: Natural history; Parkinsonism; Progressive supranuclear gaze palsy; Steele–Richardson–Olszewski syndrome; Survival