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The symptoms of PSP usually appear very slowly. Many people experience a prolonged phase of symptoms such as fatigue (feeling tired), headaches, joint pains, dizziness, and depression. Gradually, the following more specific symptoms appear:

• Unexplained balance problems
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• Stiff or awkward steps while walking
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• Very slow movements
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• Frequent falls, clumsiness
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• Visual problems - Blurry or double vision, problems controlling eye movements (inability to maintain eye contact), light sensitivity
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• Behavior or personality changes - Irritation, grouchiness
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• Memory loss, forgetfulness
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• Apathy (indifference)
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• Slowed thinking, reasoning, planning
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• Inappropriate laughing or crying
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• Angry or aggressive outbursts
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• Slurred speech
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• Swallowing problems - Solids and liquids
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• Mask-like facial expression (no expression)
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• Muscle spasms
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• Inability to hold urine (incontinence) - Late stages only

No one has all these symptoms. The pattern of symptoms varies widely from person to person. Often, friends and family members are more aware of these changes than the affected person.

Most patients with PSP display the characteristic findings of slowness of movement, stiffness, balance difficulty, and eye movement problems. The classic eye movement problem is an inability to voluntarily move the eyes downward, although this problem may take time to develop. Ultimately, all voluntary eye movements may be lost.

Generally, the cognitive and behavioral symptoms are mild and less severe than in other types of dementia, such as Alzheimer disease and stroke-related dementia. These symptoms are more likely to occur in later stages of the disease.

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