title: The phenotypic spectrum of progressive supranuclear palsy: a retrospective multicenter study of 100 definite cases.
abstract: The phenotypic variability of progressive supranuclear palsy (PSP) may account for its frequent misdiagnosis, in particular in early stages of the disease. However, large multicenter studies to define the frequency and natural history of PSP phenotypes are missing. In a cohort of 100 autopsy-confirmed patients we studied the phenotypic spectrum of PSP by retrospective chart review. Patients were derived from five brain banks with expertise in neurodegenerative disorders with referrals from multiple academic hospitals. The clinical characteristics of the 100 cases showed remarkable heterogeneity. Most strikingly, only 24% of cases presented as Richardson's Syndrome (RS), and more than half of the cases either showed overlapping features of several predescribed phenotypes, or features not fitting proposed classification criteria for PSP phenotypes. Classification of patients according to predominant clinical features in the first 2 years of the disease course allowed a more comprehensive description of the phenotypic spectrum. These predominance types differed significantly with regard to survival time and frequency of cognitive deficits. In summary, the phenotypic spectrum of PSP may be broader and more variable than previously described in single-center studies. Thus, too strict clinical criteria defining distinct phenotypes may not reflect this variability. A more pragmatic clinical approach using predominance types could potentially be more helpful in the early recognition of and for making prognostic predictions for these patients. Given the limitations arising from the retrospective nature of this analysis, a systematic validation in a prospective cohort study is imperative.
authors.affiliation: Department of Neurology, Technische Universität München, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Department of Neurology, Philipps Universität, Marburg, Germany.
authors.forename: Gesine
authors.initials: G
authors.lastname: Respondek
authors.forename: Maria
authors.initials: M
authors.lastname: Stamelou
authors.forename: Carolin
authors.initials: C
authors.lastname: Kurz
authors.forename: Leslie W
authors.initials: LW
authors.lastname: Ferguson
authors.forename: Alexander
authors.initials: A
authors.lastname: Rajput
authors.forename: Wan Zheng
authors.initials: WZ
authors.lastname: Chiu
authors.forename: John C
authors.initials: JC
authors.lastname: van Swieten
authors.forename: Claire
authors.initials: C
authors.lastname: Troakes
authors.forename: Safa
authors.initials: S
authors.lastname: Al Sarraj
authors.forename: Ellen
authors.initials: E
authors.lastname: Gelpi
authors.forename: Carles
authors.initials: C
authors.lastname: Gaig
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tolosa
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.forename: Armin
authors.initials: A
authors.lastname: Giese
authors.forename: Sigrun
authors.initials: S
authors.lastname: Roeber
authors.forename: Thomas
authors.initials: T
authors.lastname: Arzberger
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.forename: Günter U
authors.initials: GU
authors.lastname: Höglinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001921:Brain / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011379:Prognosis; D012189:Retrospective Studies; D013494:Supranuclear Palsy, Progressive / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: clinical diagnostic criteria; neuropathology; phenotypes; progressive supranuclear palsy