Cognitive, Behavioral, and Functional Aspects of PSP
Adam Gerstenecker, PhD, University of Alabama at Birmingham
- Cognition in PSP
- #1 impairment is executive dysfunction which regulates things like multitasking, planning, organizing, etc., almost 75% PSP patients have at least one test impaired
- Executive dysfunction is major neurocognitive impairment even at early disease stage
- Relatively strong short and long delayed free recall and little additional benefit from cueing
- Behavioral abnormalities (can occur at any stage)
- Apathy and indifference were one of the biggest findings, similar with depression, and sleep/nighttime behaviors, eating behaviors, agitation, irritability, and disinhibition
- Education about apathy is important
- Particularly distressing for family members and caregivers and lead to symptoms being misinterpreted as depression
- It’s depression, it’s more “not caring” – it’s being wrongly prescribed
- Families may believe that the patient is not as interested in family
- Depression was high in comparison to prior estimates
- There aren’t that many depression studies in PSP
- Depression may not be solely a function of brain changes, but also related to functional consequences (what the disease is doing to a person)
- Therapy and behavior activation may be able to help
- Functional ability
- 2 types – basic daily activities of daily living and instrumental activities of daily living
- ADL – related to self care
- IADL – related to autonomy and independence (financial management, medications, etc.)
- Assessing functional ability in PSP
- Performance-based and caregiver-based reports
- Overall, over 80% of sample had significant decline in functional mobility, mostly in medical decision making and financial decision making (highly susceptible to financial fraud/scams) and inability to call 911
- Caregiver report was not significantly correlated with any IADL measure or with cognitive performance
- Found that caregivers were not good at quantifying level of daily functioning in patients
- Caregivers need education