Editing Progressive supranuclear palsy (section)

==== Motor Symptoms in PSP-RS ====
One of the key features of PSP-RS that occurs within the first year of symptom onset, is early postural instability which often leads to unexplained falls.<ref name=":6" /><ref name=":5" /><ref name=":8">{{Cite journal |last1=Alster |first1=Piotr |last2=Madetko |first2=Natalia |last3=Koziorowski |first3=Dariusz |last4=Friedman |first4=Andrzej |date=2020-03-10 |title=Progressive Supranuclear Palsy—Parkinsonism Predominant (PSP-P)—A Clinical Challenge at the Boundaries of PSP and Parkinson's Disease (PD) |journal=Frontiers in Neurology |volume=11 |page=180 |doi=10.3389/fneur.2020.00180 |doi-access=free |pmid=32218768 |pmc=7078665 |issn=1664-2295}}</ref> Additionally, patients present with axial rigidity, which is characterized by stiffness in the neck and body.<ref name=":5" /> This is often accompanied with [[bradykinesia]] which is slowness of movement. Although PSP-RS is often misdiagnosed as Parkinson's disease, tremors are uncommon in PSP-RS.<ref name=":3" /> Motor symptoms are often symmetrical in PSP-RS with both sides of the body being affected.<ref name=":10">{{Cite journal |last1=Chunowski |first1=Patryk |last2=Madetko-Alster |first2=Natalia |last3=Alster |first3=Piotr |date=2024-09-28 |title=Asymmetry in Atypical Parkinsonian Syndromes-A Review |journal=Journal of Clinical Medicine |volume=13 |issue=19 |pages=5798 |doi=10.3390/jcm13195798 |issn=2077-0383 |pmc=11477316 |pmid=39407856 |doi-access=free}}</ref>

===== Ocular Symptoms in PSP-RS =====
A defining feature of PSP-RS is vertical supranuclear gaze palsy, which is difficulty with voluntary downward gaze.<ref name=":9">{{Cite journal |last1=Krzosek |first1=Patrycja |last2=Madetko |first2=Natalia |last3=Migda |first3=Anna |last4=Migda |first4=Bartosz |last5=Jaguś |first5=Dominika |last6=Alster |first6=Piotr |date=2022-02-09 |title=Differential Diagnosis of Rare Subtypes of Progressive Supranuclear Palsy and PSP-Like Syndromes—Infrequent Manifestations of the Most Common Form of Atypical Parkinsonism |journal=Frontiers in Aging Neuroscience |volume=14 |doi=10.3389/fnagi.2022.804385 |doi-access=free |pmid=35221993 |pmc=8864174 |issn=1663-4365}}</ref> Vertical supranuclear gaze palsy, a symptom characterized by decreased velocity and amplitude of vertical eye movements (saccades) is often the prominent diagnostic feature of PSP-RS. Approximately 40% of patients with PSP-RS experiencing supranuclear gaze palsy, but it may not present until 3–4 years after disease onset.<ref name=":0" /><ref name=":9" /> Individuals with PSP-RS also display other ocular motor symptoms such as dry, red and sore eyes, blurred vision, and difficulty focusing.<ref name=":7" /> They may also experience spontaneuous and involuntary eye-lid closure or apraxia of the eyelid opening.<ref name=":7" />

===== Cognitive and Behavioral Symptoms in PSP-RS =====
Cognitive changes are frequent in PSP-RS compared to other PSP subtypes and include slowed thinking (bradyphrenia), executive dysfunction, and difficulty with planning or problem-solving.<ref name=":5" /><ref name=":8" /> Some patients exhibit apathy, emotional blunting, or involuntary episodes of laughing or crying unrelated to mood.<ref name=":7" /> Some studies report that around half the individuals with PSP-RS develop these personality changes within 2-years of diagnosis.<ref name=":7" /> Dementia is not typically a dominant feature early on but may develop in later stages.