Which disorder has onset around 60–70 years, predominantly male, with apathy, disinhibition, executive dysfunction, parkinsonism without tremor, axial rigidity, increased falls, decreased vertical gaze, and tau tangles?

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Multiple Choice

Which disorder has onset around 60–70 years, predominantly male, with apathy, disinhibition, executive dysfunction, parkinsonism without tremor, axial rigidity, increased falls, decreased vertical gaze, and tau tangles?

Progressive supranuclear palsy is a tauopathy that presents with a distinctive combination of features: onset in the 60s to 70s, a male predominance, and parkinsonism that is prominent for axial features (rigidity and postural instability) but typically lacks tremor. The vertical supranuclear gaze palsy—a reduction or loss of voluntary upgaze—is a hallmark and helps set PSP apart from other parkinsonian disorders. Apathy and executive dysfunction reflect frontal lobe involvement, and the overall pattern includes frequent falls and axial rigidity early in the course. The underlying pathology involves tau tangles (4-repeat tau) rather than Lewy bodies or other proteins, which explains the specific clinical picture and progression. Lewy body dementia can involve parkinsonism, but it usually features visual hallucinations and cognitive fluctuations, with Lewy body pathology rather than tau tangles. Normal pressure hydrocephalus presents with the triad of gait disturbance, cognitive impairment, and urinary incontinence and lacks the characteristic vertical gaze palsy. Frontotemporal dementia shows early social and behavioral changes or language problems, often at a different age range, and does not typically include the vertical gaze palsy and the specific parkinsonian profile seen in PSP.

Progressive supranuclear palsy is a tauopathy that presents with a distinctive combination of features: onset in the 60s to 70s, a male predominance, and parkinsonism that is prominent for axial features (rigidity and postural instability) but typically lacks tremor. The vertical supranuclear gaze palsy—a reduction or loss of voluntary upgaze—is a hallmark and helps set PSP apart from other parkinsonian disorders. Apathy and executive dysfunction reflect frontal lobe involvement, and the overall pattern includes frequent falls and axial rigidity early in the course. The underlying pathology involves tau tangles (4-repeat tau) rather than Lewy bodies or other proteins, which explains the specific clinical picture and progression.

Lewy body dementia can involve parkinsonism, but it usually features visual hallucinations and cognitive fluctuations, with Lewy body pathology rather than tau tangles. Normal pressure hydrocephalus presents with the triad of gait disturbance, cognitive impairment, and urinary incontinence and lacks the characteristic vertical gaze palsy. Frontotemporal dementia shows early social and behavioral changes or language problems, often at a different age range, and does not typically include the vertical gaze palsy and the specific parkinsonian profile seen in PSP.

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