BSN PSP/CBD Conference – Adam Gerstenecker

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