Clinical Features Distinguishing Progressive Supranuclear Palsy from Parkinson's Disease

Tolosa et al listed a variety of clinical findings that can help distinguish progressive supranuclear palsy from Parkinson's disease.

Parameter	Progressive Supranuclear Palsy	Parkinson's Disease
Parkinson's symptoms at onset	symmetrical	asymmetrical
early gait impairment	common	rare
falls	early in course	late in course
postural reflexes early in course	abnormal	normal
gait	stiff, with knees extended at the knees	small steps (marche a petit pas)
trunk posture when walking	extension	flexion
arm swing when walking	present	absent
facial expression	astonished looking	hypokinesis
blink rate	3 to 5 per minute	10+ per minute
rest tremor	rare	common
limb dystonia	less common than axial	more common than axial
limb rigidity	less common than axial	more common than axial
hand deformity	absent	characteristic
response to levodopa	none or poor	good
levodopa induced dyskinesias	rare	common
wearing off phenomenon	rare	common
on-off phenomenon	rare	common

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