Glossary of key terms in PSP

Grasping PSP's intricacies hinges on understanding key definitions and concepts. Familiarity with these principles will help you navigate its complexities.

a-synuclein

A neuronal protein involved in synaptic function that, when misfolded and aggregated, contributes to neurodegenerative diseases such as Parkinson’s disease and related synucleinopathies.

[1]

Active metabolite

A biologically active compound produced when a drug is metabolized, contributing to the drug’s therapeutic or adverse effects.

[2]

Adverse events (AEs)

Any unintended or harmful medical occurrences in a clinical trial participant who is receiving a drug or undergoing a study procedure, which does not necessarily have a causal relationship with the treatment.

[3]

Akinetic-rigid

Parkinsonian trait characterized by reduced movement initiation (akinesia) and increased muscle tone (rigidity), usually with little or no tremor.

[4]

Aphasia

In the context of PSP, it refers to an acquired, progressive impairment of language function that can manifest as non-fluent, agrammatic speech, effortful and halting verbal output, and deficits in syntactic comprehension.

[5]

Apraxia

Impairment of the ability to perform purposeful, skilled movements that cannot be explained by basic motor deficits such as weakness, rigidity, bradykinesia, or tremor. In PSP, apraxia is most commonly ideomotor apraxia, which manifests as difficulty in executing learned movements on command or by imitation, despite intact comprehension and basic motor function, but other types as limb-kinetic apraxia (clumsy, imprecise movements, and difficulty with fine motor tasks) or apraxia of speech (effortful, halting speech with sound distortions) could also occur in specific phenotypes or advanced disease.

[6] [7] [8]

Area under the curve (AUC)

A measure of the total drug exposure over time, representing the area under the plasma concentration-time curve.

[9]

Astrogliosis

Reactive proliferation and hypertrophy of astrocytes in response to neural injury or disease, contributing to inflammation and scar formation in the central nervous system.

[10]

Atrophy

Shrinkage of tissue visible on imaging tests. In the case of the PSP, it refers to loss of brain volume.

[5]

Autosomal dominant transmission

A pattern of inheritance where only one copy of a mutated gene is enough to cause the disease.

[11]

Axonal transport

The bidirectional movement of cellular structures, proteins, and other materials within neurons, essential for maintaining neuronal function and survival.

[12]

Biomarker

A measurable (quantifiable) biological indicator (in blood, spinal fluid, or brain imaging) used for diagnosis, prognosis, and as an endpoint in clinical trials.

[13]

Blood-brain barrier

A biological barrier created by closely connected cells that regulate the passage of molecules from the blood into the central nervous system. It selectively permits essential substances such as water, oxygen, and certain drugs to enter the brain while restricting others.

[14]

Bradykinesia

Slowness of movement, which can also encompass a difficulty initiating movement.

[15]

Bradyphrenia

Noticeable slowing of thought processes, evident to the patient or to someone familiar with them.

[5]

Bulbar function

Neurological control of muscles involved in speech, swallowing, and chewing.

[6]

Case-control study

A type of observational study that compares two groups of people (those with the disease or condition under study (cases) and people who do not have the disease or condition (controls)) and retrospectively examines their prior exposure to a particular factor of interest.

[16]

Cerebellar ataxia

Impaired coordination of voluntary movements (ataxia) due to cerebellar dysfunction.

[17]

Cerebrospinal fluid (CSF)

The fluid that surrounds and fills the brain and spinal cord, protecting the brain, providing nourishment for cells, and removing waste.

[14]

Clinical trial (CT)

A research study conducted in humans to evaluate the safety, efficacy, and optimal use of medical interventions such as drugs, devices, or therapies.

[3]

Cmax

The maximum (peak) concentration of a drug found in blood or plasma after the administration.

[18]

Co-pathology

The presence of multiple pathologies occurring at the same time in the same person. In PSP, co-pathologies are common and may include additional neurodegenerative changes, such as Alzheimer’s disease-related amyloid plaques, Lewy body pathology and age-related cerebrovascular changes, which may contribute to clinical variability and complicate diagnosis.

[8]

Comorbidity

The co-occurrence of multiple disorders in the same individual, which can influence the diagnosis, treatment, or prognosis of some conditions.

[19]

Corticobasal syndrome (CBS)

Neurodegenerative syndrome combining movement disorder signs (rigidity, apraxia, dystonia, myoclonus) with cortical signs (apraxia, sensory loss, alien limb).

[5]

Cost of illness (COI) studies

Descriptive analyses that estimate the overall costs associated with a disease. These studies quantify the economic burden by measuring direct, indirect, and sometimes intangible costs, but they do not compare alternative interventions or relate costs to health outcomes. Instead, they provide baseline data on disease burden, which can inform subsequent economic evaluations and policy decisions.

[20]

Dementia

A loss of global cognitive ability that interferes with normal social or occupational function.

[21]

Differential diagnosis

The process of distinguishing a disease from other conditions with similar clinical features. In PSP, it involves differentiating it from disorders such as Parkinson’s disease or other PSP-mimicking syndromes.

[22]

Disability adjusted life year (DALY)

Is a generic measure of health outcome that can be used in cost utility analysis. DALYs are a measure of overall disease burden, expressed as the number of years lost due to ill health, disability or mortality. 

[20]

Disease burden

The overall impact of a disease on patients, caregivers, and healthcare systems – including physical, emotional, social, and economic effects.

[23]

Disease-modifying therapy (DMT)

A treatment aimed at addressing the underlying cause and altering its natural progression. These work by targeting the root mechanisms that drive the disease, potentially slowing down, halting or even reversing its course.

[24]

Double-blind

A study design where neither participants nor researchers know which treatment each participant receives, reducing the likelihood of bias in the results.

[25]

Dysarthria

A speech disorder of neurological origin marked by impaired articulation.

[26]

Dysgeusia

An alteration or distortion in the normal sense of taste.

[27]

Dysphagia

Difficulty swallowing that often requires changes in diet. Some individuals with dysphagia struggle with certain foods or liquids, while others are unable to swallow at all. Additional signs may include coughing or choking during meals, regurgitating food, feeling as though food is stuck in the throat or chest, and continuous drooling.

[28]

Economic burden

In the medical context refers to the total financial impact that a disease or health condition imposes on individuals, households, healthcare systems, and society. This burden is typically divided into direct costs (such as expenditures for medical care, hospitalizations, medications, diagnostic tests, and preventive actions) and indirect costs (including lost productivity, absenteeism, presenteeism, loss of income, and premature death).

[29]

Efficacy

The ability of an intervention to produce the intended effect under controlled study conditions.

[3]

Endpoint

A predefined variable or outcome used to evaluate the effect, safety, or other impact of a treatment or intervention. For example, the primary efficacy endpoint in PROSPER is the change from baseline to Week 52 on the PSP Rating Scale (PSPRS).

[3] [30]

Epigenetic

Refers to heritable changes that do not affect the DNA sequence but influence gene expression (e.g., chemical modifications).

[31]

Extracellular

Located or occurring outside the cell.

[32]

Eyelid opening apraxia

Inability to voluntarily open the eyelids after they have been closed for a period of time.

[5]

Familial PSP

Cases of PSP that occur in multiple members of the same family, suggesting a hereditary component.

[33]

FNP-223

Investigational, brain-penetrant, selective OGA inhibitor intended as a potential DMT for PSP.

[34]

Frontal cognitive/behavioral presentation

Defined as at least three of the following features, which have to be persistent: apathy; bradyphenia; dysexecutive syndrome; reduced phonemic verbal fluency; impulsivity, disinhibition, or perseveration.

[5]

Frontal dysfunction

Impairment of the frontal lobe, which affects executive, cognitive, or behavioral functions.

[35]

Gait freezing

Sudden and transient inability to initiate walking, often described as the feet being “glued” to the floor.

[5]

Gene

A segment of genetic material (or DNA) that determines inherited characteristics and contributes to the organism’s physiological functions.

[36]

Genetic loci/ locus

The specific physical location of a gene or other DNA sequence on a chromosome.

[37]

Genome-wide association studies

A research method that examines the entire genome (the complete set of DNA of a person) to detect genetic variants linked to a specific trait or disease.

[38]

Glial fibrillary acidic protein (GFAP)

A protein expressed almost exclusively in astrocytes, used as a biomarker of astrocyte injury and neuroinflammation.

[39]

Healthcare resource utilization (HCRU)

Refers to the quantifiable use of healthcare services and resources, including hospitalizations, outpatient visits, emergency department visits, medication prescriptions, use of medical devices, allied health services, and home care. HCRU is a key metric in health services research and health economics, used to assess disease burden, plan resource allocation, and evaluate the impact of interventions on healthcare systems.

[40] [41]

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