Why some early psp people fall and others don't

New study just released but I need Strelly or someone to tell me what it means?? I am always interested in the balance problems in psp.

Cognitive dysfunction associated with falls in progressive supranuclear palsy

Sha-Lom Kim

, Myung-Jun Lee

1, Myung-Sik Lee

Yonsei University College of Medicine, Republic of Korea

1Present address at: Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan, Republic of Korea.

Received: December 31, 2013; Received in revised form: June 12, 2014; Accepted: July 8, 2014; Published Online: July 17, 2014

DOI: dx.doi.org/10.1016/j.gaitpo...



•Axial deficits were associated with the recurrent falls in PSP patients.

•Executive dysfunctions were associated with recurrent falls in PSP patients.

•Visuospatial dysfunctions were associated with recurrent falls in PSP patients.



Attentional and executive dysfunctions are associated with falls in community-dwelling elderly individuals and patients with PD. Frontal cognitive dysfunction and falls are frequent symptoms of PSP. We studied to identify the cognitive domains associated with recurrent falls in patients with PSP.


We performed a battery of neuropsychological tests in 59 individuals with probable PSP. We categorized patients into infrequent fall (≤one fall during the last 12 months, n = 29) or recurrent fall (≥two falls during the last 12 months, n = 30) groups.


UPDRS subscores for axial deficits were significantly higher in the recurrent fall group than the infrequent fall group, but there were no significant differences in UPDRS total motor scores or subscores for bradykinesia, rigidity, and tremor. There was no difference between groups in MMSE scores. ANCOVA with adjustment for confounding factors showed that, recurrent falls were associated with abnormalities in alternating hand movement, alternating square and triangle, RCFT copying task, and ideomotor apraxia. Group difference of abnormalities in Stroop test was marginal (p = 0.054). However, there were no group differences in the frequency of abnormalities in forward or backward digit span, motor impersistence, fist-edge-palm, contrast programming, go-no-go, Luria loop drawing, or Controlled Oral Word Association Tests. Recurrent falls were not associated with memory or language dysfunction.


Recurrent falls in patients with PSP were associated mainly with executive and visuospatial dysfunctions, including (1) impaired coordinated alternating uni- and bimanual motor programming and execution, (2) deficit of attention and decision making in the presence of interference, (3) visuospatial misperception and (4) ideomotor apraxia.

7 Replies

  • Hi Mcfly, let's hope who ever can explain this to us, does it in words of one syllable. Most this was way above my pay grade!!!

    Lots of love


  • Hi mcfly

    I've given this a quick look, and I am no expert in this field, but I do not like the way they have sampled the subjects. They assume they have PSP (but which type - there'll be less falls initially with PSP-P than PSP-RS), and then do not discuss the varied nature of this cardinal symptom of falling. How long had the people with "frequent or infrequent falls" showed any signs of PSP? There are other problems with this study, but let's note the conclusions.

    PSP is often associated with cognitive impairment (sometimes early but it's usually slow and remains stable throughout the course of the disease). This impairment is often executive dysfunction (inability to organise or plan etc). Cognitive dysfunction has to do with poor verbal recall, difficulty with basic arithmatic, lack of concentration and intellectual function. Mind you, there is some disagreement about the nature of this state in PSP (especially since many have sharp minds and are aware of everything around them. Some talk of dementia, but it is sub cortical dementia - inability to find those words and phrases, but not total memory loss).

    The degree of cognitive dysfunction will be associated with how severe the frontal cortex has been damaged in PSP.

    This study uses a raft of "rating scales" (like Unified Parkinson's Disease rating Scale) that looks and measures (often not very well) all sorts of functions including motor, mood, behaviour, life activities etc). The researchers have tried to match the results of these many measurements with the frequency of falling. The bottom line being that there seemed to be more falls with certain "problems" like executive dysfunctions and a couple of others.

    I'm not sure if this study has much value. Other researchers have already shown that falls in PSP are associated with certain damage to motor pathways that involve balance and co-ordination. These pathways pass through the thalamus to the pre motor frontal cortex. Cognitive function is associated frontal cortex damage and the complex damage elsewhere in this region (down to the basal ganglia) will show up in simple terms as "cognitive dysfunction is associated with the damaged pathways that cause falls"

    Cognitive dysfunction and dementia in the elderly (not just PSP) have been shown to increase the risk of falls. This study just highlights similar observation in PSP through a raft of tests, and finds three or four particular dysfunctions that are prominent in distinguishing recurrent fallers from those infrequent fallers!

    I don't suppose you wanted to know all this.......my explanation is worse than the study itself! I've written this just before I retire for the night, so I might regret what I've written when I wake tomorrow!!!! I'm getting too old for all this!!!



  • thanks for taking the time to explain. There is a very strange distinct feeling when am about to lose my balance I can usually sense when it is happening and I grab something or sit down. Many with psp just fall. So I guess I am fortunate. I am Dx psp-p. but I'm not dead yet so who knows.

  • Thank you. This was very interesting because many things you mentioned are "me!"

  • Strelly,the real benefits of getting older lie in this story,many years ago I visited my mother who was in a home ,across the hall was an old neighbour of my childhood days,during our visit Jim seemed reasonable ,Jim was 86 at this time ,out of the blue he asked about my father and if he was still fishing,dad would have been 95 or so had he still been alive,I went along saying he was in fact,I asked about his dad,after some talk he told me his dad was now almost 70 years old to wich I replied,Your dad is almost 16 years younger than you,yes he said time goes by fast,so things are just so important ,regards,Rollie

  • Thanks Rollie for recounting this story!

    Take Care


  • Interesting study, but the population was 59 patients with 'probable' PSP. The authors needed to explain how they defined the patients (how good is the clinical diagnosis), and did they stage the patients. Should they not have also queried the number of near falls, falls prevented. Many carers prevent falls, and these are not noted. So overall although interesting, its one of those pieces of work, that need to be repeated. Definitely agree there are subtle cognitive changes.

    Can I ask how cognitive changes progress. I found with my wife a fall in MMSE to around 18-20/30, over a period of about 6 months, but I dont think its progressed.

    I dont think Strelly is too old for this at all. Valuable comments


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