PROGRESSIVE SUPRANUCLEAR PALSY IN THE ELDERLY IN A DISTRICT GENERAL HOSPITAL

Progressive Supranuclear Palsy (PSP) is usually described between 50 and 70 years, and is diagnosed using clinical criteria, supported by the midbrain-to-pons ratio. It has not been frequently described in those over 75. In a UK district general hospital (DGH) providing care for 340,000 people, 24 patients aged 75 and over were diagnosed with PSP over four years. Their records were reviewed retrospectively. Almost all patients presented to other specialties, and had up to 15 A&E visits in preceding years, often with falls. Many had several hospital admissions in the months preceding diagnosis. Previous health care professionals that were frequently consulted for PSP symptoms include ophthalmologists, physiotherapists, and speech and language therapists; other key specialties include ENT, gastroenterology, orthopaedics, and falls clinics. This was always without diagnosis. Midbrain-to-pons ratios averaged 0.49. PSP-P subtype appeared common. Patients present to many different specialties, and awareness is low. PSP may be more common in the elderly than previously suspected.