Understanding Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is a disease that changes your brain. The symptoms get worse over time. That’s why it is called progressive. The disease also changes the centers in the brain that are in charge of how the eyes move. That’s where the name supranuclear comes in. There is also paralysis (palsy) that leads to lack of strength in some eye muscles. PSP can affect things like a person's eye movements, balance, walking, swallowing, eating, speech, and muscle tone.

What causes PSP?

The exact cause of PSP isn't known. But experts do know that the way a protein acts in the brain is changed in people with PSP. This change causes the cells to die so they can’t do their job.

Scientists believe that genes do play a role in PSP. They also think that factors in the environment may add to a person’s risk for this disease. But these factors are not yet known. PSP is most often found in people older than 60.

PSP is sometimes confused with Parkinson disease because the symptoms are similar. But PSP is much less common than Parkinson disease. The way the muscles are affected with PSP is different from Parkinson disease.

What are the symptoms of PSP?

Symptoms of PSP often aren't easily noticed at first. Over time they become more visible and severe.

Common signs and symptoms may include:

• Trouble with balance and walking

• Straight, stiff knees and trunk

• Difficulty controlling eye movements

• Blinking more or less than usual

• Trouble keeping eyes open

• Blurred vision

Issues with walking and balance may lead to falls. Eye changes can lead to problems with reading and driving.

Other signs and symptoms may include:

• Changes in behavior, such as being forgetful and cranky

• Strange emotional outbursts, such as crying or laughing at unexpected times

• Anger for no real reason

• Shaking (tremors) in the hands

• Stiff muscles in the neck and upper chest

• Surprised look on the face

• Speech problems, such as slurring, repeating of words, phrases, or sounds, or trouble finding words of common objects

• Trouble swallowing

• Trouble sleeping, such as waking up often during the night, or talking or moving during sleep

• Memory problems

• Depression

How is PSP treated?

Most often, treatment for PSP is based on the symptoms. There are no medicines or other treatments that have been shown to limit or cure the disease. Treatment may include:

• Certain medicines. Medicines used to treat Parkinson disease and some older types of medicines used to treat depression can help with balance and walking problems. However, these medicines don't work as well for PSP.

• Glasses. Glasses with special lenses may help make vision better.

• Physical therapy and exercise. These may help you be more flexible and gain better balance. Walking aids, such as a weighted tool can help keep you from falling backward so it’s easier to walk.

• Occupational therapy. This type of therapy can help you learn to do as much for yourself as possible for as long as possible.

• Nutrition and speech therapy. You can learn how to swallow so you won’t choke. This therapy may be needed to help with other ways of eating, such as tube feedings, if swallowing becomes too hard.

• Social services. Social services can help link you and your family to the community so that you can get the help and services you need. Support groups may be beneficial for people with PSP and their caregivers.

What are possible complications of PSP?

PSP can cause serious complications that are tied to the symptoms. Swallowing problems can lead to choking or breathing food or liquids into the lungs. This can lead to pneumonia. Falls are likely because walking is stiff and you may have problems with balance. This can lead to bruises anywhere on the body and head injuries, as well as cuts and broken bones. Problems with the eyes can add to the risk for falls and injury.

When to call your healthcare provider

Call your healthcare provider right away if any of the following occur:

• Change in vision, memory, walking, or balance

• Trouble swallowing or choking on food or water

• Falls