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PSP stands for Progressive Supranuclear Palsy. It's a relatively rare neurological condition and as the name suggests, it's a progressively deteriorating condition. And is characterized by a supranuclear gaze palsy, which people have difficulty with their vertical, that up and down gaze. The prevalence is approximately six in every 100,000 people, which is approximately the same as for motor neuron disease. Information from the PSP Society, we think there's probably about 10,000 people at any one time in the UK experiencing the condition. I think more people are aware of motor neuron disease, although it's very, very closely linked to progressive supranuclear palsy. However, there's been a lot of information, films made about motor neuron disease, so it's received a higher profile across the country. PSP affects people of all gender, ethnicity and background. However, there does seem that more men are affected. The first signs and symptoms come after the age of 40. We think people in their 60s, that's the most common time when we see people diagnosed with PSP, especially the 62-63 age bracket.

People with PSP present with a variety of symptoms, some of them more subtle. Some of the symptoms are very similar to Parkinson's. The main one is Bradykinesia, which is slowness of movement, a general slowing down, rigidity, rigidity in the upper limbs and in the neck. Most characteristic is people beginning to have difficulty with vision. So the vision, maybe some people mention they begin to get blurred vision or double vision. Trying to find the difference between Parkinson's and PSP can be very difficult and can take quite a lot of time. As time goes on, the clinical picture becomes more apparent and then, of course, it's easier to diagnose.

People with PSP will present with a lot of lacerations to the back of their head. They won't be aware that they're going to fall, they just suddenly go backwards. Slowness of movement or Bradykinesia may be one of the earliest symptoms that the family notice. Maybe going out on walks, when maybe the father used to be well ahead walking. They'll think well, the pace isn't so fluid as it was. So a general slowing down, slowing down in motor tasks. Motor recklessness is one of the key indicators in PSP. When people may be having frequent falls and they're sitting in a chair and suddenly they'll get up, or suddenly get up and do something. Although they may be aware that they're going to fall, they have little insight into the condition, so that's quite a danger. You need to be very aware if people have PSP and they're having impulsivity and motor recklessness that's one of the key areas where they're going to fall. Then they would just get up.

Eye problems and changes in vision are one of the early indicators of PSP. People will often present with double vision, blurred vision, or difficulty with eye-opening, blepharospasm. So we may think somebody is asleep, in fact, they are awake, but they're just having trouble opening their eyelids. Alternatively, people may be speaking to you or watching television and their eyes will close, they'll have trouble keeping them open while they're doing a functional task. There's often a reduced eye blink and so people will get dry eyes and for that, we might use artificial tears. And the supranuclear gaze palsy is the biggest characteristic. When people have slowness of movement of their eyes and then the movement becomes very restricted, so that's what the upwards and more predominantly the downward gaze.

People with PSP become very light sensitive and this can cause a lot of problems, not only outside of the house but in the house. People often have to dim the lights down and find that they're pulling the blinds down, which is difficult for the rest of the family to cope with. People often initially start wearing sunglasses and you can also get wraparound sunglasses, which really restricts the amount of light that's getting in, but people are still able to see. It's easily addressed using the sunglasses or the wrap around glasses, yes. And the optician will often put a prism lens in their normal glasses. However, the PSPA also supply prism glasses, which helps with their downward gaze.

Speech is often affected quite early on in the condition. People may present with their speech gets quieter. A lot of people have quiet speech, which is very, very rapid, so it's very difficult in a consultation to follow what they're saying. Other people may have very strained speech and other people's speech might be slurred. So different presentations, but speech will be an indicator that something isn't quite right early on in the condition. People have a difficulty with their upward and downward gaze. One of the main characteristics of PSP is that people have eye problems. So this may start off that people will report they're having blurred vision, double vision and as time goes on people find it difficult to look down. So if they are looking down to try and eat, they find it difficult to look down to see food on their plate, which leads to us calling it the dirty tie syndrome when people drop food because they can't actually see they're putting it up into their mouth.

Difficulty going downstairs, because if you can't look down when you're going downstairs. People also have trouble with eye-opening. Often, if you're speaking to people, you'll think they might be asleep. We call it blepharospasm when the eye keeps itself shut. And the treatment for that, some people have Botox, which paralyses a bit of the muscle so that easier eye-opening. Also, people may, when they are talking to you, they might start closing their eyes. So there's a lot of problems associated to eye-opening, eye closure and general vision.