Neuropathologic basis of frontotemporal dementia in progressive supranuclear palsy

Nobutaka Sakae, Keith A. Josephs, Irene Litvan, Melissa E. Murray, Ranjan Duara, Ryan J. Uitti, Zbigniew K. Wszolek, Neil R. Graff-Radford, Dennis W. Dickson

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by neuronal loss in the extrapyramidal system with pathologic accumulation of tau in neurons and glia. The most common clinical presentation of PSP, referred to as Richardson syndrome, is that of atypical parkinsonism with vertical gaze palsy, axial rigidity, and frequent falls. Although cognitive deficits in PSP are often ascribed to subcortical dysfunction, a subset of patients has dementia with behavioral features similar to the behavioral variant of frontotemporal dementia. In this study we aimed to identify the clinical and pathological characteristics of PSP presenting with frontotemporal dementia. Methods: In this study, we compared clinical and pathologic characteristics of 31 patients with PSP with Richardson syndrome with 15 patients with PSP with frontotemporal dementia. For pathological analysis, we used semiquantitative methods to assess neuronal and glial lesions with tau immunohistochemistry, as well image analysis of tau burden using digital microscopic methods. Results: We found greater frontal and temporal neocortical neuronal tau pathology in PSP with frontotemporal dementia compared with PSP with Richardson syndrome. White matter tau pathology was also greater in PSP with frontotemporal dementia than PSP with Richardson syndrome. Genetic and demographic factors were not associated with atypical distribution of tau pathology in PSP with frontotemporal dementia. Conclusions: The results confirm the subset of cognitive-predominant PSP mimicking frontotemporal dementia in PSP. PSP with frontotemporal dementia has distinct clinical features that differ from PSP with Richardson syndrome, as well as differences in distribution and density of tau pathology.

Original languageEnglish (US)
Pages (from-to)1655-1662
Number of pages8
JournalMovement Disorders
Issue number11
StatePublished - Nov 1 2019


  • behavioral variant frontotemporal dementia
  • immunohistochemistry, image analysis
  • progressive supranuclear palsy
  • tau

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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