Increasing awareness of rare PSP-F, where rehabilitation is the primary treatment: A case report

Issue title: Neuropsychiatric Aspects of Neurorehabilitation

Guest editors: Matthew E. Peters, Lindsey J. Gurin, Davin K. Quinn and Durga Roy

Article type: Case Report

Authors: Reisch, Anne^{a; 1} | Gerety, Gregory^b | Ding, Andrew^b | Narapareddy, Laren^{c; 1} | Narapareddy, Bharat R.^{b; 1; *}

Affiliations: [a] University of Connecticut, School of Medicine, Farmington, CT, USA | [b] Institute of Living, Hartford Hospital, Hartford, CT, USA | [c] Emory University, School of Nursing, Atlanta, GA, USA

Correspondence: [*] Address for correspondence: Bharat R. Narapareddy, MD, Institute of Living, Hartford Hospital, Hartford, CT, USA. E-mail: bharat.narapareddy@hhchealth.org.

Note: [1] Anne Reisch, Laren Narapareddy and Bharat R. Narapareddy contributed equally to this study.

Abstract: BACKGROUND:Progressive Supranuclear Palsy (PSP) is an incurable neurodegenerative disorder. One variant of PSP is a frontal lobe cognitive or behavioral presentation (PSP-F). Currently, the primary management of this disease is rooted in neurological rehabilitation, therefore, early, and accurate diagnosis is key. CASE REPORT:Here we present a 60-year-old man with a 2–3-year history of functional decline and behavioral changes. He was misdiagnosed with a late-onset psychiatric disorder. During his second inpatient admission, a full workup for neurodegenerative diseases was performed, and the patient was ultimately diagnosed with probable PSP-F. We describe his neurological rehabilitation plan, examining recommendations before and after diagnosis. RESULTS:After the neurodegenerative disorder diagnosis, the neurological rehabilitation plan, particularly PT and OT, changed drastically despite no change in clinical presentation emphasizing the value of an appropriate and early diagnosis. Furthermore, in an OT session, the patient demonstrated longitudinal improvement, emphasizing the importance of rehabilitation in these patient’s lives. CONCLUSION:Increased recognition of PSP variants amongst healthcare providers will allow more patients to receive early and appropriate diagnoses, so that they can benefit maximally from their neurological rehabilitation plans, maintain quality of life and experience longer periods of functioning. Furthermore, developing PSP-specific rehabilitation guidelines are crucial for improved outcomes. Correct diagnosis will also reduce the use of inappropriate and potentially harmful medications in these populations.

Keywords: Progressive supranuclear palsy, dementia, neurorehabilitation, frontotemporal dementia, behavioral variant frontotemporal dementia, occupational rehabilitation, physical therapy

DOI: 10.3233/NRE-220235

Journal: NeuroRehabilitation, vol. 53, no. 2, pp. 239-247, 2023