Abstract

Progressive supranuclear palsy (PSP) is a clinically heterogeneous tauopathy characterized by parkinsonism along with oculomotor dysfunction, axial rigidity, and cognitive involvement. Variants of PSP in which cognitive impairment and speech apraxia are prominent may pose diagnostic challenges and frequently overlap with frontotemporal dementia or primary progressive aphasia. In this case report, we present a 72-year-old female patient who initially presented with depressive symptoms and apathy, subsequently manifesting speech arrest, balance instability, severe cognitive impairment, and unresponsiveness to dopaminergic therapy, in light of clinical, neuropsychological, and radiological findings. Neuropsychological testing revealed marked naming difficulties and impaired fluency. Cranial magnetic resonance imaging demonstrated midbrain atrophy and superior cerebellar peduncle thinning. This case highlights the importance of recognizing cognitive variants of PSP in the differential diagnosis of atypical parkinsonian syndromes.