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Investigating differences in young- and late-onset progressive supranuclear palsy
Batoul A AlWazan1,2, Indira Garcia-Cordero3, Blas Couto4
1Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada. Batoul.Alwazan@medportal.ca.
Insights
Young-onset progressive supranuclear palsy (PSP) patients are more likely to exhibit speech and language deficits. Early age of onset may predict specific PSP phenotypes, offering clinical and prognostic insights.
Area of Science:
- Neurology
- Neurodegenerative Diseases
- Clinical Phenotyping
Background:
- The influence of age of onset on progressive supranuclear palsy (PSP) phenotypes remains underexplored.
- A hypothesis suggests distinct presentations between young-onset PSP (YOPSP) and late-onset PSP (LOPSP).
Purpose of the Study:
- To compare the clinical phenotypes and the rate of disability progression between YOPSP and LOPSP.
- To identify differences in presenting symptoms and diagnostic criteria fulfillment.
Main Methods:
- Retrospective analysis of 107 patients diagnosed with PSP according to MDS 2017 criteria.
- Patients categorized into YOPSP and LOPSP based on a 65-year age cutoff.
- Phenotypes, symptoms, MDS core criteria, and disease severity (PSP-RS) were compared.
Main Results:
- YOPSP patients showed a higher prevalence of the PSP speech/language (SL) phenotype (18% vs 0%) and aphasia (16% vs 1.4%).
- Speech and language dysfunction (C1) was more common in YOPSP (33.3% vs 12.2%).
- Longitudinal PSP-RS data indicated a faster worsening of the bulbar score in YOPSP at 6 months.
Conclusions:
- Young-onset PSP is frequently associated with a speech and language variant.
- Age of onset is a potential predictor of PSP phenotypes, with significant clinical and prognostic implications.
Background:
The impact of age of onset on the presentation of progressive supranuclear palsy phenotypes is not well studied. We hypothesized that there is difference in presentation and phenotype between young- and late-onset PSP.
Objectives:
Our aim was to compare phenotypes and rate of change in disability between young-onset PSP (YOPSP) and late-onset PSP (LOPSP).
Methods:
Retrospective data of patients seen in the Rossy PSP Centre from March 2014 to April 2022 with clinical diagnosis of PSP as per the MDS 2017 diagnostic criteria were examined. We used cut-off age of 65 years to categorize the patients into YOPSP and LOPSP. We compared the prevalence of phenotypes, presenting symptoms, and MDS core criteria between the two groups. The severity of disease between the two groups was measured using PSP-RS.
Results:
We found 107 patients with clinical diagnosis of PSP as per MDS criteria, a third were defined as YOPSP. PSP speech/language (SL) phenotype was more prevalent in YOPSP (18% vs 0%, p < 0.001). Aphasia was significantly higher in YOPSP (16% vs 1.4%, p = 0.03). The speech and language dysfunction (C1) core criteria were more prevalent in YOPSP (33.3% vs 12.2%, p = 0.05). Longitudinal analysis of PSP-RS showed worsening of bulbar total score at 6 months in YOPSP (t (38) = 2.87; p = 0.05).
Conclusion:
Our study revealed that YOPSP are more likely to present with a speech and language variant. Our results highlight that age of onset may predict PSP phenotypes, which holds both clinical and prognostic importance.
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