Progressive supranuclear palsy - Symptoms of progressive supranuclear palsy

As the name suggests, progressive supranuclear palsy (PSP) is a progressive condition.

This means that the symptoms often develop gradually, which makes it easy for them to be mistaken for the symptoms of other, more common conditions.

The symptoms of PSP become more severe over time. Individual symptoms can also vary in severity from person to person. Only a few people will experience all of the symptoms listed below.

Initial symptoms

The initial symptoms of PSP may include:

  • sudden loss of balance when walking that usually results in repeated falls, often backwards
  • muscle stiffness, particularly in the neck
  • changes in personality, such as irritability, apathy (lack of interest) and mood swings
  • changes in behaviour, such as recklessness and poor judgement
  • a dislike of bright lights (photophobia)
  • difficulty controlling the eye muscles, particularly problems with looking up and down (this is the supranuclear palsy that gives the condition its name)
  • blurred or double vision

Intermediate symptoms

Over time, the initial symptoms of PSP will become more severe and new symptoms will develop. The loss of balance can be so severe that walking becomes impossible and a wheelchair will eventually be required. A person with PSP may develop slow, quiet or slurred speech with some swallowing problems.

Controlling the eye muscles will become more difficult, increasing the risk of falls and making everyday tasks, such as reading and eating, more problematic.

Some people with PSP will also experience problems controlling their eyelids, including:

  • reduced blinking reflex - which can cause the eyes to dry out and become irritated
  • involuntary closing of the eyes - which can last from several seconds to hours
  • difficulties opening the eyelids 

Advanced stages

As PSP progresses to an advanced stage, people with the condition may begin to experience increasing difficulties controlling the muscles of their mouth, throat and tongue.

Speech may become increasingly slow and slurred, making it harder to understand. There may also be some problems with thinking, concentration and word finding, although severe dementia is rare.

The loss of control of the throat muscles leads to difficulties swallowing (dysphagia). At some point, many people with PSP will need to consider using a feeding tube.

Many people with PSP also develop problems with their bowel and bladder functions. Constipation and difficulty passing urine are common, as is the need to pass urine several times during the night.

Because of dysphagia, people with PSP often experience repeated chest infections caused by fluids or small particles of food passing into their lungs. This is known as aspiration pneumonia and it's a leading cause of death in cases of PSP.

Read more about the complications of PSP.

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