National Institute of Neurological Disorders and Stroke and Society for Progressive Supranuclear Palsy Clinical Criteria for the Diagnosis of Progressive Supranuclear Palsy

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Diagnostic categories

Inclusion criteria

Exclusion criteria

Supportive criteria




For possible and probable: For possible and probable:

Gradually progressive disorder with age at onset at 40 or later

Recent history of encephalitis; alien limb syndrome; cortical sensory deficits; focal frontal or temporoparietal atrophy; hallucinations or delusions unrelated to dopaminergic therapy; cortical dementia of Alzheimer's type; prominent, early cerebellar symptoms or unexplained dysautonomia; or evidence of other diseases that could explain the clinical features

Either vertical supranuclear palsy or both slowing of vertical saccades and postural instability with falls within 1 year of disease onset Vertical supranuclear palsy and prominent postural instability with falls within first year of disease onseta All criteria for possible or probable PSP are met and histopathological confirmation at autopsy

Symmetric akinesia or rigidity, proximal more than distal; abnormal neck posture, especially retrocollis; poor or absent response of parkinsonism to levodopa; early dysphagia and dysarthria; early onset of cognitive impairment including more than two of apathy, impairment in abstract thought, decreased verbal fluency, utilization or imitation behavior, or frontal release signs aLater defined as falls or the tendency to fall (patients are able to stabilize themselves). PSP, progressive supranuclear palsy.

(Adapted with permission from Litvan I, Bhatia KP, Burn DJ, et al. SIC task force appraisal of clinical diagnostic criteria for Parkinsonian disorders. Mov Dis 2003;18:467-486.)

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